[slymon99]

Not really - it's just saying that the definitive link is almost entirely caused by hyperinsulinemia and inflammation, and if you control for them, there's no other causality. Hyperinsulinemia and inflammation are massive metabolic problems, controlling for them is effectively like controlling for lung cancer in a study of smoker. Like, sure, people aren't choking to death on cigarettes.

This is still a useful study though! It's useful to know that the cause is almost entirely through those factors. Though this is also an epidemiological study with no randomization and some of the hazard ratios are not particularly high.