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Table 1 The characteristic of included cohort studies

From: The association between bilirubin levels, and the incidence of metabolic syndrome and diabetes mellitus: a systematic review and meta-analysis of cohort studies

Authors (Year)

Study design

Year(s) of study

Study population

Age ± SD (years)

Sample size

Bilirubin type

Type of measure DM/MS

Effect size (95% CI)

Outcome

S.-E. Lee et al., 2016

Retrospective longitudinal cohort

2006–2012

Korean adults

51.2 ± 8.3

22,084

PCB

DM

a participant’s self-reported diagnosis on the questionnaire

FPG ≥ 7 mmol/L

HbA1c ≥ 6.5%.

HR for 1-SD increment: 1.26 (1.20–1.33)

HRs by quartile:

Q1 = (≤ − 28.6 (%)) = 1

Q2 = (− 28.5 – − 12.5 (%)) = 1.23 (1.00–1.51)

Q3 = (− 12.4–11.1 (%)) = 1.69 (1.39–2.05)

Q4 = (>  11.1(%)) = 2.13 (1.77–2.56)

T2DM

Xiao-Hong Li et al., 2017

Cohort

2011–2016

Healthy Chinese men

45.6 ± 12.7

1339

TBIL,DBIL,IBIL

AHA criteria

Model ORs

TBIL

Q1 (≤11.75 μmol/L) = 1

Q2 (11.76–14.30 μmol/L) = 1.32 (0.79–2.21)

Q3 (14.31–18.12 μmol/L) = 0.87 (0.50–1.52)

Q4 (> 18.12 μmol/L) = 0.61 (0.34–1.12)

DBIL

Q1 (≤2.09 μmol/L) = 1

Q2 (2.10_2.60 μmol/L) = 1.00 (0.61–1.63)

Q3 (2.61_3.22 μmol/L) = 0.57 (0.32–1.02)

Q4 (> 3.22 μmol/L) = 0.51 (0.28–0.92)

IBIL

Q1 (≤9.58 μmol/L) = 1

Q2 (9.59–11.76 μmol/L) = 1.16 (0.69–1.96)

Q3 (11.77–14.90 μmol/L) = 0.92 (0.53–1.58)

Q4 (> 14.90 μmol/L) = 0.58 (0.32–1.06)

MetS

Chaoqun Liu et al., 2016

Prospective Cohort

2013–2016

Chinese Han. Women receiving their first

prenatal care prior to 16 weeks of gestation

28.31 ± 3.04

1135

TBIL,DBIL,IBIL

WHO criteria

Model RRs:

TBIL

T1 (1.7–4.8 μmol/L) = 1(reference)

T2 (4.9–6.3 μmol/L) = 0.99 (0.82, 1.22)

T3 (6.4–23 μmol/L) = 0.90 (0.82, 1.00)

DBIL

T1 (0.9–2.2 μmol/L) = 1 (reference)

T2 (2.3–2.8 μmol/L) = 0.91 (0.75, 1.00)

T3 (2.9–9.8 μmol/L) = 0.60 (0.35, 0.89)

IBIL

T1(0.1–2.6 μmol/L) = 1 (reference)

T2(2.7–3.6 μmol/L) = 1.1 (0.76, 1.3)

T3(3.7–13.9 μmol/L) = 0.86 (0.74, 1.0)

GDM

Sen Wang et al., 2017

Cohort

2011–2016

Healthy Chinese men and women

48.65 ± 11.05

32,768

TBIL

AHA criteria

ORs for Males

Q1(≤ 9.90 μmol/L) = (reference)

Q2(9.90–12.90 μmol/L) = 0.829 (0.758–0.908)

Q3(12.90–16.80 μmol/L) = 0.814 (0.743–0.891)

Q4(>  16.80 μmol/L) = 0.673 (0.613–0.739)

ORs for Females

Q1(≤ 8.00 μmol/L) = (reference)

Q2(8.00–10.30 μmol/L) = 0.874 (0.762–1.001)

Q3(10.30–13.40 μmol/L) = 0.761 (0.661–0.875)

Q4(>  13.40 μmol/L) = 0.753 (0.653–0.867)

Mets

Y.J. Kwon et al., 2017

Prospective cohort

2001–2014

Korean adults 40 to 69 years of age

T2DM group: 54.3 ± 8.5

non-T2DM group: 51.6 ± 8.8

8650

TBIL

WHO criteria

ORs in men

Q1 (< 0.47 mg/dL) = 1 (reference)

Q1(< 8.03)

Q2 (0.47–0.61 mg/dL) = 0.75 (0.55–1.03)

Q2(8.03–10.43) μmol/L

Q3 (0.61–0.82 mg/dL) = 0.73 (0.53–1.01)

Q3(10.43–14.02) μmol/L

Q4 (0.82–2.00 mg/dL) = 0.52 (0.36–0.74)

Q4(14.02–34.2) μmol/L

ORs in women

Q1(<  0.36 mg/dL) = 1 (reference)

Q1 < 6.15 μmol/L

Q2 (0.36–0.46 mg/dL) = 0.73 (0.54–0.98)

Q2(6.15–7.91) μmol/L

Q3(0.46–0.62 mg/dL) = 0.54 (0.39–0.74)

Q3(7.91–10.60) μmol/L

Q4(0.62–2.00 mg/dL) = 0.65 (0.47–0.89)

Q4(10.60–34.2) μmol/L

T2DM

Hao et al., 2020

Cohort

2009–2017

Kazakh permanent residents

40.33 ± 11.86

565

TBIL,DBIL,IBIL

JIS criteria

TBIL HR

0.35 (0.21–0.60)

0.36 (0.21–0.62)

0.38 (0.22–0.64)

IBIL HR

0.31 (0.18–0.54)

0.39 (0.23–0.66)

0.31 (0.18–0.54)

Mets

Min Yang et al.,2019

Prospective cohort

2012–2014

all patients > 18 years of age

and diagnosed for the first time with impaired glucose regular

(IFG or IGT)

Q1: 60.4 ± 5.0

Q2: 61.6 ± 5.3

Q3: 62.7 ± 5.4

Q4: 64.0 ± 5.7

523

TBIL

WHO criteria

ORs

Q1: Ref (< 8.2 μmol/L) =1

Q2: (8.3–11.1 μmol/L) = 0.83 (0.74–0.96)

Q3(11.2–14.5 μmol/L) = 0.78 (0.68–0.90)

Q4:> 14.6 μmol/L = 0.74 (0.64–0.87)

T2DM

Makoto Shiraishi et al., 2019

Retrospective cohort

2013–2018

middle-aged Japanese without Mets

44.8

8992

TBIL

JIS, AHA, WHO, IAS

HRs

All: 0.70 (0.59–0.85)

Men: 0.82 (0.66–1.01)

Women: 0.60 (0.43–0.84)

Mets

Fan Zhang et al., 2020

Cohort

2014–2018

consecutive obese patients

29.85 ± 9.75 years

71

TBIL,DBIL,IBIL

hyperinsulinemia-euglycemic clamp technique (HEC) with glucose disposal rate (GDR, M value)

OR

TBIL: 0.744 (0.590–0.938)

DBIL: 0.575 (0.326–1.015)

IBIL: 0.602 (0.413–0.878)

Insulin Sensitivity

Abbasi et al., 2015

Cohort

2015

Dutch population participate in the (PREVEND) study

49.4 ± 12.4

3381

TBIL

FPG level was ≥7.0 mmol/L (126 mg/dL), the random sample plasma glucose concentration was ≥11.1 mmol/L (200 mg/dL), they reported a physician diagnosis of T2DM, or they received insulin or oral hypoglycemic agents based on a central pharmacy registration.

OR

TBIL:0.58 [0.39–0.84]; P = 0.005)

T2DM

  1. T2DM Type 2 Diabetes mellitus, Mets Metabolic Syndrome, GDM Gestational diabetes mellitus, FPG fasting plasma glucose, HbA1c glycosylated hemoglobin, AHA American Heart Association, WHO World Health Organization, JIS Joint Interim Statement, IAS The International Atherosclerosis Society, PCB percentage change in serum bilirubin levels, TBIL Total bilirubin, DBIL Direct bilirubin, IBIL Indirect bilirubin