Lean type 2 diabetes mellitus is an independent predictor of mortality in primary biliary cholangitis

doi:10.3748/wjg.v32.i13.115649

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Apr 7, 2026; 32(13): 115649
Published online Apr 7, 2026. doi: 10.3748/wjg.v32.i13.115649

Lean type 2 diabetes mellitus is an independent predictor of mortality in primary biliary cholangitis

Ting-Ting Yin, Hui-Ying Lin, Min Zhou, Jian-Wei Li, Qiu-Lan Mo, Hong-Jing Wang, Jie Chen, Hui-Ling Zhu, Yu-Ting Li, Meng-Yao Zheng, Jin-Hui Yang

Ting-Ting Yin, Hui-Ying Lin, Min Zhou, Jian-Wei Li, Qiu-Lan Mo, Hong-Jing Wang, Jie Chen, Hui-Ling Zhu, Yu-Ting Li, Meng-Yao Zheng, Jin-Hui Yang, Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China

Co-first authors: Ting-Ting Yin and Hui-Ying Lin.

Co-corresponding authors: Meng-Yao Zheng and Jin-Hui Yang.

Author contributions: Yin TT and Lin HY made equal contributions as co-first authors; Yin TT, Lin HY, and Zhou M contributed to the study design and manuscript preparation; Li JW, Mo QL, Wang HJ, Chen J, Zhu HL, and Li YT collected the clinical data; Zheng MY and Yang JH reviewed the data and revised the manuscript, contributed equally as co-corresponding authors. All authors approved the final version.

Supported by National Natural Science Foundation of China, No. 82160106; Yunnan Provincial Department of Education Scientific Research Fund Project, No. 2025J0270; and Yunnan Provincial Science and Technology Department Science and Technology Program Project, No. 202501AY070001-088.

Institutional review board statement: The present study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Kunming Medical University, No. YJ-2023-96.

Informed consent statement: The requirement for informed consent was waived by Ethics Committee of the Second Affiliated Hospital of Kunming Medical University due to retrospective nature of study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to ethical restrictions.

Corresponding author: Jin-Hui Yang, Chief Physician, Full Professor, Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dianmian Avenue, Wuhua District, Kunming 650101, Yunnan Province, China. yangjinhui@kmmu.edu.cn

Received: October 22, 2025
Revised: December 16, 2025
Accepted: January 28, 2026
Published online: April 7, 2026
Processing time: 156 Days and 19 Hours

Abstract

BACKGROUND

The impact of lean type 2 diabetes mellitus (T2DM) on the prognosis of patients with primary biliary cholangitis (PBC) remains unclear.

AIM

To explore the adverse prognostic impact of lean T2DM on liver-related mortality risk in patients with PBC.

METHODS

This retrospective cohort study of 877 PBC patients stratified by T2DM status and lean phenotype used Cox regression models to analyze liver-related outcomes. Interaction effect models investigated T2DM and lean phenotype synergy. Propensity score matching (1:1) controlled for confounders between lean T2DM and non-T2DM non-lean groups, with sensitivity analyses validating results.

RESULTS

The median age of patients was 57 years (50-66), with 716 (81.64%) being female, and median follow-up was 45 months (25-48), during which 234 deaths (26.68%) occurred. After fully adjusting for confounding factors, lean T2DM remained an independent mortality risk factor in PBC patients [hazard ratio (HR) = 1.845, 95% confidence interval: 1.219-2.793, P = 0.004]. Interaction effect analysis confirmed a significant synergistic effect of T2DM and lean phenotype on mortality risk (interaction term HR = 2.546, 95% confidence interval: 1.342-4.831, P = 0.004). Stratified analysis further substantiated that T2DM significantly increased mortality risk only in lean patients (HR = 2.331, P < 0.001), while lean phenotype elevated risk only among T2DM patients (HR = 2.165, P = 0.0078). Propensity score matching validated this association (HR = 1.63, P = 0.008), with sensitivity analyses confirming the robustness of the conclusions.

CONCLUSION

Lean T2DM is an independent risk factor for liver-related adverse outcomes in PBC patients, and the coexistence of T2DM and lean phenotype exhibits a significant synergistic effect on mortality risk.

Keywords: Diabetes mellitus; Lean body weight; Nutritional status; Primary biliary cholangitis; Prognosis

Core Tip: Although the adverse prognostic implications of lean diabetes have been documented in various disease contexts, its specific impact on clinical outcomes and underlying mechanisms in primary biliary cholangitis patients remain largely unexplored. This study represents the first comprehensive investigation that systematically evaluates the detrimental effects of lean diabetes on primary biliary cholangitis patient prognosis and critically examines the synergistic interaction and cooperative enhancement mechanisms between diabetes and lean phenotype.