Abstract
Purpose To determine whether hypertriglyceridemic waist (HTGW) and high lipid accumulation product (LAP) preceded the incidence of type 2 diabetes mellitus (T2DM), and to investigate the interactions of HTGW and LAP with other components of metabolic syndrome on the risk of T2DM. Methods A total of 15,717 eligible participants without baseline T2DM and aged 35 and over were included from a Chinese rural cohort. Cox proportional hazards regression models were used to estimate the association of HTGW and LAP with the incidence of T2DM, and the restricted cubic spline model was used to evaluate the dose-response association. Results Overall, 867 new T2DM cases were diagnosed after 7.77 years of follow-up. Participants with HTGW had a higher hazard ratio for T2DM (hazard ratio (HR): 6.249, 95% confidence interval (CI): 5.199-7.511) after adjustment for potential confounders. The risk of incident T2DM was increased with quartiles 3 and 4 versus quartile 1 of LAP, and the adjusted HRs (95% CIs) were 2.903 (2.226-3.784) and 6.298 (4.911-8.077), respectively. There were additive interactions of HTGW (synergy index (SI): 1.678, 95% CI: 1.358-2.072) and high LAP (SI: 1.701, 95% CI: 1.406-2.059) with increased fasting plasma glucose (FPG) on the risk of T2DM. Additionally, a nonlinear (P nonlinear < 0.001) dose-response association was found between LAP and T2DM. Conclusion The subjects with HTGW and high LAP were at high risk of developing T2DM, and the association between LAP and the risk of T2DM may be nonlinear. Our study further demonstrates additive interactions of HTGW and high LAP with increased FPG on the risk of T2DM.
Highlights
Type 2 diabetes mellitus (T2DM) is a global health priority, and the International Diabetes Federation has predicted that the number of individuals with diabetes will increase from 425 million in 2017 to 700 million in 2045, with 80% of the disease burden in low- and middle-income countries [1]
The results showed that there was an additive interaction between hypertriglyceridemic waist (HTGW) and increased fasting plasma glucose (FPG), and the SI was 1.678 (1.358-2.072), suggesting that the risk of T2DM in HTGW subjects with increased FPG was 1.678 times as high as the sum of risks in participants exposed to a single risk factor alone
Our study further demonstrates the additive interaction effects of HTGW and high lipid accumulation product (LAP) with increased FPG, and the risks of T2DM were significantly higher than the sum of risks in participants exposed to a single risk factor alone
Summary
Type 2 diabetes mellitus (T2DM) is a global health priority, and the International Diabetes Federation has predicted that the number of individuals with diabetes will increase from 425 million in 2017 to 700 million in 2045, with 80% of the disease burden in low- and middle-income countries [1]. Waist circumference (WC) and triglyceride (TG) levels are important components of metabolic syndrome, according to the definitions of the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP-ATP III) [6] and International Diabetes Federation (IDF) [7]. Subsequent studies showed that HTGW was significantly associated with an increased risk of type 2 diabetes mellitus [11,12,13,14,15,16] and cardiovascular disease [17, 18]. Many studies have indicated that metabolic syndrome and its components were risk factors for T2DM [23, 24]. Few studies have focused on the interaction effects of HTGW and LAP with other components of metabolic syndrome on the incident of T2DM, and no prior work has been done to explore the dose-response association between LAP and risk of T2DM
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