{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T10:09:55Z","timestamp":1788775795945,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81860577"],"award-info":[{"award-number":["81860577"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"award":["81860577"],"award-info":[{"award-number":["81860577"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Hainan Provincial Graduate Student Innovation Research Project","award":["Qhys2024-462"],"award-info":[{"award-number":["Qhys2024-462"]}]},{"name":"Hainan Provincial Graduate Student Innovation Research Project","award":["Hyb2025-182"],"award-info":[{"award-number":["Hyb2025-182"]}]},{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"publisher","award":["2017YFC0907104"],"award-info":[{"award-number":["2017YFC0907104"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Objectives: To examine the joint association of hydration status and sleep quality with prevalent type 2 diabetes mellitus (T2DM) and to quantify their additive and multiplicative interactions. Methods: This cross-sectional study included 4762 participants from the baseline Hainan Prospective Cohort Study. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the four combinations of hydration status and sleep quality. Additive interaction was assessed with the relative excess risk due to interaction (RERI), the attributable proportion (AP), and the synergy index (S); multiplicative interaction was assessed with a product term. Predicted probabilities were estimated by g-computation. Results: The prevalence of T2DM was 8.13% (387\/4762). Compared with non-dehydration and good sleep quality, the combination of dehydration and poor sleep quality was associated with substantially higher odds of prevalent T2DM (adjusted OR 9.92, 95% CI 7.14 to 14.00). All three additive interaction measures were statistically significant (RERI 7.74, 95% CI 4.99 to 10.50; AP 78.04%, 95% CI 69.28 to 86.80; S 7.57, 95% CI 3.49 to 16.42), as was the multiplicative interaction (OR 3.96, 95% CI 2.30\u20136.90). On the absolute risk scale, the interaction contrast was 14.53 percentage points (95% CI: 11.01 to 18.34), with an attributable proportion of 80.5% (95% CI: 66.3 to 94.6) and a synergy index of 5.14 (95% CI: 2.94 to 17.25). The predicted probability of prevalent T2DM was highest in the combined dehydration and poor sleep group. Conclusions: The combination of dehydration and poor sleep quality was associated with higher odds of prevalent T2DM than either condition alone, and a statistically significant additive interaction was observed. Because these additive interaction measures were derived from odds ratios for a non-rare outcome, their absolute magnitude may be overestimated on the odds-ratio scale; the risk-difference-scale measures confirmed the interaction. Given the cross-sectional design, reverse causation cannot be excluded, and longitudinal data are needed to clarify the temporal sequence of these associations.<\/jats:p>","DOI":"10.3390\/nu18172929","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T09:23:37Z","timestamp":1788773017000},"page":"2929","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Joint Association of Hydration Status and Sleep Quality with Type 2 Diabetes Mellitus in a Population-Based Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9512-6951","authenticated-orcid":false,"given":"Miaolin","family":"Han","sequence":"first","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Public Health, Hainan Medical University, 3 Xue Yuan Road, Longhua District, Haikou 571199, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Yixi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Public Health, Hainan Medical University, 3 Xue Yuan Road, Longhua District, Haikou 571199, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7713-5980","authenticated-orcid":false,"given":"Na","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Changyou","family":"Zhao","sequence":"additional","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Public Health, Hainan Medical University, 3 Xue Yuan Road, Longhua District, Haikou 571199, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Limin","family":"He","sequence":"additional","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Public Health, Hainan Medical University, 3 Xue Yuan Road, Longhua District, Haikou 571199, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Jingyue","family":"Guo","sequence":"additional","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Public Health, Hainan Medical University, 3 Xue Yuan Road, Longhua District, Haikou 571199, China"},{"name":"Deyang Center for Disease Control and Prevention (Deyang Health Supervision Institute), No. 1, Section 1, Qianshan Street, Jingyang District, Deyang 618000, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Qiuyun","family":"Cheng","sequence":"additional","affiliation":[{"name":"Haikou Center for Disease Control and Prevention, 56 Yehai Avenue, Qiongshan District, Haikou 571100, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Guotian","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Tourism and Health, University of Sanya, 191 Xue Yuan Road, Jiyang District, Sanya 572022, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9600-2737","authenticated-orcid":false,"given":"Fan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Public Health, Hainan Medical University, 3 Xue Yuan Road, Longhua District, Haikou 571199, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref_1","unstructured":"Magliano, D.J., and Boyko, E.J. (2021). IDF Diabetes Atlas 10th edition scientific committee. IDF DIABETES ATLAS, International Diabetes Federation. [10th ed.]. Available online: https:\/\/idf.org\/news-and-resources\/resources\/idf-diabetes-atlas-2021\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e2416786","DOI":"10.1001\/jamanetworkopen.2024.16786","article-title":"A 5:2 Intermittent Fasting Meal Replacement Diet and Glycemic Control for Adults with Diabetes: The EARLY Randomized Clinical Trial","volume":"7","author":"Guo","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.pop.2021.11.001","article-title":"Risk Factors and Lifestyle Interventions","volume":"49","author":"Salzberg","year":"2022","journal-title":"Prim. Care"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Hu, S., Ji, W., Zhang, Y., Zhu, W., Sun, H., and Sun, Y. (2025). Risk factors for progression to type 2 diabetes in prediabetes: A systematic review and meta-analysis. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-21404-4"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1111\/obr.12921","article-title":"Gene-lifestyle interaction on risk of type 2 diabetes: A systematic review","volume":"20","author":"Dietrich","year":"2019","journal-title":"Obes. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100287","DOI":"10.1016\/j.metop.2024.100287","article-title":"Deciphering the complex interplay of risk factors in type 2 diabetes mellitus: A comprehensive review","volume":"22","author":"Singh","year":"2024","journal-title":"Metabol. Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1159\/000515021","article-title":"A Journey through the Early Evidence Linking Hydration to Metabolic Health","volume":"76","author":"Vanhaecke","year":"2020","journal-title":"Ann. Nutr. Metab."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s00394-022-02972-2","article-title":"Total water intake guidelines are sufficient for optimal hydration in United States adults","volume":"62","author":"Seal","year":"2023","journal-title":"Eur. J. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1159\/000445959","article-title":"Hydration and Chronic Kidney Disease Progression: A Critical Review of the Evidence","volume":"43","author":"Clark","year":"2016","journal-title":"Am. J. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1093\/ndt\/gfab036","article-title":"CKD-REIN study group. Water intake and progression of chronic kidney disease: The CKD-REIN cohort study","volume":"37","author":"Wagner","year":"2022","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Fr\u0105ckiewicz, J., Ciecierska, A., Bia\u0142kowska, A., Drywie\u0144, M., and Hamulka, J. (2024). Hydration status in adults with metabolic disorders in relation to socioeconomic, lifestyle and health factors. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0305540"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3106","DOI":"10.1210\/jc.2004-1056","article-title":"On the interactions of the hypothalamic-pituitary-adrenal (HPA) axis and sleep: Normal HPA axis activity and circadian rhythm, exemplary sleep disorders","volume":"90","author":"Buckley","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1016\/j.chest.2017.05.009","article-title":"Obstructive Sleep Apnea and Diabetes: A State of the Art Review","volume":"152","author":"Reutrakul","year":"2017","journal-title":"Chest"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e000604","DOI":"10.1136\/bmjdrc-2018-000604","article-title":"Insomnia is associated with an increased risk of type 2 diabetes in the clinical setting","volume":"6","author":"LeBlanc","year":"2018","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zhang, N., Du, S.M., Zhang, J.F., and Ma, G.S. (2019). Effects of Dehydration and Rehydration on Cognitive Performance and Mood among Male College Students in Cangzhou, China: A Self-Controlled Trial. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16111891"},{"key":"ref_16","first-page":"164","article-title":"Changes of circulating atrial natriuretic peptide and antidiuretic hormone in obstructive sleep apnea syndrome","volume":"59","author":"Ichioka","year":"1992","journal-title":"Respiration"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e062222","DOI":"10.1136\/bmjopen-2022-062222","article-title":"Chronic non-communicable diseases: Hainan prospective cohort study","volume":"12","author":"Gu","year":"2022","journal-title":"BMJ Open"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Dong, Y., Chen, S., Yu, Y., Li, W., Xu, Z., Du, J., Huang, S., Wu, S., and Cai, Y. (2024). Association between Urine Specific Gravity as a Measure of Hydration Status and Risk of Type 2 Diabetes: The Kailuan Prospective Cohort Study. Nutrients, 16.","DOI":"10.3390\/nu16111643"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2011). Diagnosis and classification of diabetes mellitus. Diabetes Care, 34, S62\u2013S69.","DOI":"10.2337\/dc11-S062"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1210\/clinem\/dgaa722","article-title":"Performance of 4 Creatinine-based Equations in Assessing Glomerular Filtration Rate in Adults with Diabetes","volume":"106","author":"Zafari","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1053\/j.ajkd.2024.04.011","article-title":"Smoking Timing, Healthy Diet, and Risk of Incident CKD Among Smokers: Findings from UK Biobank","volume":"84","author":"Tang","year":"2024","journal-title":"Am. J. Kidney Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s12933-020-01095-4","article-title":"Associations between abdominal obesity indices and diabetic complications: Chinese visceral adiposity index and neck circumference","volume":"19","author":"Wan","year":"2020","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1038\/s41581-024-00817-1","article-title":"Long-term health outcomes associated with hydration status","volume":"20","author":"Dmitrieva","year":"2024","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lin, G., Zhang, N., Lin, Z., He, L., and Zhang, F. (2024). Plain Water Intake, Sleep Quality, and Hydration Status of Pregnant Woman in Hainan, China: A Cross-Sectional Study. Nutrients, 16.","DOI":"10.3390\/nu16111626"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1136\/bjsports-2022-105435","article-title":"Do associations of physical activity and sedentary behaviour with cardiovascular disease and mortality differ across socioeconomic groups? A prospective analysis of device-measured and self-reported UK Biobank data","volume":"57","author":"Paudel","year":"2023","journal-title":"Br. J. Sports Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s10654-005-7835-x","article-title":"Calculating measures of biological interaction","volume":"20","author":"Andersson","year":"2005","journal-title":"Eur. J. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1093\/ije\/dyr218","article-title":"Recommendations for presenting analyses of effect modification and interaction","volume":"41","author":"Knol","year":"2012","journal-title":"Int. J. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"414","DOI":"10.2337\/dc09-1124","article-title":"Quantity and quality of sleep and incidence of type 2 diabetes: A systematic review and meta-analysis","volume":"33","author":"Cappuccio","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.nutres.2017.05.004","article-title":"Reduced water intake deteriorates glucose regulation in patients with type 2 diabetes","volume":"43","author":"Johnson","year":"2017","journal-title":"Nutr. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1017\/S0007114520001063","article-title":"Low hydration status may be associated with insulin resistance and fat distribution: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2010","volume":"124","author":"Min","year":"2020","journal-title":"Br. J. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Huang, R., Kong, X., Geng, R., Wu, J., Chen, T., Li, J., Li, C., Wu, Y., You, D., and Zhao, Y. (2024). Joint and interactive associations of body mass index and genetic factors with cardiovascular disease: A prospective study in UK Biobank. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-19916-6"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40885-019-0111-2","article-title":"The effect of body mass index and its interaction with family history on hypertension: A case-control study","volume":"25","author":"Li","year":"2019","journal-title":"Clin. Hypertens."},{"key":"ref_33","unstructured":"Qin, L. (2011). Physical Activity and Obesity-Related Metabolic Impairments: Estimating Interaction from an Additive Model. [Ph.D. Thesis, University of North Carolina at Chapel Hill]."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.metabol.2018.02.010","article-title":"Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes","volume":"84","author":"Reutrakul","year":"2018","journal-title":"Metabolism"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1016\/S0140-6736(22)01655-5","article-title":"Type 2 diabetes","volume":"400","author":"Ahmad","year":"2022","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2753","DOI":"10.2337\/dci22-0034","article-title":"Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)","volume":"45","author":"Davies","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1007\/s00125-021-05541-0","article-title":"Sleep disorders in people with type 2 diabetes and associated health outcomes: A review of the literature","volume":"64","author":"Schipper","year":"2021","journal-title":"Diabetologia"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Feng, Y., Fang, G., Qu, C., Cui, S., Geng, X., Gao, D., Qin, F., and Zhao, J. (2022). Validation of urine colour L*a*b* for assessing hydration amongst athletes. Front. Nutr., 10.","DOI":"10.3389\/fnut.2022.997189"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/17\/2929\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T09:35:49Z","timestamp":1788773749000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/17\/2929"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":38,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18172929"],"URL":"https:\/\/doi.org\/10.3390\/nu18172929","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]}}}