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. 2022 Sep 28;107(10):2822-2832.
doi: 10.1210/clinem/dgac429.

Associations of Serum Vitamin B6 Status and Catabolism With All-Cause Mortality in Patients With T2DM

Dandan Zhang  1   2 , Yilan Li  1   2 , Xueyan Lang  1   2 , Yao Zhang  1   2
Affiliations

Associations of Serum Vitamin B6 Status and Catabolism With All-Cause Mortality in Patients With T2DM

Dandan Zhang et al. J Clin Endocrinol Metab. .

Erratum in

Abstract

Context: There is little evidence regarding the association between serum vitamin B6 status and catabolism and all-cause mortality in patients with type-2 diabetes mellitus (T2DM).

Objective: We aimed to ascertain if the serum level of vitamin B6 and catabolism, including pyridoxal 5'-phosphate (PLP) and 4-pyridoxic acid (4-PA), were associated with risk of all-cause mortality in T2DM patients.

Methods: This prospective cohort study involved 2574 patients with T2DM who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010. The serum concentrations of PLP and 4-PA were used to assess the serum level of vitamin B6. Mortality status was determined by routine follow-up using the National Death Index through December 31, 2015.

Results: Over a median follow-up of 85 months, there were 588 deaths. The fully adjusted Cox model indicated that the highest serum PLP concentrations (> 63.6 nmol/L) were associated with a decrease in all-cause mortality (hazard ratio [HR], 0.74; 95% CI, 0.55-0.99, P trend = .035). The risk for all-cause mortality was 59% higher for participants with the highest quartile of 4-PA level compared with the lowest quartile (HR, 1.62; 95% CI, 1.12-2.35; P trend = .003). The sensitivity and specificity of the combination of PLP and 4-PA levels for the prediction of all-cause mortality were 59.5% and 60.9%, respectively (area under the receiver operating characteristic curve = 0.632). The Kaplan-Meier method was used to estimate overall survival for patients based on different combinations of PLP level and 4-PA level. Patients with PLP less than 24.3 nmol/L and 4-PA greater than or equal to 25.4 nmol/L had the worst outcomes (log-rank P < .001).

Conclusion: Overall, our data suggest that a low serum level of PLP and high serum level of 4-PA, which represent the serum level of vitamin B6, increases the risk of all-cause mortality significantly in patients with T2DM.

Keywords: 4-pyridoxic acid (4-PA); NHANES; all-cause mortality; pyridoxal 5′-phosphate (PLP); serum vitamin B6; type 2 diabetes mellitus.

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Figures

Figure 1.
Figure 1.
Flowchart of the screening process for the selection of eligible participants.
Figure 2.
Figure 2.
Association of A, pyridoxal 5′-phosphate (PLP) and B, 4-pyridoxic acid (4-PA) with all-cause mortality in unadjusted restricted cubic splines in National Health and Nutrition Examination Survey participants from 2005 to 2010.
Figure 3.
Figure 3.
Receiver operating characteristic curve analyses were used to evaluate the utility of A, pyridoxal 5′-phosphate (PLP), B, 4-pyridoxic acid (4-PA), and C, PLP combination with 4-PA in the prediction of all-cause mortality.
Figure 4.
Figure 4.
Kaplan-Meier plots of overall survival for patients based on different combinations of pyridoxal 5′-phosphate (PLP) status and 4-pyridoxic acid (4-PA) status. Log-rank P values are shown.
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