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Background: Obesity has been linked to cognitive impairment. However, how changes in body mass index (BMI) over the life course influence cognitive function remains unclear. Objective: The influence of distinct weight-change patterns from young adulthood to midlife and late adulthood on cognitive function in older adults was explored. Methods: A total of 5,809 individuals aged≥60 years were included and categorized into four groups on the basis of BMI change patterns. Cognitive function was assessed using four cognition tests in the baseline survey. The relationship between the weight-change patterns and cognition was evaluated using regression models. Results: In comparison with participants who remained at non-obese, those moving from the non-obese to obese weight-change pattern from young (25 years of age) to middle adulthood showed lower Digit Symbol Substitution Test (DSST) scores (β= –1.28; 95% confidence interval [CI]: –2.24 to –0.32). A non-obese to obese change pattern from age 25 years of age to 10 years before baseline was associated with a higher risk of DSST impairment (odds ratio = 1.40; 95% CI: 1.09 to 1.79). In comparison with participants whose heaviest weight was recorded after 60 years of age, those with the heaviest weight between 18 and 40 years of age had lower DSST scores (β= –1.46; 95% CI: –2.77 to –1.52). Conclusion: Our results suggest that the transition from the non-obese to obese category in early adulthood and appearance of the heaviest weight between 18 and 40 years of age are associated with lower cognitive function in later life.

Background: Reduction in cerebral blood flow (CBF) plays an essential role in the cognitive impairment and dementia in obesity. However, current conclusions regarding CBF changes in patients with obesity are inconsistent. Objective: A systematic review and meta-analysis was performed to evaluate the relationship between obesity and CBF alterations. Methods: We systematically screened published cross-sectional and longitudinal studies focusing on the differences in CBF between obese and normal-weight individuals. Eighteen studies including 24,866 participants, of which seven articles reported longitudinal results, were evaluated in the present study. Results: The results of the meta-analysis showed that in cross-sectional studies, body mass index (BMI) was negatively associated with CBF (β= –0.31, 95% confidence interval [CI]: –0.44, –0.19). Moreover, this systematic review demonstrated that obese individuals showed global and regional reductions in the CBF and increased CBF in diverse functional areas of the frontal lobe, including the prefrontal cortex, left frontal superior orbital, right frontal mid-orbital cortex, and left premotor superior frontal gyrus. Conclusion: Our findings suggest that BMI, rather than waist circumference and waist-to-hip ratio, is inversely associated with CBF in cross-sectional studies. The CBF of obese individuals showed global and regional reductions, including the frontal lobe, temporal and parietal lobes, cerebellum, hippocampus, and thalamus.

PURPOSE: To evaluate the association between diabetic retinopathy (DR) and cerebral disease or cognitive impairment. DESIGN: systematic review and meta-analysis. METHOD: The hypothesis was formulated prior to data collection. Cross-sectional studies and cohort studies that assessed the association between any measure of DR and cerebral small vessel disease or any type of cognitive impairment in diabetic participants were included. The data were independently extracted by two investigators. This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines RESULTS: Twenty-seven studies were included. The combined odds ratio of five cross-sectional/cohort studies that reported that the associations between DR and cerebral structural changes was 1.75 (95% confidence interval [CI]: 1.36-2.25). The combined hazard ratio of four cohort studies that examined the association between DR and cognitive impairment events was 1.47 (95%CI: 1.22-1.78). The combined odds ratio of 14 cross-sectional/cohort studies that examined the association between DR and different cognitive impairment events was 1.43 (95%CI: 1.06-1.93). The overall coefficient (b) of four studies that examined the relationship between DR and specific cognitive performance was 0.09 (95%CI: 0.00-0.18). Considering the quality of the data, we have performed subgroup analysis in studies scored >7 and studies scored

Divergent double-subduction is an important component of plate tectonics and continental growth at modern active convergent margins. However, such a process is rarely identified by deep seismic reflection (DSR) profiles, which casts doubt on its past significance. We report here a 416 km DSR profile of large dynamite shots across the Great Xing’an Range (NE China), which shows multiple arc-shaped reflections in the upper-middle crust of the Xing’an terrane, and densely layered reflection structures suggesting tectonic nappes in the lower crust. This new evidence, together with recent geological studies, indicates that the Xing’an terrane may not be a micro-continental block as previously thought, but a Paleozoic accretionary complex. In addition, there is a strong west-dipping reflection at the boundary between the Xing’an and Erguna terranes in the western DSR profile extending from the lower crust to the lithospheric mantle, suggesting that this fossil subduction zone is most likely the Toudaoqiao-Xinlin suture, which separates the Xing’an and Erguna terranes. In addition, an east-dipping strong reflection was also found in the eastern profile between the Xing’an and Songliao terranes, corresponding to the Hegenshan-Nenjiang suture at the surface. Given the newly identified crust-mantle structure, the opposite subduction zone, and other geological evidence, we propose a new model that the Xing’an terrane was developed by divergent double-subduction of the Paleo-Xing’an Ocean (part of the Paleo-Asian Ocean in the area) from ca. 500 Ma to ca. 300 Ma. Our study provides the first DSR evidence for a divergent double-subduction in the Paleozoic, which emphasizes its importance in past accretionary orogens.

Since the Paleozoic, the tectonic evolutionary process of eastern Eurasia has been affected by at least three paleo-ocean regimes: the Paleo-Asian Ocean, the Mongol-Okhotsk Ocean, and the Paleo-Pacific Ocean. However, the tectonic transition among these ocean regimes is not well understood. Recently, the Heilongjiang Ocean was proposed to play an important role during the transition from the Paleo-Asian Ocean regime to the Mongol-Okhotsk Ocean (and later the Paleo-Pacific Ocean) regime. Here we report on a new combined study of petrological, geochemical, and geochronological data of biotite–plagioclase gneisses from the Qinglongcun Complex in the west Jiamusi-Khanka Block to better understand the tectonic evolution during this transition period. The results show that the protoliths of these biotite–plagioclase gneisses are medium-K calcalkaline rhyolites that were derived from a volcanic island arc environment related to paleo-oceanic subduction that occurred at ca. 260 Ma. Integrated with previous studies of the Permian arc-affinity rocks within the Jiamusi-Khanka Block, we identified two island arc magmatic belts with ages of ca. 290 Ma and ca. 260 Ma at the east and west margins of Jiamusi-Khanka Block, respectively. The east island arc magmatic belt was related to subduction of the Mongol-Okhotsk Ocean during the Early–middle Permian, which provided a driving force for the opening of the Heilongjiang Ocean. Subduction of the Heilongjiang Ocean during the middle–Late Permian resulted in the west arc island magmatic belt. These two belts provide key evidence for understanding the tectonic transition from the Paleo-Asian Ocean to the Mongol-Okhotsk Ocean to the Paleo-Pacific Ocean during the late Paleozoic to early Mesozoic.

Dementia; Dose-response; Thyroid dysfunction Demència; Dosi-resposta; Disfunció de la tiroide Demencia; Dosis-respuesta; Disfunción tiroidea Thyroid hormone, as a modifiable risk factor for dementia, promotes neurocognitive function and regulates metabolic processes. Various studies have defined different thyroid-stimulating hormone cutoffs, but the safest thyroid-stimulating hormone concentration was absent. A dose–response meta-analysis describing the overall functional relation and identifying exposure intervals associated with a higher or lower disease risk is thus desirable. Therefore, our current analysis was conducted to understand the influence of thyroid dysfunction on dementia risk. We searched PubMed, Embase, and Web of Science before May 1, 2020 for human studies published in English. Studies were considered for inclusion if they used a cohort study design to measure the risk of dementia in different thyroid function status groups, diagnosed thyroid functional status and all-cause dementia, included participants aged >18 years, and provided quantitative measures of data. The analysis contained 17 articles with 344,248 individuals with a 7.8-year mean follow-up. Ten studies with 329,287 participants indicated that only subclinical hyperthyroidism was associated with an increased risk of dementia. In contrast, subclinical hypothyroidism, clinical hyperthyroidism, and clinical hypothyroidism did not affect dementia. In the dose–response meta-analysis with 46,417 samples from 11 studies, the association of thyroid-stimulating hormone with the risk of dementia exhibited a U-shaped curve. Our study indicated that subclinical hyperthyroidism was associated with the risk of dementia and the thyroid-stimulating hormone concentration at around 1.55–1.60 mU/L as the optimum range for the risk of dementia. This work was supported by the National Natural Science Foundation of China (No. 82070851, 81870556, 81930019, 81670738), Beijing Municipal Administration of Hospital’s Youth Program (QML20170204), Excellent Talents in Dongcheng District of Beijing.

Patients with schizophrenia have high rates of comorbid physical illness, but there has been less attention to dental diseases in these patients. This meta-analysis of case-control studies systematically examined the oral health in patients with schizophrenia. Case-control studies comparing the oral health in patients with schizophrenia and healthy controls were screened and identified. Standardized mean difference (SMD) with its 95% confidence interval (CI) was calculated using RevMan version 5.3. Three case-control studies comprising 306 patients with schizophrenia and 306 healthy controls were included in this meta-analysis. All studies were rated as “high quality”. Patients with schizophrenia had significantly higher scores of decayed, missing and filled teeth (SMD = 0.83, 95%CI: 0.57, 1.09, p

Detailed analytical methods. Table S1: Major, REE and trace element analyses for the selected samples from the study area. Table S2: U–Pb isotopic data for zircons from selected samples in the study area.

This study conducts a systematic literature review and meta-analysis regarding the potential influence of serum uric acid levels on cerebral small vessel diseases and the cognitive status in the prodromal stages of dementia. We identified four different cerebral small vessel diseases and three specific domains of cognitive performance to be considered in the literature search. The analysis contained 14 studies (13 cross-sectional design and one longitudinal design) with 11,502 participants measuring the relationship between uric acid and cerebral small vessel disease. In both continuous and categorical analyses, significant associations were found between hyperuricemia and cerebral small vessel diseases (continuous data: pooled OR: 1.00, 95%CI: 1.00-1.01 and categorical data: pooled OR: 1.42, 95%CI: 1.15-1.75). For the relationship between uric acid and cognitive performance, 19 studies with 49,901 participants were considered, including eight cohort studies, and 11 cross-sectional studies. The cross-sectional data showed that a marginal relationship existed between uric acid and global cognition (β: 0.00, 95%CI: -0.01-0.00). The pooled analysis of cohort studies indicated that higher uric acid had a deleterious effect on attention and executive function (continuous data: β: -0.02, 95%CI: -0.04-0.00 and categorical data: β: -0.03, 95%CI: -0.07-0.00). Conclusion: Our study indicated that a higher level of uric acid had an adverse effect on brain health. Furthermore, a high level of uric acid is related to cognitive decline in attention and executive function, which may exist a long time before the diagnosis of dementia.

Objective: To investigate and analyze the reasons for metformin non-use in a hospital. Methods: Research-related non-probability physicians and patients filled questionnaire. Results: Physicians’ main influencing factors were severe liver and kidney dysfunction; gastrointestinal adverse reactions and 11 other causes. Secondary factors.included the appearance of hypoglycemia and other adverse reactions (e.g., skin rash) . Patients’ main reasons included: worry about drug’s influence on liver and kidney function, gastrointestinal adverse reactions, hypoglycemia, and further weight loss, etc. Statistical analysis showed metformin has certain effects on the mean blood glucose and the mean glycated hemoglobin levels.Conclusion: Based on the research results, we can design more targeted medication education programs.

This study aimed to evaluate the bidirectional association between the kidney dysfunction and the brain health, including structural and functional abnormalities.Systematic review and meta-analysis with network meta-analysis for outcomes with different estimated glomerular filtration rate (eGFR) ranges.PubMed, Embase database, Cochrane library and Web of Science (up to Dec. 2021).Longitudinal studies that provided evidence of the impact of kidney function estimated from eGFR and urine albumin-to-creatinine ratio (UACR) or chronic kidney disease (CKD) on structural and functional brain abnormalities, and those that provided evidence of the opposite relationship. Studies with study population mean age under 18 years old were excluded.Two independent reviewers screened the included studies, extracted the data, and assessed the risk of bias. We performed a random-effects meta-analysis and a network meta-analysis for outcomes with compatible data. We assessed the risk of bias using the Newcastle-Ottawa Quality Assessment Scale criteria (NOS). Subgroup and sensitivity analyses were conducted to explore heterogeneity in the meta-analyses. Inconsistency analyses using the node-splitting method were performed to confirm the results of network meta-analysis.A total of 53 studies with 3037,357 participants were included in the current systematic review. Among these, 16 provided evidence of structural brain abnormalities, and 38 provided evidence of cognitive impairment and dementia. Analysis of evidence of categorical kidney function showed a positive association between kidney dysfunction and cerebral small vessel disease (cSVD) (relative risk (RR) 1.77, 95% confidence interval (CI) 1.40-2.24, IIn this systematic review and meta-analysis, we found a positive association between CKD and functional brain disorders. However, the relationship between the kidney dysfunction and structural abnormalities in the brain remains controversial. As for the opposite relationship, structural brain abnormalities, especially cerebral microbleeds and silent infarction, but not functional brain abnormalities, are associated with worse renal function. In addition, a higher UACR, but not a lower eGFR, was associated with a higher risk of Alzheimer's disease and vascular dementia.

Contrasting data about the association between proliferative diabetic retinopathy (PDR) and vitamin D status remain unknown. First, a hospital-based cross-sectional study consisting of 889 diabetic retinopathy (DR) and non-DR (NDR) patients was admitted. Further the accumulated evidence was performed to explore the association and dose-response relationship. Our study indicated that the odd ratio for PDR in vitamin D deficiency (VDD) individuals was significantly increased (1.60, 95% CI 1.06–2.42), compared with NDR in vitamin D sufficiency individuals, adjusted by age, sex, diabetic duration, and HbA1c. Four studies plus our study with data on vitamin D levels in 4970 patients with PDR and NDR subjects are compared. Association between vitamin D deficiency and risk of PDR exists (OR=1.69, 95% CI 1.40–2.05; I2=0%, p=0.61). Association between a nonlinear trend for vitamin D decrease with risk of DR was significant (chi2=16.53, p=0.0003). No significant heterogeneity in identified studies was found (goodness of fit chi2=2.98, p=0.225). It is concluded that vitamin D deficiency is significantly associated with risk of proliferative diabetic retinopathy.

The eastern margin of the Jiamusi Block records the tectonic transition from a passive to an active continental margin during the Late Paleozoic- Early Mesozoic. Late Paleozoic sedimentary rocks from the Heitai and Zhenzishan formations along the eastern margin of the Jiamusi Block are a key to resolving these events. Major and trace element data (including REE) for 18 samples from late Paleozoic sedimentary rocks, with the characteristics of high SiO2, Al2O3, Na2O and K2O, low CaO, MgO and TiO2, enrichment in LREE and LILE, depletion in HFSE, and negative Eu anomalies, were plotted on various discrimination diagrams, indicating that the Heitai Formation formed in a passive continental margin setting, whereas the Zhenzishan Formation formed in an active continental margin setting. LA-ICPMS U-Pb dating of detrital zircon from two samples of the Heitai Formation and two samples from the Zhenzishan Formation indicates a range in age from 2735 ± 19 to 308 ± 3 Ma, showing similar populations to the Jiamusi Block. These detrital zircons not only indicate that the sedimentary material was derived from the Jiamusi Block, but also limit the depositional ages of the Heitai and Zhenzishan formations. The youngest zircon population of 374–384 Ma, with a peak at 382 Ma, from the Heitai Formation, together with evidence from paleontological studies, indicates the depositionol age of the Heitai Formation is Devonian (Givetian- Famennian), whereas the 308–318 Ma population, with a peak at 315 Ma, from the Zhenzishan Formation indicates that the depositionol age was late Carboniferous (post- Moscovian). This indicates that the transition from a passive to an active continental margin in the Jiamusi Block occurred between the Late Devonian and the late Carboniferous (380-310Ma) and was more likely related to the Mongol-Okhotsk oceanic subduction-accretion or Panthalassa Ocean, and not to the Paleo-Pacific Ocean or to the Paleo-Asian Ocean as previous considered.

Regulatory Factor X-box binding transcriptional factor 6 (Rfx6) plays an important role in the differentiation and development of pancreas in mammals. However, the direct target genes of Rfx6 to regulate this process were largely unknown. The present study aimed to investigate the function of Rfx6 on regulating pancreatic differentiation and development in a physiologically-relevant context. We performed the chromatin immunoprecipitation followed by the next generation sequencing analysis (ChIP-seq) using whole pancreatic tissue harvested from C57/BL6 adult mice to find target genes of Rfx6. We captured 4146 unique peaks in the genome region of the adult murine pancreas. Among all these binding peaks, a majority were located in intron or intergenic regions. We further annotated all peaks to their nearest gene, and over 1000 genes were captured as Rfx6-binding genes in the pancreas. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) analysis found that Rfx6-binding genes to be associated with the pancreas developmental process. A portion of selected ChIP-seq targets related with pancreas differentiation including Pdx1, Neurod1, Hnf1a, Nkx6-1, St18 and Shox2 were selected and validated as true targets by independent qPCR experiments. In addition, Rfx6 can directly bind to upstream of MiR-145, MiR-195, and possibly other non-protein-coding functional RNAs to control adult mouse pancreatic differentiation. Interestingly, our study revealed that Rfx6 played an important role in insulin translation by binding to the Eif2ak1, Upf1, and Eif5. Our data provide direct target genes of Rfx6 during pancreas development and point to Rfx6 as a potential therapeutic target for improving insulin protein content.

The quality of EGD is a prerequisite for a high detection rate of upper GI lesions, especially early gastric cancer. Our previous study showed that an artificial intelligence system, named intelligent detection endoscopic assistant (IDEA), could help to monitor blind spots and provide an operation score during EGD. Here, we verified the effectiveness of IDEA to help evaluate the quality of EGD in a large-scale multicenter trial.Patients undergoing EGD in 12 hospitals were consecutively enrolled. All hospitals were equipped with IDEA developed using deep convolutional neural networks and long short-term memory. Patients were examined by EGD, and the results were recorded by IDEA. The primary outcome was the detection rate of upper GI cancer. Secondary outcomes were part scores, total scores, and endoscopic procedure time, which were analyzed by IDEA.A total of 17,787 patients were recruited. The total detection rate of cancer-positive cases was 1.50%, ranging from .60% to 3.94% in each hospital. The total detection rate of early cancer-positive cases was .36%, ranging from .00% to 1.58% in each hospital. The average total score analyzed by IDEA ranged from 64.87 ± 16.87 to 83.50 ± 9.57 in each hospital. The cancer detection rate in each hospital was positively correlated with total score (r = .775, P = .003). Similarly, the early cancer detection rate was positively correlated with total score (r = .756, P = .004).This multicenter trial confirmed that the quality of the EGD result is positively correlated with the detection rate of cancer, which can be monitored by IDEA. (Clinical trial registration number: ChiCTR2000029001.).

This study examined the association of anthropometric measurements [body mass index (BMI), waist circumference (WC), percentage body fat (PBF), body roundness index (BRI) and A Body Shape Index (ABSI)] with pulmonary function using a United States national cohort. This cross-sectional study included 7346 participants. The association between anthropometric measurements and pulmonary function was assessed by multivariable linear regression. Where there was evidence of non-linearity, we applied a restricted cubic spline to explore the non-linear association. All analyses were weighted to represent the U.S. population and to account for the intricate survey design. After adjusting for age, race, education, smoking, and physical activity, both underweight and obesity were associated with reduced forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Furthermore, the associations between BMI and FEV1, as well as FVC, were reversed U-shape in both males and females. Similar non-linear association shape occurred in WC, PBF, BRI and ABSI. Conclusion: BMI, WC, PBF, BRI, ABSI are non-linearly associated with pulmonary function. Reduced pulmonary function is a risk factor for future all-cause mortality and cardiovascular events; thus, this nonlinearity may explain the U-shape or J-shape association of BMI with overall mortality and cardiovascular events. Tis work was supported by (i) the National Natural Science Foundation of China (No. 82070851, 81870556, 81670738, 81930019), Beijing Municipal Administration of Hospital`s Youth Program (QML20170204), Excellent Talents in Dongcheng District of Beijing and (ii) the Instituto de Salud Carlos III (Fondo de Investigación Sanitaria, PI 15/00260 and PI18/00640), European Union, European Regional Development Fund (Fondo Europeo de Desarrollo Regional, FEDER, “Una manera de hacer Europa”). CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) are initiatives of the Instituto Carlos III. Te European Foundation for the Study of Diabetes (EFSD/Lilly-Mental Health and Diabetes Programme) and Laboratorios Menarini. Te funders played no role in the design or conduct of the study; in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.

Salut cerebral; Diabetis; Control intensiu de la glucosa Salud cerebral; Diabetes; Control intensivo de la glucosa Brain health; Diabetes; Intensive glucose control Introduction Despite growing evidence that type 2 diabetes is associated with dementia, the question of whether intensive glucose control can prevent or arrest cognitive decline remains unanswered. In the analysis reported here, we explored the effect of intensive glucose control versus standard care on brain health, including structural abnormalities of the brain (atrophy, white matter hyperintensities, lacunar infarction, and cerebral microbleeds), cognitive dysfunction, and risk of dementia. Methods We searched the PubMed and Embase databases, the Web of Science website, and the Clinicaltrial.gov registry for studies published in English prior to July 2020. Only studies with a randomized controlled trial (RCT) design were considered. We analyzed structural abnormalities of the brain (atrophy, white matter hyperintensities, lacunar infarction, and cerebral microbleeds), cognitive function (cognitive impairment, executive function, memory, attention, and information-processing speed), and dementia (Alzheimer’s disease, vascular dementia, and mixed dementia). Results Six studies (5 different RCTs) with 16,584 participants were included in this meta-analysis. One study that compared structural changes between groups receiving intensive versus conventional glucose control measures reported non-significant results. The results of the five studies, comprising four cohorts, indicated a significantly poorer decline in cognitive function in the intensive glucose control group (β − 0.03, 95% confidence interval [CI] − 0.05 to − 0.02) than in the conventional glucose control group. Further subgroup analysis showed a significant difference in the change in cognitive performance in composite cognitive function (β − 0.03, 95% CI − 0.05 to − 0.01) and memory (β − 0.13, 95% CI − 0.25 to − 0.02). One trial evaluated the prevalence of cognitive impairment and dementia between groups receiving intensive and conventional glucose control, respectively, and the differences were insignificant. Conclusion This meta-analysis suggests that intensive glucose control in patients with type 2 diabetes can slow down cognitive decline, especially the decline in composite cognition and memory function. However, further studies are necessary to confirm the impact of strict glucose control on structural abnormalities in the brain and the risk of dementia. This work was supported by the National Natural Science Foundation of China (No. 82070851, 81870556, 81930019), Beijing Municipal Administration of Hospital's Youth Program (QML20170204), Excellent Talents in Dongcheng District of Beijing. Capital's Funds for Health Improvement and Research (2020-1-1181). The Rapid Service Fee was funded by the authors.

Central obesity, measured by the waist circumference (WC) or waist-to-hip ratio, has been linked with metabolic dysfunction and structural abnormalities in the brain, two risk factors for cognitive impairment and dementia. The current analysis was performed to understand the influence of central obesity on the incidence of cognitive impairment and dementia. It included 21 studies involving 5,060,687 participants and showed that a high WC was associated with a greater risk of cognitive impairment and dementia (HR = 1.10, 95 % CI: 1.05–1.15), compared with a low WC. Sub-group analysis showed that a high WC increased the likelihood of developing cognitive impairment and dementia in individuals older than 65 years of age (HR = 1.13, 95 % CI: 1.08–1.19), whereas no association was observed in individuals younger than 65 years of age (HR = 1.04, 95 % CI: 0.93–1.16). Furthermore, dose-response meta-analysis confirmed that a high WC was a risk factor for cognitive impairment and dementia. In conclusion, central obesity, as measured by WC, was associated with a risk of cognitive impairment and dementia.

Background: There is increasing evidence that the lung is a target organ of diabetes. This study aimed to examine in detail the association between diabetes mellitus and pulmonary function using a national cohort. We also aimed to explore the non-linear association between pulmonary function and blood glucose, insulin resistance, and C-reactive protein (CRP). Methods: A total of 30,442 participants from the National Health and Nutrition Examination Survey from the period between 2007 and 2012 were included. The cross-sectional association between diabetes mellitus and pulmonary function was assessed using multiple linear regression. Where there was evidence of non-linearity, we applied a restricted cubic spline with three knots to explore the non-linear association. Partial mediation analysis was performed to evaluate the underlying mechanism. All analyses were weighted to represent the US population and to account for the intricate survey design. Results: A total of 8584 people were included in the fnal study population. We found that diabetes was signifcantly associated with reduced forced expiratory volume in one second (FEV1) and forced vital capacity. We further found L-shaped associations between hemoglobin A1c (HbA1c) and pulmonary function. There was a negative association between HbA1c and FEV1 in diabetes participants with good glucose control (HbA1c