Urinary Volatile Organic Compounds (VOC) Are Associated with All-Cause Mortality Risk in Individuals with Diabetes: A Longitudinal Analysis of NHANES

Abstract Background Exposure to volatile organic compounds (VOCs) has been implicated in diabetes mellitus (DM). However, the impacts of VOCs on mortality in patients with DM remains unclear. Methods This retrospective study utilized data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011–2018 to analyze the associations between urinary VOC metabolite levels and all-cause mortality in adults with DM. Mortality data were obtained from the National Death Index through December 31, 2019. Associations between VOC metabolite levels and all-cause mortality were assessed using Cox proportional hazards regression models, with adjustment for demographic and clinical covariates. Results A total of 1336 participants in NHANES with DM were analyzed. After adjusting for relevant confounders, higher levels of 2-methylhippuric acid (2MHA) (adjusted hazard ratio [aHR] = 1.38, 95% confidence interval [CI] 1.04–1.83, p = 0.027) and combined 3MHA + 4MHA (aHR = 1.40, 95%CI 1.04–1.89, p = 0.029) were significantly associated with higher all-cause mortality. Conclusion Elevated urinary levels of 2MHA and combined 3MHA + 4MHA, metabolites of xylene, were independently associated with an increased all-cause mortality risk among individuals with DM in the US community. Further research is warranted to elucidate the underlying mechanisms and clinical implications of the observed association. Graphical Abstract