Study design and populations

We used data from a prospective observational cohort study of Mexican adults living in large urban settings of central Mexico. The study sample was comprised of healthy adults ≥ 20 years old, with body mass index (BMI) ≥ 20 kg/m², without previously diagnosed diabetes, cardiovascular disease, and cerebral vascular disease. Exclusion criteria included pregnancy or having an alcohol habit defined as consuming more than 10 servings of alcohol per week. Potential participants were evaluated at their workplaces (offices of the federal government or private companies), homes or during a visit to a relative in a medical unit. In the baseline visit, personal medical history, family history of type 2 diabetes, years of formal education, and socioeconomic status were recorded. The entire cohort was composed of 9637 participants with baseline evaluation. The follow-up examinations took place after a 3-year period (± 6 months). The response rate at follow-up was 63.7% (N = 6144). Impaired fasting glucose (IFG) and type 2 diabetes were defined according to the American Diabetes Association guidelines [39] using a measure of fasting plasma glucose between 100 and 125 mg/dL for prediabetes and ≥ 126 mg/dL for diabetes. The analysis sample was restricted to the IFG subset of the cohort.

The study was approved by the Ethics Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Written informed consent was obtained from each participant. Our investigation and subsequent analyses were conducted in accordance with the Helsinki Declaration of Human Studies principles.