Tohidi Maryam, Asgari Samaneh, Chary Abdolreza, Safiee Siavash, Azizi Fereidoun, Hadaegh Farzad
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box 19395-4763, Tehran, Islamic Republic of Iran.
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Diabetol Metab Syndr. 2023 Feb 2;15(1):13. doi: 10.1186/s13098-023-00988-0.
To determine the association between triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) for identifying subjects at risk of incident prediabetes and type 2 diabetes mellitus (T2DM).
In 5064 subjects (men = 2247) aged ≥ 20 years, using Cox proportional hazards regression analyses, the associations of TG/HDL-C with incident prediabetes and T2DM were examined among normoglycemic men and women. Furthermore, the association of this lipid ratio with incident T2DM was also assessed among prediabetic subjects (n = 1414). The multivariable analyses were adjusted for age, body mass index, waist-to-height ratio, wrist circumference, systolic blood pressure, family history of T2DM, education level, history of cardiovascular diseases, and fasting plasma glucose (FPG).
During a median follow-up of 11.2 years, 2140 new cases of prediabetes (men = 1070) and 360 incident T2DM (men = 152) were identified among normoglycemic individuals. In the prediabetic population, 574 new cases of T2DM (men = 252) were developed. Among the whole population, compared to the first quartile (reference), higher quartiles of TG/HDL-C were significantly associated with higher risks of incident prediabetes and T2DM among normoglycemic individuals and incident T2DM in the prediabetic population (all P for trend < 0.001). The corresponding hazard ratios (HRs) and 95% confidence intervals (CIs) for the fourth quartiles were 1.37(1.20-1.58), 1.92(1.34-2.75), and 1.57(1.22-2.01), respectively. The sex-stratified analyses demonstrated similar significant associations in both sexes; however, TG/HDL-C lost its association with incident T2DM among prediabetic men. Among the normoglycemic population, 1 unit increase in TG/HDL-C was significantly associated with incident prediabetes and T2DM [1.02(1.00-1.03) and 1.06(1.03-1.08), respectively]. The corresponding value for incident T2DM in prediabetic individuals was 1.01(1.00-1.03). In a subgroup population having insulin data (n = 2897), the associations between TG/HDL-C and incident prediabetes and T2DM among normoglycemic individuals generally persisted even after replacing FPG with an index of insulin resistance (IR), i.e., homeostasis model assessment of IR (HOMA-IR) in the adjusted model.
In conclusion, in the normoglycemic population, the increasing value of TG/HDL-C was unfavorably associated with incident prediabetes and T2DM, especially among women. Similarly, TG/HDL-C was associated with incident T2DM in prediabetic individuals. Generally, we found that the correlation between TG/HDL-C and different states of dysglycemia is independent of HOMA-IR.
确定甘油三酯与高密度脂蛋白胆固醇比值（TG/HDL-C）与新发糖尿病前期和2型糖尿病（T2DM）风险个体之间的关联。
在5064名年龄≥20岁的受试者（男性=2247名）中，使用Cox比例风险回归分析，在血糖正常的男性和女性中检查TG/HDL-C与新发糖尿病前期和T2DM的关联。此外，还在糖尿病前期受试者（n = 1414）中评估了该血脂比值与新发T2DM的关联。多变量分析对年龄、体重指数、腰高比、腕围、收缩压、T2DM家族史、教育水平、心血管疾病史和空腹血糖（FPG）进行了校正。
在中位随访11.2年期间，在血糖正常个体中确定了2140例新发糖尿病前期病例（男性=1070例）和360例新发T2DM病例（男性=152例）。在糖尿病前期人群中，出现了574例新发T2DM病例（男性=252例）。在整个人群中，与第一四分位数（参照）相比，TG/HDL-C的较高四分位数与血糖正常个体中新发糖尿病前期和T2DM的较高风险以及糖尿病前期人群中新发T2DM的风险显著相关（所有趋势P<0.001）。第四四分位数的相应风险比（HRs）和95%置信区间（CIs）分别为1.37（1.20 - 1.58）、1.92（1.34 - 2.75）和1.57（1.22 - 2.01）。按性别分层分析显示，两性之间存在相似的显著关联；然而，在糖尿病前期男性中，TG/HDL-C与新发T2DM失去了关联。在血糖正常人群中，TG/HDL-C每增加1个单位与新发糖尿病前期和T2DM显著相关[分别为1.02（1.00 - 1.03）和1.06（1.03 - 1.08）]。糖尿病前期个体中新发T2DM的相应值为1.01（1.00 - 1.03）。在有胰岛素数据的亚组人群（n = 2897）中，即使在调整模型中用胰岛素抵抗指数（IR）即稳态模型评估IR（HOMA-IR）替代FPG后，血糖正常个体中TG/HDL-C与新发糖尿病前期和T2DM之间的关联通常仍然存在。
总之，在血糖正常人群中，TG/HDL-C值的增加与新发糖尿病前期和T2DM呈不利关联，尤其是在女性中。同样，TG/HDL-C与糖尿病前期个体中的新发T2DM相关。一般来说，我们发现TG/HDL-C与不同血糖异常状态之间的相关性独立于HOMA-IR。
