{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T06:18:25Z","timestamp":1787811505112,"version":"build-2784847793"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obesity and chronic low-grade inflammation are established risk factors for type 2 diabetes, yet their joint longitudinal evolution and combined contribution to diabetes incidence remain poorly characterized in aging populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify joint trajectories of adiposity and systemic inflammation, evaluate their associations with incident diabetes, and quantify the mediating role of glycated hemoglobin (HbA1c) across two independent cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This prospective study included 3,733 diabetes-free adults aged \u226550\u202fyears from the English Longitudinal Study of Ageing (ELSA,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1,778) and the Health and Retirement Study (HRS,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1,955), with approximately 8 years of follow-up. Group-based multi-trajectory modeling identified joint trajectory groups under two strategies: general adiposity (body mass index paired with log-transformed C-reactive protein) and central adiposity (waist-to-height ratio paired with log-transformed C-reactive protein). Associations with incident diabetes were estimated using Cox proportional hazards models pooled via random-effects meta-analysis. Mediation analysis quantified the proportion statistically mediated through mid-wave HbA1c.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four trajectory groups were identified under each strategy in both cohorts. A graded association was observed: the highest-risk group exhibited substantially elevated diabetes risk under both general adiposity (pooled HR 6.00, 95% CI 3.71\u20139.70) and central adiposity strategies (pooled HR 5.69, 95% CI 3.37\u20139.59) after full adjustment. Under the conservative outcome definition, HbA1c mediated 13.7\u201327.5% of the total effect (25.7\u201344.8% under the original definition representing an upper bound). Trajectory classification yielded modestly higher C-statistics over baseline cross-classification (\u0394C 0.061\u20130.067, statistically significant in HRS), with significant net reclassification improvement primarily driven by event cases. Results were consistent across strategies and cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Co-evolving trajectories of adiposity and systemic inflammation exhibit a graded association with incident diabetes in older adults, partially mediated through glycemic deterioration. Trajectory modeling offered modest discriminative gains over single-time-point assessment. These findings support concurrent adiposity-inflammation monitoring for diabetes risk stratification in aging populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1867835","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:35:20Z","timestamp":1787808920000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Joint trajectories of adiposity and systemic inflammation and incident diabetes among older adults: a bi-cohort prospective study with mediation analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Fubin","family":"Teng","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Nephrology, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shichao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nephrology, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nephrology, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.2337\/dc23-0294","article-title":"Relationship among diabetes, obesity, and cardiovascular disease phenotypes: a UK biobank cohort 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