The impact of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) on the development of prediabetes in middle-aged and older Chinese adults: a national cohort study.

Background: Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has demonstrated significant clinical application potential in the evaluation of vascular-related diseases. Our objective was to explore the impact of NHHR on the progression from prediabetes to diabetes or the regression to normal fasting glucose (NFG).

Method: This study utilized data from the first and third waves of the China Health and Retirement Longitudinal Study, involving 2922 participants. Based on the changes in glycemic status during the follow-up period, the outcome variables were categorized into three categories: progression to diabetes, persistence in prediabetes status, or return to NFG. Multivariable logistic regression analyses, restricted cubic spline regression analyses, stratification analyses, and sensitivity analyses were used to assess the effect of NHHR on the development of prediabetes.

Results: In a follow-up study spanning approximately three years, we observed that 558 participants (19.1%) returned to normal blood glucose levels, while 514 participants (17.6%) progressed to diabetes. After adjusting for potential confounding factors, we found a linear negative relationship between NHHR and the reversion from prediabetes to NFG [(odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80-0.98)]. Additionally, NHHR exhibited a linear positive association with the progression from prediabetes to diabetes (OR 1.28, 95% CI 1.15-1.41). Stratified analyses revealed no significant interactions between NHHR and the subgroup variables.

Conclusion: NHHR is significantly associated with prediabetes development in middle-aged and older adults. Lower NHHR levels increase the likelihood of prediabetes regression, whereas higher NHHR levels elevate the risk of prediabetes progression.