Liao Yuheng, Han Yong, Cao Changchun, Song Haiying, Hu Haofei
Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China.
School of Medicine, Shenzhen University, Shenzhen, Guangdong Province, 518000, China.
Diabetol Metab Syndr. 2025 Aug 22;17(1):349. doi: 10.1186/s13098-025-01907-1.
The atherogenic index of plasma (AIP) has emerged as a promising predictor for type 2 diabetes mellitus (T2DM), but population-specific patterns and underlying mechanisms remain poorly understood. This study investigated the association between AIP and T2DM risk in Chinese and Japanese populations, focusing on non-linear relationships, population-specific thresholds, and the mediating role of body mass index (BMI).
We conducted a retrospective cohort study using data from the China Rich Healthcare Group (n = 112,483) and the Japanese NAGALA database (n = 15,453). AIP was calculated as log10[triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C)]. T2DM was defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/L, hemoglobin A1c (HbA1c) ≥ 6.5%, or self-reported diabetes during follow-up. Cox proportional hazards models with restricted cubic splines were used to examine non-linear relationships. Two-piecewise regression models identified population-specific thresholds, and formal mediation analyses quantified BMI's mediating effect.
During a median follow-up of 3.0 years, 1,801 participants (1.41%) developed T2DM. AIP demonstrated a significant positive association with T2DM risk in both populations: hazard ratio (HR) per unit increase: Chinese 1.84, 95% confidence interval (CI) 1.54-2.21; Japanese 2.42, 95% CI 1.67-3.52) after comprehensive adjustment. We identified distinct population-specific non-linear relationships with different threshold effects: in Chinese participants, T2DM risk increased significantly until AIP reached 0.436, while in Japanese participants, significant risk elevation began at AIP values exceeding - 0.449. BMI mediated a considerably higher proportion of the total effect in Chinese (39.84%) compared to Japanese participants (27.11%), indicating differential pathophysiological mechanisms.
Our findings reveal substantial population-specific differences in the AIP-T2DM relationship, including population-specific thresholds and mediation pathways. These results underscore the importance of population-tailored screening strategies and suggest that interventions targeting lipid metabolism and BMI management may have varying efficacy across East Asian populations.
血浆致动脉粥样硬化指数（AIP）已成为2型糖尿病（T2DM）的一个有前景的预测指标，但特定人群的模式和潜在机制仍知之甚少。本研究调查了中国和日本人群中AIP与T2DM风险之间的关联，重点关注非线性关系、特定人群阈值以及体重指数（BMI）的中介作用。
我们使用来自中国睿健医疗集团（n = 112,483）和日本NAGALA数据库（n = 15,453）的数据进行了一项回顾性队列研究。AIP计算为log10[甘油三酯（TG）/高密度脂蛋白胆固醇（HDL-C）]。T2DM定义为空腹血糖（FPG）≥7.0 mmol/L、糖化血红蛋白（HbA1c）≥6.5%或随访期间自我报告的糖尿病。使用带有受限立方样条的Cox比例风险模型来检验非线性关系。两段式回归模型确定特定人群阈值，正式的中介分析量化BMI的中介效应。
在中位随访3.0年期间，1801名参与者（1.41%）发生了T2DM。AIP在两个人群中均与T2DM风险呈显著正相关：全面调整后，每单位增加的风险比（HR）：中国人为1.84，95%置信区间（CI）为1.54 - 2.21；日本人为2.42，95%CI为1.67 - 3.52。我们确定了具有不同阈值效应的不同特定人群非线性关系：在中国参与者中，直到AIP达到0.436时T2DM风险才显著增加，而在日本参与者中，当AIP值超过 - 0.449时风险开始显著升高。与日本参与者（27.11%）相比，BMI在中国参与者中介导的总效应比例更高（39.84%），表明病理生理机制存在差异。
我们的研究结果揭示了AIP与T2DM关系中存在显著的特定人群差异，包括特定人群阈值和中介途径。这些结果强调了针对特定人群的筛查策略的重要性，并表明针对脂质代谢和BMI管理的干预措施在东亚人群中可能具有不同的疗效。
