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Article History

Received: 22 October 2025

Accepted: 24 February 2026

First Online: 30 April 2026

Acknowledgements

: The authors gratefully acknowledge the contributions of the study participants in the HCHS/SOL and the dedication of the staff at the HCHS/SOL sites. This work was previously presented in abstract form as an oral presentation at the American Heart Association EPI|Lifestyle Scientific Sessions in March 2025 (New Orleans, LA, USA).

: The HCHS/SOL data are archived at the National Institutes of Health repositories dbGaP and BIOLINCC. The HCHS/SOL has established a process for the scientific community to apply for access to participant data and materials, with such requests reviewed by the project’s Steering Committee. These policies are described at . The analysis code supporting the findings of this study has been deposited in Zenodo and is publicly available at .

: YW was supported by the American Diabetes Association Postdoctoral Fellowship Award (11-23-PDF-60). BAP, QQ and RCK were supported by the National Heart, Lung, and Blood Institute (BAP, K01HL160146 and R03HL182350; QQ, R01HL140976, R01DK119268 and R01DK126698; RCK, R01HL148094, R01HL140976, R01MD011389 and U01HL146204-04S1). GH was partially supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK132011) and the National Institute of General Medical Sciences (U54GM104940). The HCHS/SOL was supported by contracts from the National Heart, Lung, and Blood Institute to the University of North Carolina (N01-HC65233), the University of Miami (N01-HC65234), the Albert Einstein College of Medicine (N01-HC65235), the University of Illinois at Chicago (HHSN268201300003I), Northwestern University (N01-HC65236) and San Diego State University (N01-HC65237). The following institutes/offices contributed to the HCHS/SOL through a transfer of funds to the National Heart, Lung, and Blood Institute: the National Institute on Minority Health and Health Disparities, the National Institute on Deafness and Other Communication Disorders, the National Institute of Dental and Craniofacial Research, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke and the Office of Dietary Supplements. Additional support was provided by the Life Course Methodology Core (LCMC) of the New York Regional Center for Diabetes Translation Research (P30DK111022). Support for metabolomics data was in part provided by the JLH Foundation (Austin, TX, USA) and R01HL141824.

: The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

: YW and BAP conceived and designed the study. YW performed the statistical analysis and drafted the manuscript. BAP, QQ, RCK, RDB, CRI, AMS, JH, GH, AFL-J, MLD and EB provided critical revision for important intellectual content of the manuscript. YW and BAP are the guarantors of this work and, as such, have full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to the execution, methodology and interpretation of the results and read and approved the final manuscript.