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Diabetes"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate associations of the bioelectrical impedance analysis (BIA)-derived phase angle (PhA), an indicator of body cell mass, hydration status, and cell membrane integrity, with type 2 diabetes (T2D), prediabetes, and glycemic and insulin-related traits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from the Cooperative Health Research in the Region of Augsburg (KORA) S3\/S4 studies, we analyzed 7728 participants aged 25\u201374 years for prevalent T2D and 7006 participants who did not have diabetes at baseline for incident T2D. A subsample aged 55\u201374 years at S4 was followed to assess incident oral glucose tolerance test (OGTT)-defined prediabetes or T2D (prediabetes\/T2D), and glycemic and insulin-related traits (S4\/F4\/FF4). The PhA was calculated from BIA 2000-S at 50\u2009kHz. Logistic and Cox regressions were applied for binary outcomes, and two-level growth models for continuous traits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In S3\/S4, 324 participants had prevalent T2D at baseline, and 707 developed T2D during a median 15.7-year follow-up. In S4\/F4\/FF4, during up to 14 years of follow-up, 251 out of 626 normoglycemic participants at S4 developed incident prediabetes\/T2D, and 792\u2013804 participants without diabetes at S4 had three repeated measurements of continuous traits. The PhA (per 1-degree) was positively associated with incident T2D (hazard ratio [HR] and 95% confidence interval [CI] in S3\/S4: 1.37 [1.21\u20131.54]) and incident prediabetes\/T2D (HR [95% CI] in S4\/F4\/FF4: 1.33 [1.07\u20131.67]) without sex differences. The PhA (per 1-degree) was also positively associated with fasting glucose (beta [95% CI]: 1.2% [0.1\u20132.2%]) and insulin resistance (beta [95% CI]: 7.0% [2.3\u201311.7%]) cross-sectionally, and with changes in 2-h glucose longitudinally (beta [95% CI]: 4.5% [2.3\u20136.7%]) (S4\/F4\/FF4). In contrast, the PhA (per 1-degree) was inversely associated with prevalent T2D (odds ratio [95% CI] in S3\/S4: 0.72 [0.56\u20130.93]) in men only.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The PhA at 50\u2009kHz had stage-dependent associations with glucose metabolism, with higher values observed during subclinical stages and lower values after diabetes manifestation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41387-026-00425-x","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T07:44:57Z","timestamp":1778312697000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of the phase angle with type 2 diabetes and related traits: results from two prospective KORA studies"],"prefix":"10.1038","volume":"16","author":[{"given":"Feiling","family":"Ai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-Theres","family":"Huemer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Rathmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8200-6382","authenticated-orcid":false,"given":"Michael","family":"Roden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2050-093X","authenticated-orcid":false,"given":"Christian","family":"Herder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanja","family":"Zeller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2064-9603","authenticated-orcid":false,"given":"Wolfgang","family":"Koenig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jana","family":"Nano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Drey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6645-0985","authenticated-orcid":false,"given":"Annette","family":"Peters","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8416-6440","authenticated-orcid":false,"given":"Barbara","family":"Thorand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"425_CR1","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1007\/s40520-016-0622-6","volume":"29","author":"G Sergi","year":"2017","unstructured":"Sergi G, De Rui M, Stubbs B, Veronese N, Manzato E. 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TZ is funded by the German Research Foundation, the EU Horizon 2020 program, the EU ERANet and ERAPreMed Programs, the German Center for Cardiovascular Research (DZHK, 81Z0710102) and the German Ministry of Education and Research. TZ is listed as co-inventor of an international patent on the use of a computing device to estimate the probability of myocardial infarction (International Publication Number WO2022043229A1). TZ is a shareholder of the ART.EMIS GmbH Hamburg. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The KORA studies were performed in accordance with the Declaration of Helsinki 1964. Written informed consent was obtained from all participants at baseline and at each data collection examination. Study methods were approved by the Ethics Committee of the Bavarian Chamber of Physicians for each study since 1998 (KORA S4: EC No. 99186, F4 study and FF4 study: EC No. 06068). Prior to that, all studies were approved by the local authorities and conducted in accordance with the data protection regulations valid at the time. The KORA S3 study was prior to 1998 and therefore the last sentence above applies.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}],"article-number":"11"}}