Impact of cumulative exposure to a high TG to HDL-C ratio on type 2 diabetes risk in young adults

Abstract

BACKGROUND: Increases in the prevalence of type 2 diabetes (T2D) pose significant challenges to its prediction and prevention. OBJECTIVE: We aimed to evaluate whether cumulative exposure to a high triglyceride to high-density lipoprotein-cholesterol (TG/HDL-C) ratio is associated with increased T2D risk in young adults. METHODS: We collected South Korean National Health Insurance Service data between 2009 and 2012 from 1,840,251 young adults without T2D aged 20 to 39 years who underwent 4 consecutive annual health checkups. Participants were classified into 5 groups based on exposure to a high TG/HDL-C ratio, defined as the highest TG/HDL-C ratio quartile. T2D risk was evaluated using a multivariate Cox proportional hazard model. RESULTS: During the 6.53-year follow-up period, 40,286 participants (2.2%) developed T2D. The cumulative incidence of T2D increased with higher TG/HDL-C exposure scores. The adjusted hazard ratios of TG/HDL-C ratio exposure scores for T2D were 1.584 (95% confidence interval (CI), 1.488-1.686), 2.101 (95% CI, 1.980-2.228), 2.942 (95% CI, 2.787-3.106), and 4.962 (95% CI, 4.718-5.219) for groups with scores of 1 to 4, respectively, compared with those with a score of 0. Further subgroup analyses stratified by age, sex, and statin use revealed no significant differences in risk of T2D. CONCLUSION: Cumulative exposure to high TG/HDL-C ratio was associated with increased risk of T2D in young Korean adults, suggesting its importance in prediction and prevention. Subgroup analysis revealed no significant differences in age, sex, or statin use. Further research is required to explore the underlying mechanisms and develop effective interventions.