Publication Name	World Journal of Psychiatry
Manuscript ID	113063
Country	China

Category	Psychiatry
Manuscript Type	Observational Study
Article Title	L-shaped association between fasting blood glucose and comorbid anxiety in Chinese patients with first-episode untreated major depressive disorder
Manuscript Source	Unsolicited Manuscript
All Author List	Lian Yuan, Jun-Jun Liu, Zhe Li, Ying-Zhao Zhu, Wei Ren, Yao-Zhi Liu, Xue-Li Zhao, Xiang-Dong Du and Xiang-Yang Zhang
Funding Agency and Grant Number	Funding Agency Grant Number Medical Research Key Project of Jiangsu Provincial Health Commission K2023015/MR-32-25-009505 Suzhou Major Diseases Clinical Multi-Center Research Project DZXYJ202414/MR-32-25-054379 Scientific and Technological Key Program of Suzhou SYW2024008/MR-32-25-012227 Key Discipline of Psychiatry in Suzhou SZXK202521 Suzhou Science and Technology Tackling Key Problems Program Healthcare Innovation Project SYWD2025154
Corresponding Author	Xiang-Yang Zhang, MD, PhD, Department of Psychiatry, Hefei Fourth People's Hospital, Anhui Mental Health Center, Affiliated Psychological Hospital of Anhui Medical University, No. 316 Huangshan Road, Shushan District, Hefei 230022, Anhui Province, China. zhangxy@psych.ac.cn
Key Words	Major depressive disorder; Anxiety; Fasting blood glucose; Comorbidity; L-shaped association
Core Tip	Insights into the relationship between metabolic factors and psychiatric comorbidities in major depressive disorder (MDD) are limited. We conducted a cross-sectional analysis of 1718 Chinese patients with first-episode untreated MDD using advanced statistical modeling to investigate the association between fasting blood glucose (FBG) levels and comorbid anxiety. An L-shaped nonlinear relationship was revealed with a critical inflection point at 4.8 mmol/L, where FBG levels below this threshold significantly increased anxiety comorbidity risk (OR = 0.20, 95%CI: 0.06-0.67, P = 0.009), while levels above showed no association. These findings demonstrate that lower-normal FBG ranges may serve as a novel biomarker for anxiety risk stratification in MDD patients. With this knowledge, clinicians can incorporate routine FBG assessment into clinical evaluations to identify high-risk patients and optimize treatment strategies for MDD with anxiety comorbidity.
Citation	Yuan L, Liu JJ, Li Z, Zhu YZ, Ren W, Liu YZ, Zhao XL, Du XD, Zhang XY. L-shaped association between fasting blood glucose and comorbid anxiety in Chinese patients with first-episode untreated major depressive disorder. World J Psychiatry 2025; In press

Received	2025-08-15 04:17
Peer-Review Started	2025-08-15 04:17
To Make the First Decision
Return for Revision	2025-09-23 06:19
Revised	2025-10-07 06:10
Second Decision	2025-11-12 02:42
Accepted by Journal Editor-in-Chief
Accepted by Executive Editor-in-Chief	2025-11-12 08:21
Articles in Press	2025-11-12 08:21
Publication Fee Transferred	2025-10-10 13:30
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Typeset the Manuscript

ISSN	2220-3206 (online)
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