Pauline Duquenne, Cécilia Samieri, Stéphanie Chambaron, Gilles Feron, Marie-Claude Brindisi, Emmanuelle Kesse-Guyot, Florine Berthy, Damien Léger, Pilar Galan, Serge Hercberg, Mathilde Touvier, Valentina A. Andreeva1, Léopold K. Fezeu.

> Sex-specific associations of anxiety, insomnia, and their comorbidity with incident obesity in a general-population cohort 

Indira Paz-Graniel,PhD,1,2,3,4, Junko Kose, PhD, 2,5 Pauline Duquenne, PhD, 2 Nancy Babio, PhD,1,3,4, Jordi Salas-Salvado,PhD, 1,3,4 Serge Hercberg,PhD, 2 Pilar Galan,PhD,  2 MathildeTouvier,PhD, 2 LeopoldK.Fezeu,PhD, 2 Valentina A.Andreeva, PhD2

> Alcohol, Smoking, and Their Synergyas Risk Factors for Incident Type2 Diabetes

Nutritional risk factors of type 2 diabetes — Contribution of the French NutriNet-Santé cohort to scientific knowledge
Pauline Duquennea,∗, Léopold K. Fezeua, Laurent Bourhisa, Paola Yvrouda, Bernard Sroura, Emmanuelle Kesse-Guyota, Chantal Julia a,b, Julia Baudrya, Emmanuel Cossona,c, Sopio Tatulashvili a,c, Pilar Galana, Serge Hercberga,b, Mathilde Touvier a, Valentina A. Andreevaa

> Facteurs de risque d’origine nutritionnelle du diabète de type 2 — apport de la cohorte francaise NutriNet-Santé aux connaissances scientifiques

Valentina A. Andreeva1*, Nathalie Arnault1, Stéphanie Chambaron2, Cécilia Samieri3, Marie-Claude Brindisi 2, Pauline Duquenne1, Serge Hercberg1, Pilar Galan1, Mathilde Touvier1 and Leopold K. Fezeu1

1Nutritional Epidemiology Research Group, Sorbonne Paris Nord University and University of Paris, INSERM/INRAE/CNAM,
Epidemiology and Statistics Research Center, Bobigny, France, 2Center for Taste and Feeding Behavior, CNRS/INRAE/Agro
Institute, University of Bourgogne, Dijon, France, 3University of Bordeaux, INSERM, Bordeaux Population Health Research Center
UMR1219, Bordeaux, France

> Mental Multimorbidity Among General-Population Adults: Sex-Specific Sociodemographic Profiles of Anxiety, Insomnia, and Eating Disorders

Valentina A. Andreeva1*, Stéphanie Chambaron2, Cécilia Samieri3,4 and Léopold K. Fezeu1

1Nutritional Epidemiology Research Unit, Sorbonne Paris Nord University, INSERM/INRAE/CNAM, Epidemiology and Statistics
Research Center (CRESS), Bobigny, France, 2UMR6265 Centre des Sciences du Goût et de l’Alimentation (CSGA), CNRS/
INRAE/Agro Institute, University of Bourgogne, Dijon, France, 3UMR1219, Université de Bordeaux, Bordeaux, France, 4INSERM,
Bordeaux Population Health, Bordeaux, France

Keywords: anxiety, insomnia, eating disorders, general population, mental multimorbidity

> Response to M. Zhang

Pauline Duquenne 1*, Cécilia Samieri 2, Stéphanie Chambaron 3, Marie‑Claude Brindisi 3,4, Emmanuelle Kesse‑Guyot 1, Pilar Galan 1, Serge Hercberg 1,5, Mathilde Touvier 1, Damien Léger 6, Léopold K. Fezeu 1 & Valentina A. Andreeva 1,7*

The main objective of this study was to evaluate the association of the insomnia-anxiety comorbidity with incident type 2 diabetes (T2D) in a large prospective cohort. We selected adults without diabetes
at baseline from the French NutriNet-Santé cohort who had completed the trait anxiety subscale of the Spielberger State-Trait Anxiety Inventory (STAI-T, 2013–2016) and a sleep questionnaire (2014); insomnia was defined according to established criteria. Using multivariable Cox models, we compared T2D risk across 4 groups: no insomnia or anxiety (reference), insomnia alone, anxiety alone (STAI-T ≥ 40), and comorbid anxiety and insomnia. Among 35,014 participants (mean baseline age: 52.4 ± 14.0 years; 76% women), 378 (1.1%) developed T2D over a mean follow-up of 5.9 ± 2.1 years. Overall, 28.5% of the sample had anxiety alone, 7.5%—insomnia alone, and 12.5%—both disorders. In the fully-adjusted model, a higher T2D risk was associated with anxiety-insomnia comorbidity (HR = 1.40; 95% CI 1.01, 1.94), but not with each disorder separately, compared to the group without insomnia or anxiety. The findings supported a positive association between anxiety-insomnia comorbidity and incident T2D among general population adults. Future research using clinical diagnoses of mental disorders could confirm the findings and guide diabetes prevention programs.

Keywords Anxiety, Comorbidity, Diabetes mellitus, Insomnia, Mental health, Prospective study

> Chronic insomnia, high trait anxiety and their comorbidity as risk factors for incident type 2 diabetes mellitus