Association of cumulative monocyte to high-density lipoprotein ratio with the risk of type 2 diabetes: a prospective cohort study

The association between monocyte-to-high-density lipoprotein cholesterol ratio and type 2 diabetes mellitus: a cross-sectional study

Objective

Type 2 diabetes mellitus (T2DM) is a prevalent chronic condition often associated with low-grade inflammation. Previous studies have indicated that the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) may serve as a novel inflammatory biomarker with potential predictive value for various metabolic diseases. This study aims to investigate the association between the MHR and the prevalence of T2DM in a general population, using data from the National Health and Nutrition Examination Survey (NHANES).

Methods

We conducted a cross-sectional study analyzing data from five NHANES cycles spanning 2007-2016. We excluded individuals aged under 20 years, those with missing data on monocytes, HDL-C, diabetes status, or other key covariates, and extreme MHR outliers. Statistical analyses were performed using SPSS 26.0, EmpowerStats 4.1, Stata 16, and DecisionLinnc1.0. We employed weighted logistic regression models, subgroup analyses, restricted cubic splines (RCS), and threshold analyses were used to assess the MHR-T2DM association.

Results

A total of 10,066 participants met the inclusion criteria, of whom 1,792 were diagnosed with T2DM. The MHR levels in the T2DM group were significantly higher than those in the non-T2DM group. After adjusting for potential confounders, elevated MHR levels were significantly associated with an increased prevalence of T2DM (p < 0.001, OR = 2.80, 95% CI: 1.823-4.287). Subgroup analyses revealed a significant interaction between MHR and T2DM with respect to gender (P for interaction < 0.05), with a stronger association in women. No significant interactions were observed for age, race, education level, poverty income ratio (PIR), body mass index (BMI), smoking status, physical activity, alcohol consumption, or hypertension (P for interaction > 0.05). RCS analysis indicated a significant nonlinear relationship between MHR and T2DM, with a threshold point for MHR identified at 0.51. Above this threshold, the risk of T2DM increased significantly.

Conclusion

Our findings suggest that elevated MHR levels, particularly above the threshold of 0.51, are significantly associated with an increased prevalence of T2DM. The gender-specific interaction further highlights that women may be more susceptible to the impact of elevated MHR on T2DM risk. These findings suggest MHR as a potential biomarker for early T2DM screening and highlight gender-specific risk factors.

Non-linear association of a novel inflammation-lipid composite marker CRP/HDL with insulin resistance and type 2 diabetes: findings from a comprehensive national cross-sectional study

BACKGROUND

Chronic low-grade inflammation and dyslipidemia are central to the development of insulin resistance (IR) and type 2 diabetes (T2D). The ratio of high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) integrates these factors, potentially serving as a novel biomarker for metabolic risk. However, the combined impact of these markers on the risks of IR and T2D has not been thoroughly examined. This study aims to elucidate the relationship between the hs-CRP/HDL-C ratio and the risks of IR and T2D.

METHODS

The cross-sectional methodology of this investigation is underpinned by data procured from the National Health and Nutrition Examination Survey (NHANES), encompassing a sample of 4,928 individuals from 2015 to 2018. The outcome variables were IR and T2D, as defined by the 2013 guidelines of the American Diabetes Association. To thoroughly investigate the association, a variety of analytical techniques were employed. These included weighted multivariate linear regression, weighted multivariate logistic regression, and restricted cubic spline (RCS) models to capture potential nonlinear associations between the hs-CRP/HDL-C ratio and outcomes. Subgroup analyses were also conducted.

RESULTS

After controlling for multiple potential confounders, the ratio correlates with an escalated likelihood of of IR (OR = 2.46, 95% CI: 1.78, 3.40) and T2D (OR = 2.45, 95% CI: 1.48, 4.05). An inverted U-shaped, nonlinear relationship was identified between the ratio and IR, while a nonlinear association was also observed for T2D. However, the non-linear correlation between this ratio and T2D is more pronounced in individuals with hypertension, female, and non-drinkers.

CONCLUSIONS

The hs-CRP/HDL-C ratio exhibits a postive correlation with IR and T2D. These findings suggest that hs-CRP/HDL-C ratio has the potential to be used as biomarker for assessing IR and T2D risk in clinical settings. These results highlight the significance of keeping the hs-CRP/HDL-C ratio within optimal ranges to promote metabolic health, particularly among high-risk groups.

High sensitivity C-reactive protein implicates heterogeneous metabolic phenotypes and severity in metabolic dysfunction associated-steatotic liver disease

BACKGROUND

Whether include high-sensitivity C-reactive protein (Hs-CRP) in diagnostic flow remains debatable during the updated definition to metabolic dysfunction-associated steatotic liver disease (MASLD) despite systemic inflammation contributes to the disease development and progression. We aimed to identify values of hs-CRP compared to other inflammatory markers derived from routine blood tests in MASLD.

MATERIALS AND METHODS

This cross-sectional study included consecutive participants (ultrasound-diagnosed MASLD: 1,006, healthy controls: 582), and 175 patients received liver biopsy., with 733 and 310 patients underwent magnetic resonance imaging proton density fat fraction for liver fat content (LFC) quantification and two-dimensional shear-wave elastography liver stiffness measurements (LSM), respectively.

RESULTS

Multiple linear regression analysis revealed a significant positive association between hs-CRP and LFC among overweight/obesity group patients (β 0.19, P = 0.03), and LSM among lean/normal weight group (β 0.30, P < 0.001). For the metabolic dysfunction-associated steatohepatitis (MASH), the hs-CRP and the ratio of monocytes to high-density lipoprotein both performed well in the overweight/obesity group and type 2 diabetes group (Overweight/obesity group, hs-CPR AUC 0.65 and 0.74, P = 0.02), bu no valuable inflammatory indicators were observed in MASH and liver fibrosis.

CONCLUSION

Hs-CRP levels are associated with LFC in overweight/obese MASLD and liver stiffness in lean MASLD patients, yet the reported AUC values suggest weak predictive ability.

TRIAL REGISTRATION

The study protocol was registered at the Chinese Clinical Trial Registry, (ChiCTR-ChiCTR2000034197), approved by the First Affiliated Hospital of Sun Yat-sen University institutional with the regional medical ethics committees (Approval number: [2020] No. 187), and performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. Written informed consent was obtained from all the patients.

Nomogram incorporating preoperative pan-immune-inflammation value and monocyte to high-density lipoprotein ratio for survival prediction in patients with colorectal cancer: a retrospective study

OBJECTIVE

Using the preoperative pan-immune-inflammation value (PIV) and the monocyte to high-density lipoprotein ratio (MHR) to reflect inflammation, immunity, and cholesterol metabolism, we aim to develop and visualize a novel nomogram model for predicting the survival outcomes in patients with colorectal cancer (CRC).

METHODS

A total of 172 patients with CRC who underwent radical resection were retrospectively analyzed. Survival analysis was conducted after patients were grouped according to the optimal cut-off values of PIV and MHR. Univariate and multivariate analyses were performed using Cox proportional hazards regression to screen the independent prognostic factors. Based on these factors, a nomogram was constructed and validated.

RESULTS

The PIV was significantly associated with tumor location (P < 0.001), tumor maximum diameter (P = 0.008), and T stage (P = 0.019). The MHR was closely related to gender (P = 0.016), tumor maximum diameter (P = 0.002), and T stage (P = 0.038). Multivariate analysis results showed that PIV (Hazard Ratio (HR) = 2.476, 95% Confidence Interval (CI) = 1.410-4.348, P = 0.002), MHR (HR = 3.803, 95%CI = 1.609-8.989, P = 0.002), CEA (HR = 1.977, 95%CI = 1.121-3.485, P = 0.019), and TNM stage (HR = 1.759, 95%CI = 1.010-3.063, P = 0.046) were independent prognostic indicators for overall survival (OS). A nomogram incorporating these variables was developed, demonstrating robust predictive accuracy for OS. The area under the curve (AUC) values of the predictive model for 1-, 2-, and 3- year are 0.791,0.768,0.811, respectively. The calibration curves for the probability of survival at 1-, 2-, and 3- year presented a high degree of credibility. Furthermore, Decision curve analysis (DCA) for the probability of survival at 1-, 2-, and 3- year demonstrate the significant clinical utility in predicting survival outcomes.

CONCLUSION

Preoperative PIV and MHR are independent risk factors for CRC prognosis. The novel developed nomogram demonstrates a robust predictive ability, offering substantial utility in facilitating the clinical decision-making process.

Association between Urine Specific Gravity as a Measure of Hydration Status and Risk of Type 2 Diabetes: The Kailuan Prospective Cohort Study

Diabetes, especially type 2 diabetes (T2D), poses an unprecedented challenge to global public health. Hydration status also plays a fundamental role in human health, especially in people with T2D, which is often overlooked. This study aimed to explore the longitudinal associations between hydration status and the risk of T2D among the Chinese population. This study used data from the large community-based Kailuan cohort, which included adults who attended physical examinations from 2006 to 2007 and were followed until 2020. A total of 71,526 participants who eventually met the standards were divided into five hydration-status groups based on their levels of urine specific gravity (USG). Multivariable and time-dependent Cox proportional hazards models were employed to evaluate the associations of baseline and time-dependent hydration status with T2D incidence. Restricted cubic splines (RCS) analysis was used to examine the dose-response relationship between hydration status and the risk of T2D. Over a median 12.22-year follow-up time, 11,804 of the participants developed T2D. Compared with the optimal hydration-status group, participants with dehydration and severe dehydration had a significantly increased risk of diabetes, with adjusted hazard ratios (95% CI) of 1.30 (1.04-1.63) and 1.38 (1.10-1.74). Time-dependent analyses further confirmed the adverse effects of impending dehydration, dehydration, and severe dehydration on T2D incidence by 16%, 26%, and 33% compared with the reference group. Inadequate hydration is significantly associated with increased risks of T2D among Chinese adults. Our findings provided new epidemiological evidence and highlighted the potential role of adequate hydration status in the early prevention of T2D development.

Association Between Monocyte-to-High-Density Lipoprotein Ratio and Prediabetes: A Cross-Sectional Study in Chinese Population

Background

The monocyte-to-high-density lipoprotein cholesterol (MHR) ratio has been linked to metabolic disorders. However, there is limited research on the predisposition to MHR and prediabetes. Hence, we conducted a study to investigate the relationship between MHR and the prevalence of prediabetes.

Methods

In total, 85,293 participants were included in our cross-sectional observational study. Multivariable regression analysis, subgroup analyses, and interaction testing were used to determine the relationship between MHR and prediabetes. To explore the non-linear association of MHR with prediabetes risk, generalized additive model (GAM) and smoothing splines were applied. The threshold effect analysis of MHR on the risk of prediabetes was further employed to identify the turning point.

Results

After controlling for covariates, the results indicated that a positive correlation persisted between MHR and prediabetes (odds ratio (OR) =1.64, 95% confidence interval (CI), 1.48-1.82), and subgroup analyses found a more robust correlation between MHR and prediabetes in individuals with lower age, SBP, DBP, TG, TC and higher values of BMI and LDL-C than in their counterparts. Additionally, the correlation between MHR and the risk of prediabetes was found to be non-linear, with a turning point of -0.4 (Log-Likelihood Ratio, P< 0.001). The impact of variables on the two sides of the turning point were 1.94 (1.72, 2.19) and 0.88 (0.69, 1.14).

Conclusion

The positive correlation between MHR and the risk of prediabetes in Chinese participants was observed to be non-linear, and MHR ≤ -0.4 was strongly positively correlated with prediabetes risk.

Association of the monocytes to high-density lipoprotein cholesterol ratio with in-stent neoatherosclerosis and plaque vulnerability: An optical coherence tomography study

BACKGROUND

Monocyte-to-high-density lipoprotein cholesterol ratio (MHR) is an independent predictor of atherosclerosis and in-stent restenosis (ISR). However, the association between MHR and the incidence of in-stent neoatherosclerosis (ISNA) remains to be validated.

METHODS

This study included 216 patients with acute coronary syndrome who had 220 ISR lesions and had undergone optical coherence tomography (OCT). All eligible patients were divided into three groups according to their MHR tertile level. OCT characteristics were comparatively analyzed between groups of different MHR levels, and univariate and multivariate logistic regression analyses were constructed to assess correlations between MHR level and ISNA as well as in-stent thin-cap fibroatheroma (TCFA). A receiver operating characteristic curve was used to determine the optimal MHR thresholds for predicting ISNA and in-stent TCFA.

RESULTS

The incidence of ISNA (70.3% vs. 61.1% vs. 20.3%, P < 0.001) and in-stent TCFA (40.5% vs. 31.9% vs. 6.8%, P < 0.001) was the highest in the third tertile, followed by the second and first tertiles, respectively. Multivariate analysis revealed that MHR was independently associated with ISNA (odds ratio [OR], 7.212; 95% confidence interval [CI], 1.287-40.416; P = 0.025) and in-stent TCFA (OR, 5.610; 95% CI, 1.743-18.051; P = 0.004) after adjusting for other clinical factors. The area under the curve was 0.745 (95% CI, 0.678-0.811; P < 0.001) for the prediction of ISNA and 0.718 (95% CI, 0.637-0.778; P < 0.001) for the prediction of in-stent TCFA.

CONCLUSION

MHR levels are an independent risk factor for ISNA.

Measurement of cumulative high-sensitivity C-reactive protein and monocyte to high-density lipoprotein ratio in the risk prediction of type 2 diabetes: a prospective cohort study

BACKGROUND

Converging data have suggested that monocytic inflammation and C-reactive protein (CRP) are biologically intertwined processes and are involved in diabetogenesis. This study aimed to investigate the association between systemic inflammation assessed by joint cumulative high-sensitivity C-reactive protein (CumCRP) and monocyte to high-density lipoprotein ratio (CumMHR) and incident type 2 diabetes (T2D) and their predictive value for T2D in a general population.

METHODS

A total of 40,813 nondiabetic participants from a prospective real-life cohort (Kailuan Study, China) were followed biennially from 2010/2011 until December 31, 2020. Multivariable Cox regression analyses were conducted to evaluate the adjusted hazard ratios (aHRs) of incident diabetes.

RESULTS

During a median follow-up of 7.98 (IQR: 5.74-8.87) years, 4848 T2D cases developed. CumMHR and CumCRP were alone or jointly associated with incident T2D after adjusting for potential confounders. Elevated CumMHR levels significantly increased the risk of incident diabetes in each CumCRP strata (P-interaction: 0.0278). Participants with concomitant elevations in CumMHR and CumCRP levels had the highest risk (aHR: 1.71, 95% CI 1.52-1.91) compared to both in the low strata. Notably, the coexposure-associated T2D risk was modified by age, sex, hypertension, dyslipidemia, and prediabetes status. C-statistics increased from 0.7377 to 0.7417 when CumMHR and CumCRP were added into the multivariable-adjusted model, with a net reclassification improvement (%) of 12.39 (9.39-15.37) (P < 0.0001).

CONCLUSIONS

Cumulative hsCRP and MHR were both independently and jointly associated with an increased risk of T2D and their addition to established risk factors should improve risk prediction and reclassification of diabetes.

Neutrophil/HDL-C, Lymphocyte/HDL-C and Monocyte/HDL-C in subjects with asymptomatic carotid atherosclerosis

BACKGROUND

Leukocyte count is a prognostic marker for cardiovascular diseases, with key role in atherosclerosis development. Specific number of neutrophils, lymphocytes and monocytes can predict cardiovascular risk, also in asymptomatic subjects. Among the lipoprotein fractions, HDL-C is a protective factor in the cardiovascular disorders. For the above reason, we have examined the peripheral count of leukocytes, neutrophils, lymphocytes and monocytes, and the ratios between neutrophils/HDL-cholesterol, lymphocytes/HDL-cholesterol, and monocytes/HDL-cholesterol, to evaluate the possible utility of the obtained values in progression of asymptomatic carotid atherosclerosis.

METHODS

We performed our analysis in a cohort of 100 subjects with asymptomatic carotid atherosclerosis, of which 43 men and 57 women. The data were expressed as medians and IQR. To analyse the differences in leukocyte, neutrophil, lymphocyte, monocytes count and their ratio with HDL-cholesterol the Mann-Whitney test was employed.

RESULTS

The peripheral count of leukocyte subtypes and the ratios, they change in relation to the number of cardiovascular risk factors and the degree of insulin resistance.

CONCLUSIONS

In this cohort of subjects, the percentage of observed cardiovascular risk factors significantly affect some leukocyte parameters. These results, allow us to underline the importance of the leukocyte indices in the evaluation of subjects with asymptomatic vascular atherosclerosis.

Association between cumulative uric acid to high-density lipoprotein cholesterol ratio and the incidence and progression of chronic kidney disease

Objective

The ratio of uric acid to high-density lipoprotein cholesterol (UHR) was related to the risk of chronic kidney disease (CKD), we aimed to investigate the association of cumulative UHR (cumUHR) with incidence and progression of CKD.

Methods

Our study included a total of 49,913 participants (mean age 52.57 years, 77% males) from the Kailuan Study conducted between 2006 and 2018. Participants who completed three consecutive physical examinations were included. Cumulative UHR (cumUHR) was computed as the summed average UHR between two consecutive physical examinations, multiplied by the time between the two examinations. Participants were then categorized into four groups based on cumUHR quartiles. Subsequently, participants were further divided into a CKD group and a non-CKD group. The associations between cumUHR and CKD and it's progression were assessed by Cox proportional hazards regression models. The cumulative incidence of endpoint events was compared between the cumUHR groups using the log-rank test. The C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to assess the predictive performance of cumUHR.

Results

After a mean follow-up of 8.0 ± 1.7 years, there were 4843 cases of new-onset CKD, 2504 of low eGFR, and 2617 of proteinuria in the non-CKD group. Within the CKD group, there were 1952 cases of decline in eGFR category, 1465 of >30% decline in eGFR, and 2100 of increased proteinuria. In the non-CKD group, the adjusted hazard ratios (HRs) and confidence intervals (CIs) in the fourth quartile were 1.484 (1.362-1.617), 1.643 (1.457-1.852), and 1.324 (1.179-1.486) for new-onset CKD, low eGFR, and proteinuria, respectively. In the CKD group, the adjusted HRs in the fourth quartile were 1.337 (1.164-1.534), 1.428 (1.216-1.677), and 1.446 (1.267-1.651) for decline in eGFR category, >30% decline in eGFR, and increase in proteinuria, respectively. In addition, we separately added a single UHR measurement and cumUHR to the CKD base prediction model and the CKD progression base prediction model, and found that the models added cumUHR had the highest predictive value.

Conclusion

High cumUHR exposure was an independent risk factor for the incidence and progression of CKD, and it was a better predictor than a single UHR measurement.