{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T05:44:12Z","timestamp":1762235052565,"version":"build-2065373602"},"reference-count":53,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"crossref","award":["PI17\/02136","PI20\/01322","PI23\/00347","FI21\/0040"],"award-info":[{"award-number":["PI17\/02136","PI20\/01322","PI23\/00347","FI21\/0040"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Nicol\u00e1s Monardes research program of the Consejer\u00eda de Salud","award":["C-0060-2012"],"award-info":[{"award-number":["C-0060-2012"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoX"],"abstract":"<jats:p>It is well known that environmental factors influence the risk of type 2 diabetes mellitus (T2DM). Several studies have linked the xenobiotics present in tobacco or air pollutants to T2DM development, although the underlying mechanisms remain unclear. Surfactant protein D (SP-D), an immune component released into the bloodstream after lung injury, has been associated with metabolic diseases. The aim of this study was to investigate whether SP-D mediates the effects of smoking or air pollution exposure on T2DM risk in the Spanish adult population. Socio-demographic, lifestyle (including smoking status) and clinical data from 2155 participants from the Di@bet.es cohort were analyzed. Annual concentrations of PM10, PM2.5, SO2, CO and NO2 according to participants\u2019 residential address codes were used to study air pollution exposure. T2DM was diagnosed at baseline and after 7.5 years of follow-up. SP-D serum levels were measured by ELISA and categorized as above or below the 25th percentile. Our results revealed a higher percentage of smokers in the high SP-D category; however, no associations were observed between air pollutants (PM10, PM2.5, SO2, CO) and SP-D categories. Both smoking and elevated SP-D levels were found to increase the risk of T2DM independently. Mediation analysis indicated that SP-D mediates 14% of the effect of smoking on T2DM incidence in the Spanish adult population.<\/jats:p>","DOI":"10.3390\/jox15060184","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:47:58Z","timestamp":1762177678000},"page":"184","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surfactant Protein D Mediates the Association Between Smoking and Type 2 Diabetes Mellitus Incidence in the Spanish Adult Population: Di@bet.es Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9760-0883","authenticated-orcid":false,"given":"Wasima","family":"Oualla-Bachiri","sequence":"first","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga, IBIMA Plataforma BIONAND, 29590 Malaga, Spain"},{"name":"Facultad de Medicina, Universidad de M\u00e1laga, Andaluc\u00eda Tech, Campus de Teatinos s\/n, 29071 M\u00e1laga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Lago-Sampedro","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga, IBIMA Plataforma BIONAND, 29590 Malaga, Spain"},{"name":"Facultad de Medicina, Universidad de M\u00e1laga, Andaluc\u00eda Tech, Campus de Teatinos s\/n, 29071 M\u00e1laga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0134-3473","authenticated-orcid":false,"given":"Eva","family":"Garc\u00eda-Escobar","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga, IBIMA Plataforma BIONAND, 29590 Malaga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3452-3489","authenticated-orcid":false,"given":"Cristina","family":"Maldonado-Araque","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga, IBIMA Plataforma BIONAND, 29590 Malaga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0178-0040","authenticated-orcid":false,"given":"Viyey","family":"Doulatram-Gamgaram","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga, IBIMA Plataforma BIONAND, 29590 Malaga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Garc\u00eda-Vivanco","sequence":"additional","affiliation":[{"name":"Divisi\u00f3n De Contaminaci\u00f3n Atmosf\u00e9rica, Centro de Investigaciones Energ\u00e9ticas, Medioambientales y Tecnol\u00f3gicas (CIEMAT), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4654-9272","authenticated-orcid":false,"given":"Fernando","family":"Mart\u00edn-Llorente","sequence":"additional","affiliation":[{"name":"Divisi\u00f3n De Contaminaci\u00f3n Atmosf\u00e9rica, Centro de Investigaciones Energ\u00e9ticas, Medioambientales y Tecnol\u00f3gicas (CIEMAT), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9417-1905","authenticated-orcid":false,"given":"Juan Luis","family":"Garrido","sequence":"additional","affiliation":[{"name":"Divisi\u00f3n De Contaminaci\u00f3n Atmosf\u00e9rica, Centro de Investigaciones Energ\u00e9ticas, Medioambientales y Tecnol\u00f3gicas (CIEMAT), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6114-9712","authenticated-orcid":false,"given":"El\u00edas","family":"Delgado","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Raras (CIBERER), Instituto De Salud Carlos III, 28029 Madrid, Spain"},{"name":"Department of Endocrinology and Nutrition, Central University Hospital of Asturias, Health Research Institute of the Principality of Asturias (ISPA), University of Oviedo, 33011 Oviedo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8009-3689","authenticated-orcid":false,"given":"Felipe J.","family":"Chaves","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Genomic and Genetic Diagnosis Unit, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Casta\u00f1o","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Cruces University Hospital, Bio-Bizkaia, Department of Pediatrics, University of the Basque Country (UPV\/EHU), European Reference Network on Rare Endocrine Conditions (Endo-ERN), 48903 Barakaldo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3628-9323","authenticated-orcid":false,"given":"Alfonso","family":"Calle-Pascual","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Department of Endocrinology and Nutrition, San Carlos University Hospital of Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5175-1555","authenticated-orcid":false,"given":"Josep","family":"Franch-Nadal","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"EAP Raval Sud, Catalan Institute of Health, GEDAPS Network, Primary Care, Research Support Unit (IDIAP-Jordi Gol Foundation), 08007 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7646-2899","authenticated-orcid":false,"given":"Gabriel","family":"Olveira","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga, IBIMA Plataforma BIONAND, 29590 Malaga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio","family":"Vald\u00e9s","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga, IBIMA Plataforma BIONAND, 29590 Malaga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2179-2134","authenticated-orcid":false,"given":"Gemma","family":"Rojo-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades 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