Triglyceride to High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio, a Simple but Effective Indicator in Predicting Type 2 Diabetes Mellitus in Older Adults

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2022 Mar 14

PMID 35282431

Authors

Hongzhou Liu

Jing Liu

Jixiang Liu

Shuanli Xin

Zhaohui Lyu

Xiaomin Fu

Affiliations

Soon will be listed here.

Abstract

Background: A simple and readily available biomarker can provide an effective approach for the surveillance of type 2 diabetes mellitus (T2DM) in the elderly. In this research, we aim to evaluate the role of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as an indicator for new-onset T2DM in an elderly Chinese population aged over 75 years.

Methods: This longitudinal retrospective cohort study was conducted using a free database from a health check screening project in China. Participants with baseline TG and HDL measurements were enrolled, and the data of T2DM development were collected. The cumulative incident T2DM rates in different quintile groups of TG/HDL-C ratio (Q1 to Q5) were calculated and plotted. The independent effect of baseline TG/HDL-C ratio on T2DM risk during the follow-up period was tested by the Cox proportional hazard model. Subgroup analysis was also conducted to clarify the role of TG/HDL-C ratio in specific populations.

Results: A total of 231 individuals developed T2DM among 2,571 subjects aged over 75 years during follow-up. Regardless of adjustment for potential confounding variables, elevated TG/HDL-C ratio independently indicated a higher risk of incident T2DM [hazard ratio (HR) = 1.29; 95% confidence interval (CI), 1.14-1.47; < 0.01. As compared with the lowest quintile (Q1), elevated TG/HDL-C ratio quintiles (Q2 to Q5) were associated with larger HR estimates of incident T2DM [HR (95% CI), 1.35 (0.85-2.17), 1.31 (0.83-2.06), 1.85 (1.20-2.85), and 2.10 (1.38-3.20), respectively]. In addition, a non-linear correlation was found between TG/HDL-C ratio and the risk of T2DM, and the slope of the curve decreased after the cutoff point of 2.54. Subgroup analysis revealed a stronger positive correlation among male individuals and those with body mass index <24 kg/m.

Conclusions: Increased TG/HDL-C ratio indicates a greater risk of new-onset T2DM regardless of confounding variables. TG/HDL-C ratio is a simple but effective indicator in predicting T2DM in older adults. More future investigations are warranted to further promote the clinical application of TG/HDL-C ratio.

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References

Wilson P, Meigs J, Sullivan L, Fox C, Nathan D, DAgostino Sr R . Prediction of incident diabetes mellitus in middle-aged adults: the Framingham Offspring Study. Arch Intern Med. 2007; 167(10):1068-74. DOI: 10.1001/archinte.167.10.1068. View

Seshasai S, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N . Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011; 364(9):829-841. PMC: 4109980. DOI: 10.1056/NEJMoa1008862. View

He S, Wang S, Chen X, Jiang L, Peng Y, Li L . Higher ratio of triglyceride to high-density lipoprotein cholesterol may predispose to diabetes mellitus: 15-year prospective study in a general population. Metabolism. 2011; 61(1):30-6. DOI: 10.1016/j.metabol.2011.05.007. View

Schulze M, Weikert C, Pischon T, Bergmann M, Al-Hasani H, Schleicher E . Use of multiple metabolic and genetic markers to improve the prediction of type 2 diabetes: the EPIC-Potsdam Study. Diabetes Care. 2009; 32(11):2116-9. PMC: 2768223. DOI: 10.2337/dc09-0197. View

Chien K, Cai T, Hsu H, Su T, Chang W, Chen M . A prediction model for type 2 diabetes risk among Chinese people. Diabetologia. 2008; 52(3):443-50. DOI: 10.1007/s00125-008-1232-4. View

Cai Z, Chen Z, Fang W, Li W, Huang Z, Wang X . Triglyceride to high-density lipoprotein cholesterol ratio variability and incident diabetes: A 7-year prospective study in a Chinese population. J Diabetes Investig. 2021; 12(10):1864-1871. PMC: 8504899. DOI: 10.1111/jdi.13536. View

Lin S, Berlin I, Younge R, Jin Z, Sibley C, Schreiner P . Does elevated plasma triglyceride level independently predict impaired fasting glucose?: the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2012; 36(2):342-7. PMC: 3554324. DOI: 10.2337/dc12-0355. View

Cho N, Shaw J, Karuranga S, Huang Y, da Rocha Fernandes J, Ohlrogge A . IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018; 138:271-281. DOI: 10.1016/j.diabres.2018.02.023. View

Tushuizen M, Bunck M, Pouwels P, Bontemps S, van Waesberghe J, Schindhelm R . Pancreatic fat content and beta-cell function in men with and without type 2 diabetes. Diabetes Care. 2007; 30(11):2916-21. DOI: 10.2337/dc07-0326. View

10.

Jia W, Weng J, Zhu D, Ji L, Lu J, Zhou Z . Standards of medical care for type 2 diabetes in China 2019. Diabetes Metab Res Rev. 2019; 35(6):e3158. DOI: 10.1002/dmrr.3158. View

11.

Lim E, Hollingsworth K, Aribisala B, Chen M, Mathers J, Taylor R . Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011; 54(10):2506-14. PMC: 3168743. DOI: 10.1007/s00125-011-2204-7. View

12.

Kim J, Lee J, Chung H, Roh E, Lee Y, Hong S . Impact of Visit-to-Visit Fasting Plasma Glucose Variability on the Development of Type 2 Diabetes: A Nationwide Population-Based Cohort Study. Diabetes Care. 2018; 41(12):2610-2616. DOI: 10.2337/dc18-0802. View

13.

Okin P, Hille D, Wiik B, Kjeldsen S, Lindholm L, Dahlof B . In-treatment HDL cholesterol levels and development of new diabetes mellitus in hypertensive patients: the LIFE Study. Diabet Med. 2013; 30(10):1189-97. DOI: 10.1111/dme.12213. View

14.

Kershaw E, Flier J . Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004; 89(6):2548-56. DOI: 10.1210/jc.2004-0395. View

15.

Rothwell P . Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet. 2010; 375(9718):938-48. DOI: 10.1016/S0140-6736(10)60309-1. View

16.

Dotevall A, Johansson S, Wilhelmsen L, Rosengren A . Increased levels of triglycerides, BMI and blood pressure and low physical activity increase the risk of diabetes in Swedish women. A prospective 18-year follow-up of the BEDA study. Diabet Med. 2004; 21(6):615-22. DOI: 10.1111/j.1464-5491.2004.01189.x. View

17.

Wu S, Huang Z, Yang X, Zhou Y, Wang A, Chen L . Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a northern Chinese industrial city. Circ Cardiovasc Qual Outcomes. 2012; 5(4):487-93. DOI: 10.1161/CIRCOUTCOMES.111.963694. View

18.

Bragg F, Holmes M, Iona A, Guo Y, Du H, Chen Y . Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China. JAMA. 2017; 317(3):280-289. PMC: 6520233. DOI: 10.1001/jama.2016.19720. View

19.

Kannel W, Vasan R, Keyes M, Sullivan L, Robins S . Usefulness of the triglyceride-high-density lipoprotein versus the cholesterol-high-density lipoprotein ratio for predicting insulin resistance and cardiometabolic risk (from the Framingham Offspring Cohort). Am J Cardiol. 2008; 101(4):497-501. PMC: 3753679. DOI: 10.1016/j.amjcard.2007.09.109. View

20.

Sadeghi M, Talaei M, Rizi E, Dianatkhah M, Oveisgharan S, Sarrafzadegan N . Determinants of incident prediabetes and type 2 diabetes in a 7-year cohort in a developing country: The Isfahan Cohort Study. J Diabetes. 2014; 7(5):633-41. DOI: 10.1111/1753-0407.12236. View