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Metabolic syndrome (MetS) is a cluster of cardiovascular and metabolic risk factors in the same individual. Inflammation has been reported to be directly involved in the development of metabolic disease. Complement component 3 (C3) and complement component 4 (C4) have been identified as important inflammatory markers relevant to metabolic disease. However, few studies have analyzed the association between C3 and/or C4 and MetS. In this study, our aim is to evaluate sex-specific association between C3 and C4 levels and risk of MetS in an adult population.A cohort of 4635 adults was followed from 2010 to 2016. Serum C3 and C4 levels were measured using an immunonephelometric technique. MetS was defined by the American Heart Association scientific statements of 2009. Cox proportional hazard regression models were used to assess sex-specific association between C3 and C4 levels and the incidence of MetS.During the ∼6 years of follow-up, 1445 new cases of MetS were identified. After being adjusted to confounding factors, the hazard ratios (95% confidence interval) of MetS for gradually increasing quintiles of C3 were 1.00, 1.23 (0.98-1.54), 1.50 (1.21-1.87), 1.64 (1.32-2.04), and 1.75 (1.41-2.18) (P for trend0.0001) in men and 1.00, 0.96 (0.60-1.53), 1.61 (1.06-2.44), 2.01 (1.34-3.03), and 2.43 (1.63-3.63) (P for trend0.0001) in women, respectively. Similar results were also obtained for gradually increasing quintiles of C4 in women, but not in men.The levels of C3 were significantly associated with the incidence of MetS in both men and women. The levels of C4 contributed to risk of MetS only in women.

Evidence suggests long-term chronic inflammation, as the pathological basis of formation and development, plays an important part in atherosclerosis. Immunoglobulins (Igs) provided key information on the humoral immune status. However, few studies have evaluated the correlation between Igs and hypertension and blood pressure (BP) in a general population. We designed a cross-sectional study to evaluate whether serum Ig levels are related to BP and the prevalence of hypertension. About 12,373 participants in Tianjin, China were recruited for this study. Hypertension was diagnosed according to the criteria of the JNC 7 and serum levels of Igs were determined by the immunonephelometric technique. Multiple logistic regression analysis and analysis of covariance were used to assess relationships between serum Ig concentrations and the prevalence of hypertension and BP. The overall prevalence of hypertension was 35.5%. The means (standard deviation) of immunoglobulins [immunoglobulin G (IgG), immunoglobulin E (IgE), immunoglobulin M (IgM), and immunoglobulin A (IgA)] were 1206.0 (249.0) mg/dL, 93.8 (235.4) IU/mL, 105.3 (56.8) mg/dL, and 236.7 (98.1) mg/dL, respectively. The multivariable-adjusted odds ratios (95% confidence interval) of hypertension for the highest immunoglobulins (IgG, IgE, IgM, and IgA) quintile, when compared to the lowest quintile were 1.10 (0.96-1.26), 1.04 (0.91-1.19), 0.83 (0.72-0.96), and 1.32 (1.15-1.51), respectively. Decreased IgM and increased IgG and IgA were related to a higher prevalence of hypertension. IgM was negatively correlated with BP, while IgG and IgA were positively correlated with BP.

To investigate the association between red cell distribution width (RDW) and elevation of glucose/glycated hemoglobin (HbA1c).An analysis was conducted using data from a prospective cohort study of adults. People without prediabetes or diabetes (n=7,795) were followed for a mean of 2.90years (range: 1-7years, 95% confidence interval: 2.86-2.94years). Glucose elevation is defined as fasting glucose levels exceeding 5.6mmol/l, or 2-hour glucose values in the oral glucose tolerance test exceeding 7.8mmol/l. HbA1c elevation is defined as a HbA1c value exceeding a normal limit of 39mmol/mol (5.7%). Adjusted Cox proportional hazards regression models were used to assess the association between RDW quartiles and elevation of HbA1c/glucose.The multiple-adjusted hazard ratios (95% confidence interval) of HbA1c elevation for increased quartiles of RDW were 1.00 (reference), 1.08 (0.89, 1.30), 1.28 (1.07, 1.54), and 1.54 (1.29, 1.85) (P for trend0.0001). However, no significant association was observed between RDW and blood glucose (fasting and postprandial).Elevated RDW is independently related to future HbA1c elevation, but not to glucose elevation. This suggests that RDW may associate with HbA1c through a non-glycemic way, which should be taken into consideration when using HbA1c as a diagnostic criterion of prediabetes or diabetes.

Aims Prediabetes has received public attention owing to the increasing prevalence worldwide. Mounting evidence has indicated that inflammation directly contributed to the etiology of glucose metabolism disorders. Although immunoglobulins play a crucial role in immune responses, little research has been done on the link between immunoglobulins and prediabetes in adults. Hence, the aim of the present study was to explore the associations between immunoglobulins levels and prevalence of prediabetes in a general adult population. Methods A cross-sectional study was conducted among 8856 adults (mean ± standard deviation age: 48.4 ± 10.7 years) in Tianjin, China. The serum immunoglobulins concentrations were measured by the immunonephelometric technique. Prediabetes was diagnosed using the following parameters in accordance with the American Diabetes Association: fasting plasma glucose, postprandial glucose and glycosylated hemoglobin. The associations between concentrations of immunoglobulins and the prevalence of prediabetes were assessed using multiple logistic regression models. Results Overall, the prevalence of prediabetes was 37.4% (3311/8856). After controlling for confounders, compared with the lowest quintile, the odds ratios (95% confidence interval) of prediabetes for the highest quintile of immunoglobulins (immunoglobulin G, immunoglobulin E, immunoglobulin M and immunoglobulin A) were as follows: 1.06 (0.91–1.23), 1.31 (1.13–1.52), 0.86 (0.74–1.01), and 1.19 (1.03–1.38) (P for trend were 0.35, Conclusions Elevated immunoglobulin E and immunoglobulin A levels were independently and positively associated with prediabetes prevalence. There was also a trending association between immunoglobulin M concentrations and prediabetes prevalence. Further studies are necessary to clarify if there is a causal association of immunoglobulins in prediabetes or if they reflect early immunologic disturbances in these patients.

Previous studies have supported the theory that there is a positive association between ferritin and carotid atherosclerosis in Western people. Diet plays an important role in determining serum ferritin concentration. Asian dietary patterns are different from Western dietary patterns, implying that there may be a difference in the association of ferritin with carotid atherosclerosis between Asian and Western people. However, few studies focus on the association between ferritin and carotid atherosclerosis among Asians. The aim of this study was to investigate how serum ferritin levels are associated with carotid atherosclerosis in an Asian adult population. A cross-sectional assessment was performed in 8302 adults in Tianjin, China. Carotid intima-media thickness (IMT) and plaques were assessed using ultrasonography, and serum ferritin was measured using the protein chip-chemiluminescence method. Multiple logistic regression analysis was used to examine the association between quartiles of serum ferritin concentration and carotid atherosclerosis. In the present study, the overall prevalence of IMT and carotid plaques in participants is 29·2 and 22·7 %, respectively. In women, after adjustments for potentially confounding factors, the OR of IMT and carotid plaques by increasing serum ferritin quartiles were 1·00, 1·39 (95 % CI 0·98–1·99), 1·39 (95 % CI 0·99–1·97), 1·81 (95 % CI 1·30–2·55) (Pfor trendPfor trend

Aim To comprehensively and exhaustively assess the relationship between serum ferritin levels and incidence of prediabetes in a prospective study. Methods This prospective cohort study ( n =7380) with a mean follow-up of 3.07 years (range: 1–7, 95% CI: 3.03–3.12) was conducted in Tianjin, China. Blood fasting glucose, oral glucose tolerance test, serum ferritin levels and other potentially confounding factors were measured at baseline and at each year of follow-up. Adjusted Cox proportional hazards regression models were used to assess the gender-specific relationship between baseline and mean serum ferritin quintiles and prediabetes. Results The incidence of prediabetes was 85 per 1000 person-years among men and 44 per 1000 person-years among women during follow-up (from 2007 to 2014). After adjusting for potential confounders, hazard ratios (95% CI) for prediabetes across baseline ferritin quintiles were: for men, 1.00, 1.13 (0.90–1.40), 1.20 (0.97–1.48), 1.41 (1.14–1.73) and 1.73 (1.41–2.11); and for women, 1.00, 1.01 (0.74–1.38), 0.68 (0.48–0.96), 0.84 (0.61–1.15) and 1.07 (0.80–1.45), respectively. Similar results were also observed for mean ferritin levels. Conclusion Both baseline and mean serum ferritin levels were significantly and linearly related to prediabetes in men, whereas U-shaped relationships were observed between baseline and mean serum ferritin and prediabetes in women. The relationship between prediabetes risk and mean serum ferritin levels may be more stable than one with baseline serum ferritin levels.

Prehypertension is a public health epidemic associated with various adverse outcomes, but can be reversed by timely intervention. However, little attention has been paid to prehypertension. Complement C3 is a central hub of complement-related immune system. We examined the association between C3 and prehypertension in an adult population for the first time, aiming to investigate whether pro-inflammatory immune response is involved in the prehypertensive state. About 7820 Tianjin residents without hypertension were categorized into sex-specific quintiles based on their serum concentration of complement C3. Adjusted logistic regression models were used separately by gender to assess the association between C3 quintiles and the prevalence of prehypertension. After multiple adjustment, the odds ratios (95% confidence interval) for prehypertension across increasing quintiles of C3 were 1.00 (reference), 1.02 (0.84, 1.25), 1.15 (0.94, 1.42), 1.25 (1.01, 1.54), and 1.71 (1.35, 2.17) (p for trend < 0.0001) among men and were 1.00 (reference), 1.17 (0.92, 1.49), 1.13 (0.88, 1.44), 1.15 (0.89, 1.48), and 1.40 (1.07, 1.84) (p for trend = 0.03) among women. The findings suggested that elevated serum C3 levels are associated with prehypertension. Reducing inflammation may be a potential therapeutic strategy for prehypertension and hypertension that is worthy of further studies and discussion.

The computer/mobile devices usage time (CMD-UT) is closely related to a sedentary lifestyle, which is an important risk factor for non-alcoholic fatty liver disease (NAFLD). But their direct relationship remains unclear.We aimed to examine the relationship between CMD-UT and newly diagnosed non-alcoholic fatty liver disease (NAFLD) in Chinese adults.This cross-sectional study was conducted on 7516 adults in Tianjin, China. The CMD-UT was collected via a questionnaire included five categories. NAFLD [with normal or elevated alanine transaminase (ALT) levels] was diagnosed by at least twice liver ultrasonography examinations and serum ALT concentrations (41 U/L in males and 33 U/L in females).The prevalence of overall NAFLD, NAFLD with normal or elevated ALT levels was 18.2, 14.2, and 4.0%, respectively. After adjustments for potential confounding factors, the odds ratios (95% confidence interval) of having overall NAFLD by increasing CMD-UT levels were 1.00 for 1 h/d, 1.58 (1.22-2.05) for 1-3 h/d, 1.58 (1.18-2.11) for 3-5 h/d, 1.65 (1.21-2.27) for 5-10 h/d, and 1.99 (1.29-3.05) for ≥10h/d (P-trend for CMD-UT levels = 0.02), respectively. Similar relations were observed with the use of NAFLD with normal or elevated ALT levels.The present study is the first to find that CMD-UT levels are independently associated with NAFLD. Key Messages The computer/mobile devices usage time levels are independently associated with the prevalence of non-alcoholic fatty liver disease.

Previous studies have indicated that consumption of particular foods or nutrients is associated with depressive symptoms, but little is known about the role of overall dietary patterns in depressive symptoms. We design this case–control study to evaluate the associations between dietary patterns and high depression symptoms in Chinese adults. A total of 1351 participants with high depressive symptoms were matched with 1351 controls using the 1:1 ratio propensity score matching method. Dietary intake was assessed using a valid self-administered food frequency questionnaire, and high depressive symptoms were assessed with the Zung Self-Rating Depression Scale, wherein cutoff point of 45 was used as a definition of high depressive symptoms. Exploratory factor analysis revealed three dietary patterns (vegetables and fruits pattern; sweets pattern; and animal foods pattern) explaining 25.1 % of the total variance. Compared with the participants in the lowest quartile, the participants in the highest quartile of vegetables and fruits pattern, which was defined as a healthy pattern, were associated with reduced odds of high depressive symptoms (OR 0.65, 95 % CI 0.52–0.83, P for trend

Although the prevalence of prehypertension is rapidly increasing in China, the medical community has paid little attention to its prevention. Prior studies have demonstrated that uric acid directly contributes to vascular remodelling and endothelial dysfunction. However, few prospective studies have assessed the relationship between serum uric acid and prehypertension. We therefore designed a larger-scale cohort study to examine whether uric acid level is a predictive factor for developing prehypertension in adults. Participants were recruited from Tianjin Medical University General Hospital-Health Management Centre. A prospective assessment (n=15 143) was performed. Participants without a history of hypertension or prehypertension were followed up for 2 to 6 years with a median follow-up duration of 2.8 years. Serum uric acid levels and blood pressure were assessed yearly during the follow-up. Adjusted Cox proportional hazards regression models were used to assess relationships between the quintiles of uric acid levels and the incidence of prehypertension. The incidence of prehypertension was 191 per 1000 person-years. In the final multivariate models, the hazard ratios (95% confidence interval) for prehypertension across uric acid quintiles were 1.00 (reference), 0.98 (0.90–1.07), 1.01 (0.93–1.10), 1.09 (1.001–1.20) and 1.17 (1.06–1.29) (P for trend

BACKGROUND: Affective disorders, especially depressive symptoms, bring such a burden to mortality and morbidity that they are associated with physical and psychological health and quality of life. Nuts, a foodstuff rich in multiple micronutrients, macronutrients, and other useful components, were considered to be a protector against depressive symptoms. Here, we conducted an analysis to examine the relationship between nut consumption and depressive symptoms. METHODS: The study performed a cross-sectional study to examine whether nut consumption is related to depressive symptoms among 13,626 inhabitants in Tianjin. Nut consumption was assessed using a validated food frequency questionnaire and depressive symptoms was assessed using the Chinese version of 20-item Self-rating Depression Scale (SDS) with four cutoffs (40, 45, 48, and 50) to indicate elevated depressive symptoms. RESULTS: The prevalence of depressive symptoms was 38.7, 19.1, 11.4, and 7.3% for SDS ≥40, 45, 48, and 50, respectively. After adjustments for potential confounding factors, the odds ratios (95% confidence interval) of having elevated depressive symptoms with SDS ≥40 by increasing frequency of nut consumption were 1.00 for CONCLUSION: The present study is the first to find that nut consumption is independently associated with depressive symptoms. It is suggested that nut consumption may be beneficial to the prevention of depressive symptoms.© 2016 Wiley Periodicals, Inc. Language: en

Epidemiological studies directly examining the association between habitual yoghurt consumption and mental health remain scarce. The aim of this study is to investigate the association of yoghurt consumption with depressive symptoms in adults. This is a cross-sectional study of 19,596 Chinese adults (mean age 41.2, standard deviation 11.8 years; males, 54.3%). Depressive symptoms were assessed using the Self-Rating Depression Scale (SDS). Dietary intake was obtained through a valid food frequency questionnaire. Multiple logistic regression analysis was conducted to assess the association between yoghurt consumption and depressive symptoms. A number of potential confounders were adjusted in the model. The prevalence of elevated depressive symptoms was 17.1% (SDS ≥45). The multivariable adjusted odds ratios (95% CI) of having elevated depressive symptoms by increasing levels of yoghurt consumption (1–3 times/week, 4–7 times/week, and ≥twice/day) were 1.05 (0.96, 1.15), 1.02 (0.91, 1.15), and 2.10 (1.61, 2.73) in comparison with lowest consumption group (

Previous studies indicated that dietary patterns were associated with metabolic syndrome (MS), but little is known in Chinese. We design this case-control study to evaluate the associations between dietary patterns and MS in Chinese adults. In this study, 1492 participants with MS were matched with 1492 controls using the 1:1 ratio propensity score matching methods. Dietary intake was assessed using a valid self-administered food frequency questionnaire, and MS was defined in accordance with the criteria of the American Heart Association scientific statement of 2009. Higher scores for the high-protein/cholesterol pattern were associated with higher prevalence of MS. Compared with the participants in the lowest quartile, the odds ratio (OR) for the extreme quartile was 1.36 (95% confidence interval (CI), 1.10–1.68) and the P for trend

Enhanced muscle strength is often related to improved insulin sensitivity and secretion, control of lipid metabolism, and increased secretion of myokines. These factors have emerged as important mechanisms involved in the development and progression of nonalcoholic fatty liver disease (NAFLD), implying that muscle strength may be a useful predictor for NAFLD. We aimed to assess the relationship between grip strength (GS) and NAFLD in a large-scale adult population. GS was assessed using an electronic hand-grip dynamometer, and NAFLD was diagnosed by the liver ultrasonography. Multiple logistic regression analysis was used to assess the relationship between the quartiles of GS per body weight and the prevalence of NAFLD. After adjusting for potentially confounding factors, the odds ratios (95% confidence interval) for overall NAFLD, NAFLD with normal alanine aminotransferase levels, and NAFLD with elevated alanine aminotransferase levels across the quartiles of GS were 1.00 (reference), 0.89 (0.78, 1.01), 0.77 (0.67, 0.89), and 0.67 (0.57, 0.79); 1.00 (reference), 0.91 (0.80, 1.04), 0.79 (0.68, 0.92), and 0.72 (0.61, 0.85); 1.00 (reference), 0.77 (0.61, 0.98), 0.67 (0.51, 0.86), and 0.53 (0.40, 0.71) (all P for trend

Soy food has been proven to have multiple positive effects on human health, however, no study has yet investigated the association between habitual intake of soy food and depressive symptoms in general population. The objective of this study was to examine this association.In a cross-sectional analysis, we studied a sample of 13,760 adults (mean age 43.5 years) in Tianjin, China. The Self-Rating Depression Scale (SDS) was used to assess depressive symptoms, with four cut-off points (SDS ≥40, 45, 48 or 50) indicating increased level of depressive symptoms. Food Frequency Questionnaire (FFQ) was used to assess dietary intake.In the total population, the prevalence of increased depressive symptoms was 7.2% (SDS ≥50). Comparing to the group with lowest intake frequency of soy food (once/week), the fully adjusted odds ratios (95% confidence intervals) of depressive symptoms were 0.80 (0.67, 0.95) for 1-3 times/week, 0.69 (0.55, 0.86) for 4-7 times/week, and 1.85 (1.21, 2.80) for ≥twice/day. Associations remained when other cut-off points (SDS ≥40, 45 or 48) were used as a definition of increased depressive symptoms.Findings from this study suggested a J-shaped association between intake frequency of soy food and incidence of depressive symptoms among adults. For the first time, the study provides evidence that light-to-moderate intake of soy food may reduce the incidence of depressive symptoms, while relatively high (≥twice/day) intake may generate the opposite effect.

Excessive consumption of soft drinks is associated with nonalcoholic fatty liver disease (NAFLD). However, the association between soft drinks consumption and NAFLD is unclear in non-Caucasian adults with relatively low soft drinks consumption. The aim of this study was to assess the association between soft drinks consumption and NAFLD in Chinese adults. A cross-sectional study was conducted with 26,790 adults living in Tianjin, China. NAFLD (with elevated alanine aminotransferase [ALT]) was diagnosed by the liver ultrasonography and serum ALT concentrations. Soft drinks consumption was assessed using a validated self-administered food frequency questionnaire, and it was summarized as three categories for analysis: almost never (reference)

Depressive symptoms have become the most important global public health issue. Iron plays an important role in brain function, cognition, and behavior, and its impacts on depressive symptoms may be multifactorial with both positive and negative effects. Previous observational studies focusing on the association between iron status and depressive symptoms showed inconsistent results. Ferritin is a ubiquitous intracellular protein that can store and release iron and is widely used as a clinical biomarker to evaluate iron status. We performed a cross-sectional study to examine the relationship between serum ferritin and depressive symptoms among 3,839 subjects who were from the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIHealth) cohort. Depressive symptoms were assessed using the Chinese version of 20-item self-rating Depression Scale (SDS) with 4 cutoffs (40, 45, 48 and 50) to indicate elevated depressive symptoms (40 was the primary cut-off). The prevalence of depressive symptoms was 36.5%, 17.6%, 11.0% and 7.0% for SDS ≥40, ≥45, ≥48 and ≥50, respectively. With the primary cut-off point of 40, multiple potential confounding factors were adjusted and the odds ratios (95% confidence interval) of having elevated depressive symptoms by quartiles of serum ferritin concentrations were 1.00 (reference), 1.10 (0.91, 1.34), 0.81 (0.66, 1.01) and 1.02 (0.81, 1.28) for the first, second, third and fourth quartile, respectively (P for trend = 0.76). Similar relations were observed with the use of other cut-offs as a definition of depressive symptoms. In conclusion, there is no significant relationship between serum ferritin concentrations and depressive symptoms among Chinese adults.

Objective Some studies have found patients with diabetes had an impaired humoral immune response. Immunoglobulins provide key information on the humoral immune status. But few population-based studies comprehensively estimated the serum immunoglobulins concentration in type 2 diabetes (T2D). So we design a cross-sectional study to investigate the relationships between immunoglobulin levels and prevalence of T2D in a large-scale adult population. Methods A cross-sectional assessment was performed in 10,691 participants living in Tianjin, China. Type 2 diabetes was defined in accordance with the criteria of the world health organization, and serum levels of immunoglobulins were determined by the immunonephelometric technique. Adjusted logistic models were used to assess relationships between the quintiles of immunoglobulins concentration and the prevalence of T2D. Results In this study, the prevalence of T2D was 11.7%, and the means (standard deviation) of immunoglobulins (IgG, IgE, IgM, IgA) were 1192.3 (241.1) mg/dL, 92.3 (234.6) IU/mL, 104.8 (55.8) mg/dL, 234.1 (96.2) mg/dL, respectively. The adjusted odds ratio (95% confidence interval) of T2D for the highest immunoglobulins (IgG, IgE, IgM, IgA) quintile, when compared to the lowest quintile were 0.64 (0.52, 0.78), 1.00 (0.81, 1.22), 0.77 (0.62, 0.95) and 1.57 (1.29, 1.92), respectively. Conclusions Decreased IgG and IgM, and increased IgA levels were independently related to the prevalence of T2D among the adult population. Our findings indicate that the immunoglobulins might useful predictive factors for T2D in the general adult population. Further studies are needed to explore the causality and exact mechanisms of immunoglobulins in T2D.

Aims We aimed to assess the predictive value of mean serum uric acid (SUA) levels for incident prediabetes. Methods Normoglycemic adults ( n = 39,353) were followed for a median of 3.0 years. Prediabetes is defined as impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or impaired HbA1c (IA1c), based on the American Diabetes Association criteria. Serum SUA levels were measured annually. Four diagnostic strategies were used to detect prediabetes in four separate analyses (Analysis 1: IFG. Analysis 2: IFG+IGT. Analysis 3: IFG+IA1c. Analysis 4: IFG+IGT+IA1c). Cox proportional hazards regression models were used to assess the relationship between SUA quintiles and prediabetes. C-statistic was additionally used in the final analysis to assess the accuracy of predictions based upon baseline SUA and mean SUA, respectively. Results After adjustment for potential confounders, the hazard ratios (95% confidence interval) of prediabetes for the highest versus lowest quintile of mean SUA were 1.22 (1.10, 1.36) in analysis 1; 1.59 (1.23, 2.05) in analysis 2; 1.62 (1.34, 1.95) in analysis 3 and 1.67 (1.31, 2.13) in analysis 4. In contrast, for baseline SUA, significance was only reached in analyses 3 and 4. Moreover, compared with baseline SUA, mean SUA value was associated with a significant increase in the C-statistic ( P Conclusions Mean SUA value was strongly and positively related to prediabetes risk, and showed better predictive ability for prediabetes than baseline SUA.

Thyroid hormones (THs) are primarily responsible for the regulation of energy balance and metabolism, suggesting that TH levels may contribute to the development of type 2 diabetes mellitus (T2DM). However, few studies have investigated the relationship between TH and T2DM in a general population. The aim of this study was to evaluate whether serum TH levels within the reference range are related to T2DM.A cross-sectional study (n = 15,296) was performed in Tianjin, China. Serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels were measured by chemiluminescence immunoassay, and T2DM was defined according to the American Diabetes Association criteria. Multiple logistic regression models were used to assess the sex-specific relationships between FT3, FT4, FT3/FT4 ratios, and TSH quintiles and T2DM.The prevalence of T2DM was 16.2% in males and 7.7% in females. In males, the multivariable-adjusted odds ratios (95% confidence interval) of T2DM for increasing quintiles of FT3, FT4, and FT3/FT4 ratios were 1.00, 0.75(0.63 to 0.89), 0.70(0.58 to 0.84), 0.63(0.52 to 0.76), 0.56(0.46 to 0.68; P for trend0.0001); 1.00, 1.05(0.87 to 1.27), 1.16(0.96 to 1.40), 1.09(0.90 to 1.31), 1.29(1.07 to 1.56; P for trend = 0.01); and 1.00, 0.69(0.58 to 0.83), 0.72(0.60 to 0.86), 0.59(0.48 to 0.71), and 0.55(0.46 to 0.66; P for trend0.0001), respectively. Similar results also were observed in females. In contrast, a strong negative correlation between TSH and T2DM was observed in males, but not in females.This study demonstrated that decreased FT3, FT3/FT4 ratios, and increased FT4 levels are independently related to a higher prevalence of T2DM in both males and females, and TSH is inversely related to T2DM in males only.