Utility of Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio in Evaluating Incident Diabetes Risk

Figures & data

Table 1 Baseline Characteristics of Diabetes and Non-Diabetes Groups

	Non-Diabetes	Diabetes	P-value
No. of subjects	15,091	373
Sex			<0.001
Female	6947 (46.03%)	87 (23.32%)
Male	8144 (53.97%)	286 (76.68%)
Age, years	42.00 (37.00–50.00)	46.00 (41.00–53.00)	<0.001
Weight, kg	59.40 (51.60–67.90)	69.00 (60.00–78.00)	<0.001
BMI, kg/m^2	22.04 (3.07)	25.03 (3.82)	<0.001
WC, cm	76.26 (8.97)	85.08 (10.20)	<0.001
ALT, U/L	17.00 (13.00–23.00)	24.00 (18.00–39.00)	<0.001
AST, U/L	17.00 (14.00–21.00)	20.00 (16.00–26.00)	<0.001
GGT, U/L	15.00 (11.00–22.00)	24.00 (17.00–36.00)	<0.001
HDL-C, mmol/L	1.42 (1.17–1.71)	1.13 (0.96–1.32)	<0.001
Non-HDL-C, mmol/L	3.59 (3.00–4.23)	4.20 (3.57–4.82)	<0.001
NHHR	2.50 (1.86–3.39)	3.71 (2.86–4.78)	<0.001
TC, mmol/L	5.12 (0.86)	5.43 (0.90)	<0.001
LDL-C, mmol/L	3.03 (2.55–3.55)	3.46 (2.93–3.95)	<0.001
TG, mmol/L	0.72 (0.49–1.11)	1.21 (0.86–1.93)	<0.001
FPG, mmol/L	5.15 (0.41)	5.61 (0.36)	<0.001
HbA1c, %	5.16 (0.32)	5.53 (0.37)	<0.001
SBP, mmHg	114.31 (14.91)	122.03 (15.59)	<0.001
DBP, mmHg	71.44 (10.47)	77.18 (10.23)	<0.001
Fatty liver	2518 (16.69%)	223 (59.79%)	<0.001
Habit of exercise	2658 (17.61%)	51 (13.67%)	0.048
Drinking status			<0.001
Non or small	11,539 (76.46%)	266 (71.31%)
Light	1718 (11.38%)	40 (10.72%)
Moderate	1323 (8.77%)	37 (9.92%)
Heavy	511 (3.39%)	30 (8.04%)
Smoking status			<0.001
Non	8886 (58.88%)	145 (38.87%)
Past	2875 (19.05%)	77 (20.64%)
Current	3330 (22.07%)	151 (40.48%)

Abbreviations: BMI, body mass index; WC, waist circumference; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma-glutamyl transferase; HDL-C, high-density lipoprotein cholesterol; TC, total cholesterol; Non-HDL-C, non-high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TG, triglyceride; NHHR, non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio; HbA1c, hemoglobin A1c; FPG, fasting plasma glucose; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Table 2 Cox Regression Analyses for the Association Between the Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio and Incident Diabetes in Different Models

	Hazard Ratios (95% Confidence Interval)
	No. of Subjects	Unadjusted Model	Model 1	Model 2	Model 3	Model 4
Main study	15,464	1.64 (1.55, 1.74)	1.34 (1.24, 1.44)	1.27 (1.16, 1.38)	1.27 (1.16, 1.39)	1.18 (1.07, 1.30)
Sensitivity-1	12,716	1.50 (1.34, 1.67)	1.25 (1.09, 1.44)	1.20 (1.03, 1.39)	1.20 (1.03, 1.39)	1.23 (1.05, 1.45)
Sensitivity-2	12,747	1.68 (1.58, 1.80)	1.35 (1.24, 1.47)	1.28 (1.16, 1.40)	1.28 (1.16, 1.41)	1.21 (1.09, 1.33)
Sensitivity-3	14,741	1.66 (1.56, 1.76)	1.33 (1.23, 1.44)	1.26 (1.15, 1.39)	1.27 (1.16, 1.39)	1.17 (1.06, 1.30)
Sensitivity-4	14,491	1.67 (1.56, 1.78)	1.33 (1.23, 1.45)	1.24 (1.13, 1.37)	1.25 (1.13, 1.38)	1.16 (1.04, 1.28)
Sensitivity-5	12,932	1.58 (1.44, 1.73)	1.33 (1.19, 1.50)	1.20 (1.06, 1.36)	1.17 (1.02, 1.34)	1.15 (1.01, 1.33)
Sensitivity-6	13,441	1.64 (1.52, 1.78)	1.37 (1.24, 1.51)	1.27 (1.14, 1.43)	0.27 (1.13, 1.42)	1.26 (1.11, 1.42)

Notes: Model 1 adjusted for age, sex and BMI; Model 2 adjusted for model 1 plus TC, FPG and HbA1c; Model 3 adjusted for model 2 plus ALT, AST and GGT; Model 4 adjusted for model 3 plus fatty liver, habit of exercise, drinking status, smoking status and SBP. Note 1: (1) sensitivity-1: excluding subjects with a baseline diagnosis of fatty liver; (2) sensitivity-2: excluding subjects with exercise habits at baseline; (3) sensitivity-3: excluding subjects more than 60 years of age at baseline; (4) sensitivity-4: excluding subjects whose baseline SBP ≥ 140 mmHg or DBP ≥ 90 mmHg; (5) sensitivity-5: excluding subjects whose baseline BMI ≥ 25 kg/m²; (6) sensitivity-6: excluding subjects whose baseline WC ≥ 90cm in male or ≥ 80cm in female. Note 2: Fatty liver was not included in model 4 of sensitivity-1; Habit of exercise was not included in model 4 of sensitivity-2.

Figure 1 Hazard ratios (95% confidence intervals) for the non-linear relationship between NHHR and the risk of diabetes.

Abbreviation: NHHR, non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio.

Table 3 Areas Under the Receiver Operating Characteristic Curves for Each Lipid Parameter in Identifying Diabetes

	AUC	95% CI Low	95% CI Upp	Best Threshold	Specificity	Sensitivity
HDL-C	0.7193*	0.6937	0.7448	1.3279	0.5969	0.7534
TC	0.6048*	0.5754	0.6342	5.3659	0.6302	0.5442
TG	0.7269*	0.7008	0.7531	0.8750	0.6218	0.7373
Non-HDL-C	0.6808*	0.6542	0.7074	3.8053	0.5949	0.6729
LDL-C	0.6496*	0.6217	0.6774	3.2534	0.6179	0.6086
NHHR	0.7405	0.7158	0.7651	2.7367	0.5776	0.7936

Note: *P<0.05, compare with NHHR.

Abbreviations: AUC, area under the curve; HDL-C, high-density lipoprotein cholesterol; TC, total cholesterol; Non-HDL-C, non-high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TG, triglyceride; NHHR, non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio.

Figure 2 Receiver operating characteristic curve analysis of diabetes-related lipid parameters.

Abbreviations: NHHR, non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio; HDL-C, high-density lipoprotein cholesterol; non-HDL-C, non-high-density lipoprotein cholesterol; TC, total cholesterol; TG, triglyceride; LDL-C, low-density lipoprotein cholesterol.