Association of dietary index for gut microbiota and all-cause and cardiovascular mortality in patients with diabetes or prediabetes

Table 1 Basic participant characteristics by dietary index for gut microbiota scores, mean (SE)/ n (%)

Variables	Total	Q1 (0-4)	Q2 (5)	Q3 (6)	Q4 (7-14)	P value
Age	53.84 (0.25)	52.07 (0.34)	53.19 (0.46)	54.63 (0.45)	57.14 (0.39)	< 0.0001
Creatinine	80.80 (0.44)	82.90 (0.92)	79.90 (0.60)	79.78 (0.96)	78.85 (0.50)	0.004
UA	338.42 (1.20)	341.76 (1.67)	337.00 (2.27)	338.33 (2.80)	333.91 (2.30)	0.05
BUN	5.21 (0.03)	5.27 (0.04)	5.16 (0.05)	5.18 (0.06)	5.19 (0.06)	0.15
HbA1c	6.06 (0.02)	6.13 (0.02)	6.06 (0.03)	5.99 (0.03)	6.02 (0.03)	< 0.001
BMI, % (SE)						< 0.0001
< 25	18.42 (0.01)	16.75 (0.80)	17.98 (1.10)	18.47 (1.11)	22.00 (1.15)
25-30	32.52 (0.01)	30.83 (0.98)	32.02 (1.12)	34.07 (1.63)	34.81 (1.21)
> 30	49.06 (0.01)	52.43 (1.13)	50.00 (1.33)	47.46 (1.37)	43.19 (1.32)
Sex, % (SE)						< 0.001
Male	52.17 (0.01)	55.30 (0.87)	51.35 (1.17)	50.70 (1.66)	48.64 (1.11)
Female	47.83 (0.01)	44.70 (0.87)	48.65 (1.17)	49.30 (1.66)	51.36 (1.11)
Race, % (SE)						< 0.0001
Mexican American	8.62 (0.01)	10.27 (1.01)	9.49 (1.13)	7.41 (0.80)	5.67 (0.68)
Non-Hispanic Black	11.72 (0.01)	15.16 (1.21)	11.29 (0.87)	9.50 (0.78)	7.87 (0.73)
Non-Hispanic White	66.87 (0.03)	62.20 (1.84)	65.80 (1.91)	70.65 (1.43)	73.24 (1.58)
Other	12.80 (0.00)	12.37 (0.80)	13.43 (0.86)	12.44 (0.83)	13.22 (0.90)
Marital status, % (SE)						< 0.0001
Married	59.18 (0.02)	55.78 (1.22)	60.15 (1.35)	59.17 (1.24)	64.45 (1.71)
Never married	11.77 (0.01)	13.65 (0.81)	11.49 (0.81)	12.21 (1.02)	8.19 (0.83)
Divorced	11.93 (0.01)	12.50 (0.79)	10.77 (0.88)	11.89 (0.98)	12.24 (1.09)
Unmarried but have/had partner	17.11 (0.01)	18.07 (0.71)	17.59 (0.97)	16.73 (0.94)	15.12 (0.96)
Education, % (SE)						< 0.0001
Less than high school	17.68 (0.01)	22.00 (0.89)	17.80 (0.87)	15.34 (0.96)	11.69 (0.94)
High school or equivalent	24.64 (0.01)	27.55 (0.88)	25.78 (1.43)	21.90 (1.46)	20.48 (1.24)
College or above	57.67 (0.02)	50.45 (1.11)	56.42 (1.64)	62.77 (1.66)	67.83 (1.61)
Smoke, % (SE)						< 0.0001
Never	51.48 (0.01)	49.70 (1.18)	51.84 (1.24)	53.65 (1.41)	52.36 (1.51)
Former	30.07 (0.01)	29.22 (1.07)	28.85 (1.09)	27.92 (1.13)	35.03 (1.63)
Now	18.46 (0.01)	21.09 (0.77)	19.30 (1.03)	18.43 (1.18)	12.61 (0.90)
Alcohol use, % (SE)						< 0.0001
Never	11.57 (0.01)	11.55 (0.61)	13.11 (1.10)	10.83 (0.80)	10.56 (0.82)
Former	16.56 (0.01)	17.18 (0.85)	17.34 (1.06)	16.69 (1.14)	14.39 (0.92)
Mild	39.62 (0.01)	36.77 (1.16)	37.13 (1.46)	39.37 (1.61)	48.01 (1.36)
Moderate	14.99 (0.01)	14.27 (0.71)	15.17 (0.90)	16.25 (1.26)	14.97 (0.89)
Heavy	17.25 (0.01)	20.23 (0.87)	17.26 (1.03)	16.86 (1.24)	12.07 (1.09)
Cancer, % (SE)						< 0.001
Yes	13.14 (0.01)	11.59 (0.60)	12.17 (0.86)	14.15 (0.92)	16.22 (0.87)
No	86.86 (0.02)	88.41 (0.60)	87.83 (0.86)	85.85 (0.92)	83.78 (0.87)
CVD, % (SE)						0.59
Yes	13.84 (0.01)	14.46 (0.60)	13.71 (0.78)	13.15 (0.97)	13.47 (0.88)
No	86.16 (0.02)	85.54 (0.60)	86.29 (0.78)	86.85 (0.97)	86.53 (0.88)
Hypertension, % (SE)						< 0.0001
Yes	52.43 (0.02)	52.89 (1.07)	52.32 (1.36)	51.16 (1.37)	52.86 (1.31)
No	47.57 (0.01)	47.11 (1.07)	47.68 (1.36)	48.84 (1.37)	47.14 (1.31)
PIR, % (SE)						< 0.0001
< 1.3	21.12 (0.01)	26.21 (0.88)	21.95 (0.96)	18.03 (1.02)	13.55 (0.96)
1.3-3.5	37.62 (0.01)	39.26 (1.18)	37.52 (1.42)	37.65 (1.58)	34.65 (1.77)
> 3.5	41.26 (0.02)	34.53 (1.37)	40.53 (1.71)	44.32 (1.58)	51.80 (2.08)
Antidiabetic treatment, % (SE)						0.02
Yes	18.42 (0.01)	19.78 (0.79)	19.05 (1.14)	16.14 (0.82)	17.30 (0.95)
No	81.58 (0.02)	80.22 (0.79)	80.95 (1.14)	83.86 (0.82)	82.70 (0.95)

PIR: Poverty income ratio; BMI: Body mass index; HbA1c: Glycosylated hemoglobin; BUN: Blood urea nitrogen; UA: Uric acid; CVD: Cardiovascular disorders.

Table 2 Association of diabetes and prediabetes all-cause mortality and cardiovascular risk with dietary index for gut microbiota

	Model 11		Model 22		Model 33
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
All-cause mortality
DI-GM	0.99 (0.95-1.02)	0.42	0.93 (0.89-0.96)	< 0.0001	0.96 (0.93-1.00)	0.05
DI-GM quartiles
Q1	Reference	Reference	Reference	Reference	Reference	Reference
Q2	0.96 (0.80-1.14)	0.63	0.89 (0.75-1.06)	0.20	0.94 (0.80-1.10)	0.45
Q3	1.01 (0.86-1.19)	0.90	0.86 (0.73-1.01)	0.06	0.93 (0.80-1.09)	0.38
Q4	0.91 (0.76-1.08)	0.27	0.68 (0.57-0.82)	< 0.0001	0.83 (0.69-0.99)	0.03
P for trend	0.608		< 0.001		0.283
Cardiovascular mortality
DI-GM	0.96 (0.90-1.02)	0.15	0.90 (0.84-0.95)	< 0.001	0.93 (0.87-0.99)	0.02
DI-GM quartiles
Q1	Reference	Reference	Reference	Reference	Reference	Reference
Q2	0.90 (0.66-1.23)	0.52	0.85 (0.62-1.17)	0.32	0.85 (0.62-1.16)	0.31
Q3	0.93 (0.72-1.20)	0.60	0.78 (0.61-1.01)	0.06	0.81 (0.63-1.06)	0.12
Q4	0.85 (0.61-1.18)	0.33	0.62 (0.45-0.86)	0.005	0.75 (0.54-1.00)	0.05
P for trend	0.604		0.013		0.916

¹Model 1: No adjustments made.

²Model 2: Adjusted for age, sex, race.

³Model 3: Adjusted for age, sex, race, poverty income ratio, smoke, alcohol, BMI, cancer, hypertension, CVD, marital and education.

HR: Hazard ratio; DI-GM: Dietary index for gut microbiota.

Table 3 Diabetes and prediabetes all-cause mortality risk subgroup analyses

Variables	Q1	Q2 HR (95%CI)	Q3 HR (95%CI)	Q4 HR (95%CI)	P for trend	P for interaction
Age (years)						0.07
< 65	Reference	1.27 (0.94-1.71)	0.93 (0.65-1.34)	1.11 (0.73-1.69)	0.88
≥ 65	Reference	0.82 (0.68-0.99)	1.01 (0.84-1.22)	0.74 (0.62-0.89)	0.21
Sex						0.50
Male	Reference	0.94 (0.76-1.17)	0.89 (0.69-1.15)	0.91 (0.70-1.19)	0.87
Female	Reference	0.94 (0.73-1.21)	0.98 (0.77-1.23)	0.71 (0.56-0.90)	0.09
Race						0.03
Mexican American	Reference	0.77 (0.48-1.25)	1.05 (0.63-1.75)	0.61 (0.34-1.08)	0.34
Non-Hispanic Black	Reference	1.14 (0.82-1.58)	0.77 (0.54-1.11)	0.62 (0.38-1.01)	0.31
Non-Hispanic White	Reference	0.93 (0.76-1.14)	0.94 (0.78-1.14)	0.88 (00.72-1.07)	0.73
Other	Reference	0.81 (0.47-1.41)	0.96 (0.64-1.44)	0.33 (0.19-0.55)	0.001
Marital						0.42
Married	Reference	0.94 (0.76-1.17)	0.93 (0.76-1.14)	0.79 (0.63-0.99)	0.28
Never married	Reference	1.05 (0.50-2.19)	0.77 (0.27-2.19)	1.46 (0.53-4.02)	0.30
Divorced	Reference	0.78 (0.53-1.15)	0.85 (0.53-1.34)	1.20 (0.75-1.92)	0.61
Unmarried but have/had partner	Reference	1.01 (0.76-1.36)	1.00 (0.75-1.35)	0.67 (0.50-0.91)	0.04
Education						0.13
Less than high school	Reference	1.01 (0.78-1.31)	1.06 (0.82-1.36)	0.81 (0.58-1.13)	0.24
High school or equivalent	Reference	0.84 (0.57-1.23)	1.22 (0.91-1.64)	0.86 (0.62-1.18)	0.90
College or above	Reference	0.97 (0.75-1.26)	0.74 (0.59-0.92)	0.79 (0.61-1.03)	0.51
BMI						0.29
< 25	Reference	0.89 (0.64-1.25)	0.82 (0.58-1.15)	0.56 (0.39-0.80)	0.08
25-30	Reference	1.07 (0.77-1.49)	1.03 (0.77-1.37)	0.86 (0.62-1.19)	0.23
> 30	Reference	0.89 (0.70-1.14)	0.94 (0.73-1.21)	0.96 (0.73-1.25)	0.73
Hypertension						0.42
Yes	Reference	0.87 (0.72-1.05)	0.92 (0.78-1.09)	0.80 (0.65-0.98)	0.05
No	Reference	1.22 (0.87-1.71)	0.97 (0.70-1.34)	0.85 (0.60-1.20)	0.35
PIR						0.99
< 1.3	Reference	0.99 (0.79-1.24)	0.90 (0.70-1.17)	0.82 (0.56-1.19)	0.74
1.3-3.5	Reference	0.92 (0.71-1.19)	1.00 (0.79-1.28)	0.83 (0.65-1.08)	0.29
> 3.5	Reference	0.98 (0.67-1.42)	0.84 (0.59-1.18)	0.84 (0.58-1.22)	0.22
Cancer						0.85
Yes	Reference	0.97 (0.72-1.32)	0.92 (0.67-1.26)	0.92 (0.69-1.23)	0.88
No	Reference	0.94 (0.78-1.14)	0.94 (0.77-1.14)	0.78 (0.64-0.95)	0.22
CVD						0.27
Yes	Reference	0.76 (0.60-0.97)	0.83 (0.63-1.09)	0.71 (0.55-0.92)	0.22
No	Reference	1.07 (0.86-1.32)	1.00 (0.81-1.22)	0.90 (0.71-1.13)	0.32

CVD: Cardiovascular disease; PIR: Poverty income ratio; BMI: Body mass index.

Table 4 Diabetes and prediabetes cardiovascular mortality risk subgroup analyses

Variables	Q1	Q2 HR (95%CI)	Q3 HR (95%CI)	Q4 HR (95%CI)	P for trend	P for interaction
Age						0.05
< 65	Reference	1.13 (0.59-2.18)	0.32 (0.13-0.79)	1.02 (0.39-2.65)	0.10
≥ 65	Reference	0.78 (0.56-1.09)	1.05 (0.76-1.46)	0.70 (0.50-0.97)	0.50
Sex						0.62
Male	Reference	0.87 (0.58-1.30)	0.70 (0.45-1.10)	0.81 (0.52-1.26)	0.78
Female	Reference	0.84 (0.52-1.36)	0.99 (0.66-1.49)	0.69 (0.42-1.13)	0.53
Race						0.33
Mexican American	Reference	0.78 (0.25-2.39)	1.31 (0.54-3.17)	0.51 (0.15-1.68)	0.23
Non-Hispanic Black	Reference	0.95 (0.60-1.52)	0.53 (0.27-1.07)	0.34 (0.13-0.87)	0.04
Non-Hispanic White	Reference	0.85 (0.56-1.29)	0.82 (0.59-1.13)	0.81 (0.56-1.19)	0.56
Other	Reference	0.95 (0.32-2.86)	1.25 (0.55-2.80)	0.50 (0.16-1.60)	0.11
Marital status						0.46
Married	Reference	1.08 (0.72-1.63)	0.90 (0.61-1.34)	0.94 (0.59-1.49)	0.66
Never married	Reference	0.56 (0.14-2.26)	0.76 (0.13-4.28)	1.01 (0.07-13.51)	0.55
Divorced	Reference	0.76 (0.39-1.48)	0.26 (0.09-0.80)	0.75 (0.33-1.70)	0.20
Unmarried but have/had partner	Reference	0.72 (0.45-1.14)	0.90 (0.57-1.43)	0.50 (0.32-0.77)	0.11
Education						0.20
Less than high school	Reference	0.90 (0.56-1.46)	1.19 (0.80-1.78)	0.94 (0.50-1.74)	0.73
High school or equivalent	Reference	0.89 (0.42-1.90)	1.39 (0.86-2.24)	0.71 (0.35-1.42)	0.54
College or above	Reference	0.78 (0.49-1.25)	0.48 (0.31-0.74)	0.62 (0.40-0.95)	0.94
BMI						0.48
< 25	Reference	1.25 (0.60-2.61)	0.90 (0.53-1.53)	0.69 (0.34-1.38)	0.18
25-30	Reference	1.02 (0.64-1.61)	0.96 (0.54-1.70)	0.58 (0.31-1.07)	0.12
> 30	Reference	0.70 (0.40-1.20)	0.70 (0.47-1.03)	0.89 (0.55-1.46)	0.48
Hypertension						0.14
Yes	Reference	0.75 (0.53-1.07)	0.87 (0.67-1.13)	0.76 (0.52-1.10)	0.17
No	Reference	1.35 (0.71-2.55)	0.68 (0.34-1.34)	0.68 (0.35-1.32)	0.58
PIR						0.93
< 1.3	Reference	1.06 (0.68-1.67)	0.83 (0.51-1.33)	1.01 (0.49-2.07)	0.69
1.3-3.5	Reference	0.73 (0.44-1.20)	0.87 (0.57-1.33)	0.66 (0.42-1.04)	0.12
> 3.5	Reference	1.06 (0.52-2.16)	0.82 (0.43-1.55)	0.84 (0.46-1.54)	0.43
Cancer						0.26
Yes	Reference	0.94 (0.48-1.84)	1.00 (0.49-2.02)	1.21 (0.61-2.37)	0.63
No	Reference	0.85 (0.59-1.23)	0.80 (0.60-1.06)	0.62 (0.43-0.88)	0.39
CVD						0.68
Yes	Reference	0.73 (0.46-1.15)	0.82 (0.51-1.31)	0.61 (0.40-0.94)	0.21
No	Reference	0.98 (0.63-1.53)	0.80 (0.54-1.18)	0.85 (0.53-1.36)	0.76

CVD: Cardiovascular disease; PIR: Poverty income ratio; BMI: Body mass index.