quote "Using a multivariable adjusted quadratic spline with HbA1c=5.2% as the cut-point, low and high HbA1c values were associated with an increased risk of all-cause mortality among individuals without diabetes."
quote "Using a multivariable adjusted quadratic spline with HbA1c=5.2% as the cut-point, low and high HbA1c values were associated with an increased risk of all-cause mortality among individuals without diabetes."
It is not clear what biological processes may be underlying the association between low HbA1c and all-cause mortality. In the present study, participants with low HbA1c values had unfavorable profiles of red blood cell related factors, iron storage, and liver function. Red blood cell distribution width has been associated with an increased risk of morbidity and mortality19–22 and with inflammation.21 Younger red blood cells are typically larger and have more size variability compared with older red blood cells,20 which could affect red blood cell distribution width and HbA1c values.6,23 Also, iron stores were elevated among those with low HbA1c in the present study. Iron-deficiency anemia has been associated with increased HbA1c values among individuals without diabetes; however, patients with iron-deficiency anemia who were treated with iron therapy had decreases in HbA1c values.24,25 Also, ferritin was elevated among those with low HbA1c in the present study. Elevated ferritin has been associated with an increased risk of myocardial infarction26 and atherosclerosis,27 but it is also an acute-phase reactant and could be reflecting an inflammatory response. Finally, liver function enzymes were elevated and hepatitis C was more prevalent among those with an HbA1c <4.0% in the present study. Elevated ALT is frequently associated with fatty liver and an adverse cardiometabolic risk factor profile. ALT was positively associated with HbA1c levels among participants with and without diabetes in the British Women’s Heart and Health Study, with a stronger association noted among women without diabetes.28 Certain combination therapies for hepatitis C have been reported to temporarily lower HbA1c levels29; however, the low HbA1c-mortality association observed in the present study was still evident after excluding participants with hepatitis C. The overall biomarker profile of the participants without diabetes and an HbA1c < 4.0% is suggestive of red blood cell markers, inflammation, and liver function as part of the biological underpinning for the association noted in this study. However, the low HbA1c and all-cause mortality association observed in this study persisted after adjustment for lifestyle, cardiovascular, metabolic, red blood cell, iron storage, and liver function indices. The association also persisted after excluding participants with cancer, CVD, anemia, or hepatitis C in sensitivity analyses. Additional research is needed to explore the potential health effects of aberrations in red blood cell markers, inflammation, and liver function indices and associations with all-cause mortality among individuals with a low HbA1c.
Using a multivariable adjusted quadratic spline with HbA1c=5.2% as the cut-point, low and high HbA1c values were associated with an increased risk of all-cause mortality among individuals without diabetes.
看了大家的讨论，一直在犹豫不决要不要改变diet习惯。
其实我不是经常买香蕉。
我吃青黄不接的香蕉。太熟了的，糖都分解出来了。
医生早就警告过我，更年期荷尔蒙水平紊乱，糖尿病很有可能重显，我撑了很多年低碳，看样子要继续下去了
最近发现那些所谓的“健康”面包，含糖量比普通面包高
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734630/
quote "Using a multivariable adjusted quadratic spline with HbA1c=5.2% as the cut-point, low and high HbA1c values were associated with an increased risk of all-cause mortality among individuals without diabetes."
主要是发现现在胃口也没有以前那么好。吃外食很容易身体不舒服，口干舌燥。我觉得就是盐或者糖太大的原因。自己做的饭就没有这个问题。夏天冰激凌也吃，不怎么忌口。
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734630/
quote "Using a multivariable adjusted quadratic spline with HbA1c=5.2% as the cut-point, low and high HbA1c values were associated with an increased risk of all-cause mortality among individuals without diabetes."
这一段阐释了为什么a1c值低死亡率反而高，总结一下就是有一些基础血红蛋白病，慢性贫血性疾病，炎症，肝病，会引起血红蛋白异常，因而引起糖化血红蛋白A1c异常降低。这类人的死亡率高，不是因为他们血糖太低，而是因为本身的基础疾病。正常人很少看到a1c会低于四。文章里说调整了这些marker，还是死亡率升高，但是不是很确定为什么。所以也没有完全定论。其实大部分人都不用去担心自己a1c太低
临床上怀疑病人有血红蛋白疾病，贫血性疾病时候，是不测a1c的，用其他方法监测血糖
It is not clear what biological processes may be underlying the association between low HbA1c and all-cause mortality. In the present study, participants with low HbA1c values had unfavorable profiles of red blood cell related factors, iron storage, and liver function. Red blood cell distribution width has been associated with an increased risk of morbidity and mortality19–22 and with inflammation.21 Younger red blood cells are typically larger and have more size variability compared with older red blood cells,20 which could affect red blood cell distribution width and HbA1c values.6,23 Also, iron stores were elevated among those with low HbA1c in the present study. Iron-deficiency anemia has been associated with increased HbA1c values among individuals without diabetes; however, patients with iron-deficiency anemia who were treated with iron therapy had decreases in HbA1c values.24,25 Also, ferritin was elevated among those with low HbA1c in the present study. Elevated ferritin has been associated with an increased risk of myocardial infarction26 and atherosclerosis,27 but it is also an acute-phase reactant and could be reflecting an inflammatory response. Finally, liver function enzymes were elevated and hepatitis C was more prevalent among those with an HbA1c <4.0% in the present study. Elevated ALT is frequently associated with fatty liver and an adverse cardiometabolic risk factor profile. ALT was positively associated with HbA1c levels among participants with and without diabetes in the British Women’s Heart and Health Study, with a stronger association noted among women without diabetes.28 Certain combination therapies for hepatitis C have been reported to temporarily lower HbA1c levels29; however, the low HbA1c-mortality association observed in the present study was still evident after excluding participants with hepatitis C. The overall biomarker profile of the participants without diabetes and an HbA1c < 4.0% is suggestive of red blood cell markers, inflammation, and liver function as part of the biological underpinning for the association noted in this study. However, the low HbA1c and all-cause mortality association observed in this study persisted after adjustment for lifestyle, cardiovascular, metabolic, red blood cell, iron storage, and liver function indices. The association also persisted after excluding participants with cancer, CVD, anemia, or hepatitis C in sensitivity analyses. Additional research is needed to explore the potential health effects of aberrations in red blood cell markers, inflammation, and liver function indices and associations with all-cause mortality among individuals with a low HbA1c.
很多味道都是提前腌制，和后厨说少盐都没法做到。
Using a multivariable adjusted quadratic spline with HbA1c=5.2% as the cut-point, low and high HbA1c values were associated with an increased risk of all-cause mortality among individuals without diabetes.
范围lower range 4-4.8总比4.8-5.6要好.你自己也知道其实在upper range不好，应该改变，所以你才会来问。但这归根结底还是你自己认为什么事对你更重要。例如我自己做饭基本健康，不太控制，每周下馆子胡吃，但我是基于我所有血指标都是lower range. 如果我是upper range,我会放弃口腹之欲，因为我觉得活得长比吃得好更重要。但例如打铁跑马之类对我就不重要，所以我也懒得试，随意健身有个好身材自己看着开心就够了
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603057/
楼上一网友说我的值接近临界高点，所以我去找最佳值。most of testing results have a normal range, but it also has an optimal value.
东北人到南方吃N碗都不饱。
这篇论文主要是说Hemoglobin A1c这个指标对其他疾病的影响。标题就很明白"Among US Adults Without Diabetes"，已经把糖尿病排除了
所以你要是继续抬杠的话，就应该首先说明你的论点是不是Hemoglobin A1c指标和糖尿病风险的关系。是的话你就再去问问几个糖尿病专家，这个指标是Lower range 更好还是你的5.2 更好。但你非要抬杠你是在讨论Hemoglobin A1c和其他疾病的关系，就不在我讨论范围了。
Low Hemoglobin A1c and Risk of All-Cause Mortality Among US Adults Without Diabetes乱，论点论据不匹配，所以没忍住。打字多累，我以前从不发言，直到花布头的坛子出现
你如果通过生活方式改善把a1c从5.4 降低到4.8，并不代表你的死亡率会增高。
那些低于4的人，本身很大可能有血红蛋白病。
文章的作者在那段话里详细解释了。
不能因为一句结论，就到处说a1c越低越不好，如果没有血红蛋白病，你是低不到哪里去的
在转载摘抄文章的时候，应该自己先仔细阅读以下，否则容易引起误解