Association and Interaction Analysis of Lipid Accumulation Product with Impaired Fasting Glucose Risk: A Cross-Sectional Survey

Associations of obesity and novel lipid indicators in the risk of type 2 diabetes mellitus in Chinese elderly hypertensive patients

Background

The associations of waist circumference (WC), body mass index (BMI), lipid accumulation product (LAP), Chinese visceral adiposity index (CVAI), and triglyceride-glucose Index (TyG) with the risk of type 2 diabetes mellitus (T2DM) remained uncertain in Chinese middle-aged and elderly hypertensive patients.

Methods

A total of 1,965 hypertensive participants aged 45 years and elderly were included in the cross-sectional analysis, and 1,576 hypertensive participants without T2DM for the cohort analysis. In the cross-sectional study, binary logistic regression, restricted cubic splines (RCS), and receiver operating characteristic (ROC) were used to analyze the relationships between WC, BMI, LAP, CVAI, and TyG with and T2DM in hypertensive patients. In the cohort study, Kaplan-Meier survival analyses and Cox regression were further performed to determine the associations of these indicators with incident T2DM risk.

Results

In the cohort study, there were 101 incident T2DM cases occurred during a median follow-up of 30 months, with an incident rate was 2.78 per 100 person-years. The cross-sectional study showed that the risk of T2DM increased significantly with higher quartiles of WC, BMI, LAP, CVAI, and TyG (all P -trend < 0.001). In the cohort study, Cox regression model showed that WC (Q4 vs. Q1, HR = 3.30, 95% CI = 1.66-6.59), BMI (Q4 vs. Q1, HR = 2.38, 95% CI = 1.30-4.36), LAP (Q4 vs. Q1, HR = 5.15, 95% CI = 2.40-11.02), CVAI (Q4 vs. Q1, HR = 3.38, 95% CI = 1.76-6.50), and TyG (Q4 vs. Q1, HR = 5.76, 95% CI = 2.82-11.77) were associated with a higher risk of incident T2DM. RCS confirmed the positive dose-response relationships of WC, BMI, CVAI and TyG with T2DM in both study design, except for LAP in the cohort study. Additionally, ROC analysis revealed that TyG had the strongest area under the curve (AUC) of 0.70 (95% CI = 0.67-0.72) in the cross-sectional study, and the AUC of other indicators ranged from 0.55 to 0.57.

Conclusion

Higher levels of WC, BMI, LAP, CVAI, and TyG are associated with a higher riskof developing incident T2DM in Chinese elderly hypertensive patients, and TyG might be the most effective predictive indicator.

The triglyceride-glucose index and risk of cognitive impairment: a systematic review and meta-analysis with inclusion of two national databases

Background

To investigate the relationship between the triglyceride and glucose (TyG) index and cognitive impairment (CI).

Methods

Five authoritative databases were systematically searched for potentially relevant studies on 'TyG index' and 'CI' from inception to 27 April 2024. Two representative databases from the United Kingdom and United States were also included. We used the PICOS criteria to select available articles. All data was combined to compute Odd Ratios (ORs).

Results

15 studies were included in the meta-analysis (participants: 5604303). The pooled effect sizes demonstrate that individuals with a high TyG index exhibit a significantly elevated risk of CI compared to those with a low TyG index (OR = 2.16, 95%CI: 1.51; 3.08, p < 0.001). The subgroup analysis showed that inpatients with a high TyG index exhibited an increased risk of CI (OR = 4.56, 95%CI: 3.09; 6.74, p < 0.001). Furthermore, the risk of developing distinct types of CI differed significantly [CI: OR = 1.64, 95% CI: 1.29; 2.07, p < 0.001; Vascular Cognitive Impairment (VCI): OR = 5.39, 95% CI: 3.33; 8.70, p < 0.001].

Conclusion

A positive correlation exists between the TyG index and risk of CI, which has potential value in optimizing CI risk stratification among elderly people, especially those hospitalized.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023450336.

Non-linear relationship between lipid accumulation products and risk of diabetes in Japanese adults

The lipid accumulation product (LAP) is a novel, sex-specific indicator of lipid accumulation. While previous studies have investigated the relationship between LAP and diabetes, they have not specifically addressed potential sex differences in this association. The present study explores the potential sex-specific differences in the relationship between LAP and diabetes mellitus (DM) risk in the Japanese population. From 2004 to 2015, a total of 15,263 Japanese individuals without DM underwent physical assessments at Murakami Memorial Hospital. The association between LAP and incident diabetes was analyzed using Cox proportional hazards regression models, incorporating cubic spline functions and smooth curve fitting to identify potential non-linear relationships. Subgroup and sensitivity analysis assessments were conducted to validate the robustness of our findings. After adjusting for covariates, a positive association between LAP and DM risk was observed in both females (HR: 1.02, 95% CI: 1.00-1.03, P = 0.0138) and males (HR: 1.01, 95% CI: 1.00-1.01, P = 0.0314). A non-linear association between LAP and incident DM was identified for both sexes. The inflection points for LAP were 16.58 for females and 11.11 for males. In females, the HR to the left and right of the inflection point were 1.09 (95% CI: 1.02-1.17) and 1.01 (95% CI: 1.00-1.03), respectively. In males, the HR to the left and right of the inflection point were 0.92 (95% CI: 0.86-0.98) and 1.01 (95% CI: 1.00-1.01), respectively. Sensitivity analysis indicated a stronger association between LAP and DM risk. Elevated baseline LAP levels were associated with an increased risk of incident DM, with the relationship exhibiting non-linear characteristics. These findings suggest that maintaining lower LAP levels may help mitigate the risk of developing diabetes.

Association between a body shape index and female infertility: a cross-sectional study

BACKGROUND

The relationship between A Body Shape Index (ABSI) and female infertility is not well understood. ABSI, a novel anthropometric measure, is gaining recognition for its ability to more accurately capture visceral fat characteristics than traditional metrics like BMI. This study aims to explore the association between ABSI and female infertility, considering its potential applications in medical screening and risk assessment.

METHODS

This cross-sectional study analyzed data from the NHANES from 2013 to 2020. Female infertility was assessed through reproductive health questionnaires, and ABSI was calculated using waist circumference, BMI, and height. Weighted logistic regression models and trend tests were used to evaluate the association between ABSI and female infertility. Restricted cubic splines (RCS) were employed to explore potential nonlinear relationships. Subgroup analyses were conducted to examine the consistency of the association across various demographic and health-related factors. Sensitivity analyses were also performed, including the exclusion of participants with missing covariate data, the application of propensity score matching, and restricting the analysis to women aged 20-45 years.

RESULTS

The study included 3,718 participants, 433 of whom were diagnosed with infertility. Higher ABSI was associated with an increased risk of female infertility (OR = 1.56, 95% CI: 1.21-2.00, P = 0.001), as demonstrated by weighted logistic regression and trend tests. Women in the highest ABSI quartile had a significantly higher prevalence of infertility compared to those in the lowest quartile (OR = 1.73, 95% CI: 1.27-2.37, P = 0.001). RCS curves indicated a linear positive relationship between ABSI and infertility risk, with a critical value at 0.079. Subgroup and sensitivity analyses confirmed the stability of these findings.

CONCLUSION

This study demonstrates a positive linear relationship between ABSI and the risk of female infertility. The use of a simple, non-invasive ABSI measurement could facilitate the early identification of high-risk individuals in large-scale screenings, potentially helping to prevent or reduce the incidence of infertility.

Lipid accumulation product is closely associated with hypertension and prehypertension in prediabetic population in China: results from the REACTION study

Prediabetes with hypertension or prehypertension increases the risk of cardiovascular events. Lipid accumulation product (LAP) is a powerful marker of visceral obesity. The current study aimed to explore the relationship between LAP and hypertension and prehypertension among prediabetic individuals. A total of 12,388 prediabetic participants from the REACTION study were recruited. LAP was calculated from waist circumference and fasting triglyceride levels. Multiple logistic regression models were conducted to assess the relationship between LAP and hypertension and prehypertension. Multiple logistic regression analysis showed that elevated LAP was associated with hypertension (Q2: odds ratio (OR): 1.263, P < 0.001; Q3: OR: 1.613, P < 0.001; Q4: OR: 1.754, P < 0.001) and prehypertension (Q2: OR: 1.255, P = 0.005; Q3: OR: 1.340, P = 0.002; Q4: OR: 1.765, P < 0.001). The results of the stratified analysis showed that prediabetic people with higher LAP levels and characterized by overweight, normal weight and a high waist-to-hip ratio (WHR) were more likely to have hypertension, and prediabetic people with higher LAP levels and characterized by overweight, normal weight, a high WHR, age <65, and low and high levels of physical activity were more likely to have prehypertension. In conclusion, visceral obesity assessed by LAP is significantly associated with hypertension and prehypertension in the Chinese prediabetic population.

Novel lipid indicators and the risk of type 2 diabetes mellitus among Chinese hypertensive patients: findings from the Guangzhou Heart Study

BACKGROUND

Data are limited on whether several easily measured indices are independent predictors of type 2 diabetes mellitus (T2DM) in hypertensive patients. This study aimed to assess the association of hypertriglyceridemic-waist phenotype, triglyceride glucose (TyG) index, lipid accumulation product (LAP), and visceral adiposity index (VAI) with T2DM risk in hypertensive patients.

METHODS

This cross-sectional study included 5321 hypertensive patients from the baseline survey of the Guangzhou Heart Study. Face-to-face questionnaire survey, physical examination, and fasting blood sample collection were completed for all subjects. Odds ratio (OR) with 95% confidence interval (95% CI) were calculated by using the logistic regression model. The potential nonlinear relationship was examined using restricted cubic spline regression.

RESULTS

The prevalence of T2DM was 19.98% among hypertensive patients. After adjusting for confounders, participants with elevated triglyceride levels and enlarged waist circumference (HTGW) were associated with a 2.57-fold risk of T2DM (OR 2.57, 95% CI 2.05, 3.23). When comparing with subjects within the lowest quartile of the indices, those in the highest quartile of TyG, LAP, and VAI were associated with 5.35-fold (95% CI 4.33, 6.64), 2.65-fold (95% CI 2.11, 3.34), and 2.17-fold (95% CI 1.77, 2.67) risk of T2DM after adjusting for confounders. Every 1-unit increment of TyG, LAP, and VAI was associated with 81%, 38%, and 31% increased risk of T2DM, respectively. The nonlinear association was observed for TyG, LAP, and VAI (all P _Non-linear < 0.001).

CONCLUSIONS

The results found that among hypertensive patients, HTGW and a higher level of TyG, LAP, and VAI were associated with an elevated risk of T2DM. The findings suggested that HTGW, TyG, LAP, and VAI may serve as simple and effective tools for T2DM risk assessment in the prevention and management of main chronic diseases.

Interaction analysis of lipid accumulation product and family history of diabetes on impaired fasting glucose and diabetes risk in population with normotension in Eastern China: a community-based cross-sectional survey

BACKGROUND

Lipid accumulation product (LAP) is considered to be a new convenient useful indicator to assess the visceral fat. Therefore, we aimed to evaluate the risk factors of impaired fasting glucose (IFG) and diabetes, and explore the possible interacting influences of LAP with other factors on the risk of IFG and diabetes among Chinese normotension adults.

METHODS

A multistage stratified cluster sampling method was conducted to select urban residents in Bengbu, China. For each eligible participant, data on questionnaire survey, anthropometric measurements and laboratory tests were obtained. The effects of body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR) and LAP for predicting IFG and diabetes were performed by multiple logistic regressions and receiver operating characteristic (ROC) analyses. The interaction effects were evaluated by relative excess risk of interaction (RERI), attributable proportion due to interaction (AP) and synergy index (SI).

RESULTS

Six thousand, four hundred sixty-seven normotension subjects (2695 men and 3772 women) were enrolled in our study, the prevalence of IFG and diabetes were 9.37% and 14.33%, respectively. When assessed using ROC curve analysis, LAP exhibited higher diagnostic accuracy for identifying IFG and diabetes than BMI, the area under the AUC curve was 0.650 (95% CI: 0.637 to 0.662). After adjustment for age, sex, educational level and other confounding factors, multivariate logistic regression analyses indicated that subjects with the fourth quartile of LAP were more likely to develop IFG (adjusted OR: 2.735, 95% CI: 1.794-4.170) and diabetes (adjusted OR: 1.815, 95% CI: 1.297-2.541) than those with the first quartile. A significant interaction between LAP and family history of diabetes was observed in participants (RERI = 1.538, 95%CI: 0.167 to 3.612; AP = 0.375, 95%CI: 0.118 to 0.631; SI = 1.980, 95%CI: 1.206 to 3.251). However, a significant interaction between LAP and abdominal obesity was indicated by the value of RERI (1.492, 95%CI: 0.087 to 3.723) and AP (0.413, 95%CI: 0.014 to 0.756), but not the value of SI (1.824, 95%CI: 0.873 to 3.526).

CONCLUSION

Our results demonstrated that there might be synergistic effect between LAP and family history of diabetes on the risk of IFG and diabetes.

Research on Quality Evaluation of Product Interactive Aging Design Based on Kano Model

At present, China’s population aging presents the characteristics of large base, fast aging process, and old age, but the research and development of product aging design in China is relatively late, which brings additional pressure to the daily life of the elderly. In such an environment, higher requirements are put forward for product aging design and service provision. Only products or services that timely meet the personalized and diversified needs of different customers can attract customers and improve customer satisfaction. How to design aging products with satisfactory appearance and humanized function is the focus of current research. Based on the product quality division of Kano model, this paper summarizes the domestic mainstream products and their functions. The designed questionnaire data are summarized; reliability and validity analysis, as well as descriptive statistical analysis, is performed on this basis for the constructed product service quality evaluation system. The service quality indicators are divided into three categories according to the Kano model: overall one-dimensional quality, charm quality, and necessary quality.

Transition of Lipid Accumulation Product Status and the Risk of Type 2 Diabetes Mellitus in Middle-Aged and Older Chinese: A National Cohort Study

Background

Lipid accumulation product (LAP), a product of waist circumference (WC) and fasting triglycerides (TG), is a measure of lipid accumulation and an effective predictor of metabolic syndrome. This study aimed to evaluate the associations of LAP and its longitudinal transitions with type 2 diabetes mellitus (T2DM) among middle-aged and older Chinese.

Methods

Data were extracted from the China Health and Retirement Longitudinal Study (2011, 2013, 2015, and 2018). LAP was defined as (WC-65) ×TG for men, and (WC-58) ×TG for women. Participants were classified into high- and low-LAP groups at baseline, and subsequently into four transition patterns during 2011-2015: maintained-high, maintained-low, high-to-low, and low-to-high LAP. The longitudinal transition patterns of LAP on the development of T2DM were assessed by multivariable Cox frailty models.

Results

Overall, 7397 participants were included for analysis, among whom 849 (11.5%) developed T2DM between 2011 and 2018. Women with high-LAP levels at baseline presented a higher risk of T2DM (hazard ratios [HR]=1.37, 95% confidence interval [CI]: 1.07-1.77), while no significant association was found in men. Compared with women with maintained-low LAP pattern, those with transition patterns of low-to-high LAP and maintained-high LAP were at higher risk of T2DM (HR =1.99 and 1.98, both P<0.05); however, for men, the significantly positive association was only observed in maintained-high LAP transition pattern (HR=1.53, 95% CI: 1.04-2.23).

Conclusions

Elevated LAP levels and the transition patterns of maintained-high LAP and low-to-high LAP are significant risk factors for T2DM in women. Preventions are needed to combat T2DM at an early dyslipidemic stage.

Gender difference in the relationship between lipid accumulation product index and pulse pressure in nondiabetic Korean adults: The Korean National Health and Nutrition Examination Survey 2013-2014

The present study was conducted to assess the association between the lipid accumulation product index (LAP) and pulse pressure (PP) by gender in nondiabetic Korean adults. This study used the data of 8,240 nondiabetic adults (3,577 men and 4,663 women) aged ≥ 20 years from the Korean National Health and Nutrition Examination Survey 2013-2014. Key findings from the study were as follows: first, the mean values of age for the overall population, men, and women were 49.59 ± 15.73 years, 49.26 ± 16.04 years, and 49.85 ± 15.47 years, respectively. Second, in women (n = 4,663), after adjustment for related variables and with quartile 1 of LAP as a reference, the odds ratios (ORs) of high PP (PP > 60 mmHg) were significantly higher in quartile 3 [1.735 (95% confidence interval [CI], 1.064-2.831)] and quartile 4 of LAP [2.271 (95% CI, 1.325-3.893)]. Third, high PP in men (n = 3,577) was not associated with the quartiles of LAP. Forth, after adjustment for related variables, the PP level was positively associated with the quartiles of LAP in women (p < .001) but not in men (p = .400). PP was positively associated with LAP in nondiabetic Korean women but not in men.

Lipid Accumulation Product is Associated with Urinary Albumin-creatinine Ratio in Chinese Prediabitic Population: A Report from the REACTION Study

BACKGROUND

Lipid accumulation product (LAP) as a powerful marker of visceral obesity is an independent risk factor of chronic kidney disease. The present study attempted to explore the association between LAP and albuminuria in prediabetic individuals.

METHODS

We conducted a cross-sectional study and enrolled 26,529 participants with prediabetes over 40 years old with prediabetes from seven provinces in China. LAP was calculated from waist circumference and fasting triglycerides. Elevated albuminuria was defined by urinary albumin-creatinine ratio (uACR) ≥30 mg/g. Propensity score matching was applied to reduce bias, comparison between LAP and other traditional visceral obesity indices was performed and multiple logistic regression models were conducted to assess the association between LAP and albuminuria in the prediabetic population.

RESULTS

Individuals with uACR ≥30 mg/g were older and had higher BP, BMI, WC, TG, fasting insulin, glycohemoglobin and LAP, as well as lower eGFR and HDL level. Multiple logistic regression analysis showed elevated LAP was associated with increased odds of albuminuria (OR [95%CI]_{Q2 vs Q1} 1.09 [0.94, 1.27], OR [95%CI]_{Q3 vs Q1} 1.13 [0.97, 1.31], OR [95%CI]_{Q4 vs Q1} 1.42 [1.21, 1.67], P for trend=0.018), and superior over waist-to-hip ratio or waist-to-height ratio. Stratification indicated that the prediabetic population with higher LAP level and characterized by female gender, middle age, being overweight, and rise in blood pressure were more likely to have increased uACR.

CONCLUSION

Elevated level of LAP was associated with increased albuminuria in the prediabetic population in China.

Hypertriglyceridemic Waist Phenotype and Lipid Accumulation Product: Two Comprehensive Obese Indicators of Waist Circumference and Triglyceride to Predict Type 2 Diabetes Mellitus in Chinese Population

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.