Nonlinear association of cholesterol, high-density lipoprotein, and glucose index with the risk of prediabetes and diabetes in normal-weight middle-aged and older Chinese adults: a multicenter retrospective cohort study
- 1Dapeng New District Kuichong Branch of Shenzhen Second People’s Hospital , , ,
- 2Department of General Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University , , ,
- 3Department of Internal Medicine, Dapeng New District Kuichong Branch of Shenzhen Second People’s Hospital , , ,
Abstract
Background: The relationship between the cholesterol, high-density lipoprotein, and glucose (CHG) index and dysglycemia is widely recognized in the general population; however, this relationship has been much less examined among normal-weight, middle-aged and older adults—a subgroup routinely marginalized in metabolic research. Accordingly, the current study was designed to evaluate the relationship of the CHG index with incident prediabetes and diabetes specifically among this population.
Methods: The study cohort comprised 19,981 Chinese adults (age ≥45 years, BMI 18.5–23.9 kg/m2) without prediabetes or diabetes at baseline, sourced from a multicenter retrospective analysis of nationwide screening data (2010–2016). The CHG index was calculated as Ln[(TC × FPG)/(2 × HDLC)] (mg/dL). The primary outcome was incident- prediabetes and diabetes. To evaluate the association, we applied Cox proportional hazards models, along with smooth curve fitting and two-piecewise regression.
Results: During an average follow-up of 3.19 years, a higher CHG index was significantly linked to a greater risk of the outcome. After adjustment (Model 3), the hazard ratio (HR) for the CHG index as a continuous variable was 2.20 (95% CI: 1.90–2.54). Compared with Quartile 1, the HRs for Quartiles 2, 3, and 4 were 1.42, 1.86, and 1.91, respectively (all p < 0.0001). A significant nonlinear relationship was identified (log-likelihood ratio test, p < 0.001), with the inflection point located at a CHG index of 5.07. To the left of the inflection point, each unit increase in CHG index was associated with a 6.39-fold increase in risk (HR: 6.39, 95% CI: 4.73–8.64), while no significant link was observed to the right (HR: 1.02, 95% CI: 0.79–1.31).
Conclusion: This study indicates a nonlinear positive association between the CHG index and the risk of incident prediabetes and diabetes among normal-weight middle-aged and older Chinese adults. Future research employing large prospective cohorts is warranted to fully explicate the mechanisms and establish a causal nexus.
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BibTeX
@article{ding2026nonlinear,
title = {{Nonlinear association of cholesterol, high-density lipoprotein, and glucose index with the risk of prediabetes and diabetes in normal-weight middle-aged and older Chinese adults: a multicenter retrospective cohort study}},
author = {Junling Ding and Zhimao Cai and Xianglin Wang and Lifen Qin and Weifeng Chen},
journal = {Frontiers in nutrition},
year = {2026},
month = oct,
doi = {10.3389/fnut.2026.1949954},
url = {https://europepmc.org/article/PMC/PMC13724456},
note = {CC BY},
}
RIS
TY - JOUR
TI - Nonlinear association of cholesterol, high-density lipoprotein, and glucose index with the risk of prediabetes and diabetes in normal-weight middle-aged and older Chinese adults: a multicenter retrospective cohort study
AU - Junling Ding
AU - Zhimao Cai
AU - Xianglin Wang
AU - Lifen Qin
AU - Weifeng Chen
PY - 2026
DA - 2026/10/19
JO - Frontiers in nutrition
DO - 10.3389/fnut.2026.1949954
UR - https://europepmc.org/article/PMC/PMC13724456
AB - Background: The relationship between the cholesterol, high-density lipoprotein, and glucose (CHG) index and dysglycemia is widely recognized in the general population; however, this relationship has been much less examined among normal-weight, middle-aged and older adults—a subgroup routinely marginalized in metabolic research. Accordingly, the current study was designed to evaluate the relationship of the CHG index with incident prediabetes and diabetes specifically among this population. Methods: The study cohort comprised 19,981 Chinese adults (age ≥45 years, BMI 18.5–23.9 kg/m2) without prediabetes or diabetes at baseline, sourced from a multicenter retrospective analysis of nationwide screening data (2010–2016). The CHG index was calculated as Ln[(TC × FPG)/(2 × HDLC)] (mg/dL). The primary outcome was incident- prediabetes and diabetes. To evaluate the association, we applied Cox proportional hazards models, along with smooth curve fitting and two-piecewise regression. Results: During an average follow-up of 3.19 years, a higher CHG index was significantly linked to a greater risk of the outcome. After adjustment (Model 3), the hazard ratio (HR) for the CHG index as a continuous variable was 2.20 (95% CI: 1.90–2.54). Compared with Quartile 1, the HRs for Quartiles 2, 3, and 4 were 1.42, 1.86, and 1.91, respectively (all p < 0.0001). A significant nonlinear relationship was identified (log-likelihood ratio test, p < 0.001), with the inflection point located at a CHG index of 5.07. To the left of the inflection point, each unit increase in CHG index was associated with a 6.39-fold increase in risk (HR: 6.39, 95% CI: 4.73–8.64), while no significant link was observed to the right (HR: 1.02, 95% CI: 0.79–1.31). Conclusion: This study indicates a nonlinear positive association between the CHG index and the risk of incident prediabetes and diabetes among normal-weight middle-aged and older Chinese adults. Future research employing large prospective cohorts is warranted to fully explicate the mechanisms and establish a causal nexus.
SN - 2296-861X
ER -