Abstract
Background: Numerous studies reported the associations between endothelial nitric oxide synthase (eNOS) polymorphisms (4b/a VNTR (rs869109213), G894T (rs1799983) and T786C (rs2070744)) and type 2 diabetes mellitus (T2DM) risk. However, the conclusions were incongruent. Moreover, since no published meta-analyses were performed, a key issue regarding false-positive results needs to be addressed. Furthermore, four new articles have been published on these issues. Therefore, an updated meta-analysis was conducted to further explore these associations. Objectives: To investigate the association between eNOS 4b/a, G894T and T786C polymorphisms and T2DM risk. Methods: Studies were searched by using the PubMed, China National Knowledge Infrastructure (CNKI), Medline, Embase, International Statistical Institute (ISI) and the China Wanfang databases. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to evaluate the associations using five genetic models. Furthermore, the false-positive report probability (FPRP), Bayesian false discovery probability (BFDP), and the Venice criteria were employed to assess the credibility of statistically significant associations. Results: Overall, the eNOS 4b/a polymorphism was associated with a significantly decreased T2DM risk in Asians (bb vs. aa: OR = 0.44, 95% CI = 0.23-0.84; ab + bb vs. aa: OR = 0.45, 95% CI = 0.24-0.86; bb vs. aa + ab: OR = 0.73, 95% CI = 0.59-0.91; b vs. a: OR = 0.71, 95% CI = 0.57-0.88); the eNOS G894T polymorphism was associated with a significantly increased T2DM risk in Asians (GT vs. GG: OR = 1.52, 95% CI = 1.15-2.01; GT + TT vs. GG: OR = 1.52, 95% CI = 1.15-2.01; T vs. G: OR = 1.39, 95% CI = 1.09-1.76); the eNOS T786C polymorphism was associated with a significantly increased T2DM risk in Indian (TC vs. TT: OR = 1.93, 95% CI = 1.27-2.94; TC + CC vs. TT: OR = 2.06, 95%CI = 1.26-3.36; C vs. T: OR = 1.90, 95%CI = 1.17-3.08). However, when a sensitivity analysis was performed after excluding low quality and Hardy-Weinberg Disequilibrium (HWD) studies, no significant association was found for the eNOS G894T polymorphism. After credibility assessment, we identified "less-credible positive results" for the statistically significant associations in the current meta-analysis. Conclusion: In conclusion, this article suggests that all substantial relationships between eNOS 4b/a, G894T, and T786C polymorphisms and T2DM risk are most likely due to false positive results rather than real connections or biological variables.