Liu Yanmei, Shi Rui, Cao Huiying, Zhang Jian, Li Shuangyue, Kang Xilin, Ma Yongjuan, Wu Yudian, Guo Yangfan, Feng Lei
Department of Clinical Laboratory, Yan'an Hospital Affiliated to Kunming Medical University, Yunnan, Email, 650000, People's Republic of China.
Department of Laboratory Medicine, Sixth School of Clinical Medicine, the Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University, Guangzhou, China.
Lipids Health Dis. 2025 Apr 2;24(1):129. doi: 10.1186/s12944-025-02546-1.
Recent studies have suggested an interplay between conicity index (C-index)-related diabetes risk and lipid burden. It is plausible that the atherogenic index of plasma (AIP), fatty liver, and HbA1c mediate the association between C-index and diabetes risk, though this has not been fully explored. This study explored whether AIP, fatty liver, and HbA1c mediate the relationship between C-index and diabetes risk, as well as their combined effect.
Data from 15,453 participants in the NAGALA Cohort were analyzed (median follow-up 5.39 years). Restricted Cubic Spline (RCS) and univariate Cox regression models adjusted for risk factors were used to assess the role of AIP in modifying the C-index-diabetes relationship. Mediation analysis assessed the contributing factors, and predictive models for diabetes were established.
Among normoglycemic individuals, the AIP and C-index remained significantly and positively associated with diabetes risk. Higher AIP levels strengthened the C-index-diabetes association, particularly in the AIP range of 0.11-≤1.21. In the initial model, hazard ratios (HRs) for those in the fourth quartile of the C-index distribution in this group showed a significant HR of 2.22 (1.37-3.59). As fatty liver and HbA1c levels were progressively adjusted, the HRs gradually decreased, but a significant HR of 1.70 (1.05-2.76) was retained in the fully adjusted model. No significant association was observed in the other AIP strata. Furthermore, AIP, fatty liver, and HbA1c mediated the relationship between C-index and diabetes risk, with mediation effects of 9.8%, 25.0%, and 13.4%, respectively. Notably, the combined model incorporating AIP, fatty liver, HbA1c, and the C-index achieved the highest predictive performance (AUC = 0.86), outperforming the C-index alone (AUC = 0.68).
C-index was significantly associated with diabetes risk, modified by AIP, fatty liver, and HbA1c. These findings emphas ize the importance of AIP along with the C-index, particularly in the context of fatty liver and HbA1c, for diabetes risk screening and management.
近期研究表明，圆锥指数（C指数）相关的糖尿病风险与脂质负担之间存在相互作用。血浆致动脉粥样硬化指数（AIP）、脂肪肝和糖化血红蛋白（HbA1c）可能介导了C指数与糖尿病风险之间的关联，尽管这一点尚未得到充分探究。本研究探讨了AIP、脂肪肝和HbA1c是否介导了C指数与糖尿病风险之间的关系以及它们的联合作用。
对NAGALA队列中15453名参与者的数据进行分析（中位随访时间5.39年）。使用受限立方样条（RCS）和针对风险因素进行调整的单变量Cox回归模型来评估AIP在改变C指数与糖尿病关系中的作用。中介分析评估了影响因素，并建立了糖尿病预测模型。
在血糖正常的个体中，AIP和C指数与糖尿病风险仍保持显著正相关。较高的AIP水平增强了C指数与糖尿病的关联，特别是在AIP范围为0.11至≤1.21时。在初始模型中，该组中C指数分布第四四分位数人群的风险比（HR）显示显著的HR为2.22（1.37 - 3.59）。随着脂肪肝和HbA1c水平逐步调整，HR逐渐降低，但在完全调整模型中仍保留了显著的HR为1.70（1.05 - 2.76）。在其他AIP分层中未观察到显著关联。此外，AIP、脂肪肝和HbA1c介导了C指数与糖尿病风险之间的关系，中介效应分别为9.8%、25.0%和13.4%。值得注意的是，纳入AIP、脂肪肝、HbA1c和C指数的联合模型具有最高的预测性能（AUC = 0.86），优于单独的C指数（AUC = 0.68）。
C指数与糖尿病风险显著相关，受AIP、脂肪肝和HbA1c影响。这些发现强调了AIP与C指数一起的重要性，特别是在脂肪肝和HbA1c的背景下，对糖尿病风险筛查和管理具有重要意义。
