{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:07:36Z","timestamp":1790172456560,"version":"4.1.0"},"reference-count":39,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2024A1515010809"],"award-info":[{"award-number":["2024A1515010809"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Food Science &amp;amp; Nutrition"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>This retrospective cohort study aimed to characterize diabetes\u2010stratified associations between serum calcium levels and all\u2010cause, cardiovascular (CVD), and cancer mortality, addressing a critical gap in nutritional epidemiology. Leveraging the National Health and Nutrition Examination Survey (NHANES) database, we conducted Cox proportional hazards regression with restricted cubic splines to model non\u2010linear calcium\u2013mortality relationships. Mediation analysis was conducted in diabetes. The T2DM group presented a J\u2010shaped relationship, with relatively stable and low mortality risk at lower calcium concentrations, followed by a significant increase at higher concentrations. In contrast, the group without diabetes exhibited a U\u2010shaped relationship, indicating that both low and high serum calcium levels are associated with increased mortality risk, with an optimal range in the middle where the risk is minimized. Mediation analysis indicated that, in individuals with T2DM, the relationship between serum calcium levels and mortality was partially mediated by markers of renal function and total cholesterol. Our findings support personalized calcium monitoring as a cost\u2010effective strategy in diabetic care. Serum calcium thresholds for mortality risk differ fundamentally by diabetes status, underscoring the need for precision nutrition strategies. Integration of calcium monitoring into routine diabetic care\u2014particularly targeting high\u2010risk subgroups\u2014may mitigate mortality.<\/jats:p>","DOI":"10.1002\/fsn3.71034","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T06:39:38Z","timestamp":1758695978000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diabetes\u2010Specific Serum Calcium Thresholds for Mortality Risk: A\n                    <scp>NHANES<\/scp>\n                    Nutritional Epidemiology Study"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9698-3130","authenticated-orcid":false,"given":"Ling","family":"Li","sequence":"first","affiliation":[{"name":"Institute of Basic Medical Sciences Meizhou People's Hospital (Huangtang Hospital)  Meizhou P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangyu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Medical Research Center, Sun Yat\u2010sen Memorial Hospital Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Ran","sequence":"additional","affiliation":[{"name":"Department of Nephrology Meizhou People's Hospital (Huangtang Hospital)  Meizhou P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0729-9095","authenticated-orcid":false,"given":"Sudong","family":"Liu","sequence":"additional","affiliation":[{"name":"Institute of Basic Medical Sciences Meizhou People's Hospital (Huangtang Hospital)  Meizhou P. R. China"},{"name":"Guangdong Engineering Technology Research Center of Molecular Diagnostics for Cardiovascular Diseases  Meizhou P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14\u20100898"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.091005"},{"issue":"184","key":"e_1_2_11_4_1","first-page":"1","article-title":"National Health and Nutrition Examination Survey, 2015\u20132018: Sample Design and Estimation Procedures","volume":"2","author":"Chen T. C.","year":"2020","journal-title":"Vital and Health Statistics"},{"issue":"160","key":"e_1_2_11_5_1","first-page":"1","article-title":"National Health and Nutrition Examination Survey: Sample Design, 2007\u20132010","volume":"2","author":"Curtin L. 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