We read with great interest the article by Galvez-Fernandez et al. (1) about the association of urinary zinc (UZn) (single exposure) with the risk of type 2 diabetes mellitus (T2DM) among 1,339 adults in the Strong Heart Study (SHS) and 1,905 family members of SHS participants in the Strong Heart Family Study (SHFS). The authors reported that higher UZn levels were statistically significantly associated with increased T2DM risk in the SHS cohort but not in the SHFS cohort. In the sensitivity analyses, the authors evaluated the association of UZn with T2DM risk by adjusting for urinary arsenic (UAs) and selenium (USe) levels using the conventional regression models. However, this study did not report details on the interactions with important predictors, levels of metal concentrations and their correlations, and explanations for their possible influence, although the combined effects of UZn, UAs, and USe on T2DM were not their primary focus.
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