{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:26:14Z","timestamp":1786112774968,"version":"build-2736575974"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Special Project for Health Scientific Research Talents of Jilin Province","award":["2024SCZ17"],"award-info":[{"award-number":["2024SCZ17"]}]},{"name":"Jilin Province Science and Technology Development Program","award":["20250203048SF"],"award-info":[{"award-number":["20250203048SF"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5,8]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>Type 2 diabetes mellitus (T2DM), as a noncommunicable chronic disease, poses a significant threat to human health. This study aims to investigate the relationship between lipid ratios and T2DM. The China Health and Retirement Longitudinal Study served as the data source for this research. The associations between lipid ratios \u2013 specifically, the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR), remnant cholesterol to high-density lipoprotein cholesterol (RC\/HDL-C) ratio, triglyceride to high-density lipoprotein cholesterol (TG\/HDL-C) ratio, total cholesterol to high-density lipoprotein cholesterol (TC\/HDL-C) ratio, and low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C\/HDL-C) ratio \u2013 and T2DM were analyzed using logistic regression analysis. Restricted cubic splines were employed to explore potential nonlinear relationships. Receiver operating characteristic analysis was utilized to assess the predictive value of lipid ratios for T2DM. A total of 7199 participants were included in this study. After adjusting for various factors, a positive association was identified between NHHR, RC\/HDL-C ratio, TC\/HDL-C ratio, TG\/HDL-C ratio, and LDL-C\/HDL-C ratio, with odds ratios of 3.34, 2.45, 3.34, 2.75, and 2.92, respectively. Nonlinear relationships were observed between NHHR, RC\/HDL-C ratio, TC\/HDL-C ratio, TG\/HDL-C ratio, and LDL-C\/HDL-C ratio and the incidence of T2DM. This study demonstrates that lipid ratios are associated with an increased risk of T2DM. This result provides a basis for the early identification of T2DM and identify novel targets for its prevention and early intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/md.0000000000048552","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T08:00:44Z","timestamp":1778745644000},"page":"e48552","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["The association between lipid ratios and type 2 diabetes mellitus in middle-aged and older Chinese adults: A nationwide prospective cohort study (STROBE)"],"prefix":"10.1097","volume":"105","author":[{"given":"Rui","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Geriatrics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7191-5682","authenticated-orcid":false,"given":"Dong","family":"Liu","sequence":"additional","affiliation":[{"name":"Emergency Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zixiang","family":"Xu","sequence":"additional","affiliation":[{"name":"Pathology Department, Jilin Cancer Hospital, Changchun, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Lou","sequence":"additional","affiliation":[{"name":"Emergency Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo","family":"Qu","sequence":"additional","affiliation":[{"name":"Emergency Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5000-1414","authenticated-orcid":false,"given":"Hailing","family":"Yang","sequence":"additional","affiliation":[{"name":"Emergency Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20260805","first-page":"28","article-title":"The national and provincial prevalence and non-fatal burdens of diabetes in China from 2005 to 2023 with projections of prevalence to 2050.","volume":"12","author":"Zhou","year":"2025","journal-title":"Mil Med Res"},{"key":"R2-20260805","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1016\/S0140-6736(24)02317-1","article-title":"Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants.","volume":"404","author":"Zhou","year":"2024","journal-title":"Lancet"},{"key":"R3-20260805","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/S0140-6736(25)01635-6","article-title":"The global, regional, and national burden of cancer, 1990-2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023.","volume":"406","author":"Force","year":"2025","journal-title":"Lancet"},{"key":"R4-20260805","doi-asserted-by":"crossref","first-page":"101882","DOI":"10.1016\/j.jacadv.2025.101882","article-title":"Type 2 Diabetes Mellitus-Related Mortality in the United States, 1999 to 2023.","volume":"4","author":"Ahmed","year":"2025","journal-title":"JACC Adv"},{"key":"R5-20260805","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12963-024-00337-x","article-title":"Projecting the economic burden of type 1 and type 2 diabetes mellitus in Germany from 2010 until 2040.","volume":"22","author":"Voeltz","year":"2024","journal-title":"Popul Health Metr"},{"key":"R6-20260805","doi-asserted-by":"crossref","first-page":"1610091","DOI":"10.3389\/fendo.2025.1610091","article-title":"Relationship between nontraditional lipid parameters and the risk of type 2 diabetes in individuals recovered from dyslipidemia: a cohort study.","volume":"16","author":"Wang","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"key":"R7-20260805","doi-asserted-by":"crossref","first-page":"2678","DOI":"10.1016\/j.ijcard.2013.03.027","article-title":"Non-HDL-cholesterol\/HDL-cholesterol is a better predictor of metabolic syndrome and insulin resistance than apolipoprotein B\/apolipoprotein A1.","volume":"168","author":"Kim","year":"2013","journal-title":"Int J Cardiol"},{"key":"R8-20260805","first-page":"e58612","article-title":"A cross-sectional observational study to assess the efficacy of triglyceride to high-density lipoprotein ratio as a marker of insulin resistance in subjects of Central Rural India.","volume":"16","author":"Khan","year":"2024","journal-title":"Cureus"},{"key":"R9-20260805","doi-asserted-by":"crossref","first-page":"e1660","DOI":"10.1212\/WNL.0000000000200112","article-title":"Prognostic role of hypertriglyceridemia in patients with stroke of atherothrombotic origin.","volume":"98","author":"Hoshino","year":"2022","journal-title":"Neurology"},{"key":"R10-20260805","doi-asserted-by":"crossref","first-page":"6617","DOI":"10.1038\/s41598-025-90131-y","article-title":"Association between lipid ratios and sarcopenia and the mediating roles of inflammatory biomarkers in a cross-sectional study from NHANES 2011-2018.","volume":"15","author":"Yin","year":"2025","journal-title":"Sci Rep"},{"key":"R11-20260805","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s12944-025-02498-6","article-title":"Systemic inflammation partially mediates the association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and chronic cough.","volume":"24","author":"Wang","year":"2025","journal-title":"Lipids Health Dis"},{"key":"R12-20260805","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.3390\/nu15051177","article-title":"Association between systemic immunity-inflammation index and hyperlipidemia: a population-based study from the NHANES (2015-2020).","volume":"15","author":"Mahemuti","year":"2023","journal-title":"Nutrients"},{"key":"R13-20260805","doi-asserted-by":"crossref","first-page":"1692742","DOI":"10.3389\/fimmu.2025.1692742","article-title":"Metabolic crossroads in insulin resistance: exploring lipid dysregulation and inflammation.","volume":"16","author":"Saadati","year":"2025","journal-title":"Front Immunol"},{"key":"R14-20260805","first-page":"e77896","article-title":"Evaluating pro- and anti-inflammatory biomarkers for predicting type 2 diabetes mellitus in the geriatric population and correlation with clinical and biochemical parameters.","volume":"17","author":"Hussain","year":"2025","journal-title":"Cureus"},{"key":"R15-20260805","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1507\/endocrj.EJ24-0189","article-title":"Association between non-high-density lipoprotein cholesterol and type 2 diabetes: a systematic review and meta-analysis of cohort studies.","volume":"72","author":"Han","year":"2025","journal-title":"Endocr J"},{"key":"R16-20260805","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1097\/MED.0000000000000398","article-title":"Elevated triglycerides and low high-density lipoprotein cholesterol level as marker of very high risk in type 2 diabetes.","volume":"25","author":"Hermans","year":"2018","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"key":"R17-20260805","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/ije\/dys203","article-title":"Cohort profile: the china health and retirement longitudinal study (CHARLS).","volume":"43","author":"Zhao","year":"2014","journal-title":"Int J Epidemiol"},{"key":"R18-20260805","doi-asserted-by":"crossref","first-page":"2486","DOI":"10.1001\/jama.285.19.2486","article-title":"Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III).","volume":"285","author":"Cleeman","year":"2001","journal-title":"JAMA"},{"key":"R19-20260805","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1097\/HCO.0000000000000862","article-title":"Triglycerides and cardiovascular disease.","volume":"36","author":"Esan","year":"2021","journal-title":"Curr Opin Cardiol"},{"key":"R20-20260805","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.jacc.2012.08.1026","article-title":"Remnant cholesterol as a causal risk factor for ischemic heart disease.","volume":"61","author":"Varbo","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"R21-20260805","doi-asserted-by":"crossref","first-page":"138105","DOI":"10.1016\/j.jhazmat.2025.138105","article-title":"Air pollution increases the risk of frailty: China health and retirement longitudinal study (CHARLS).","volume":"492","author":"Chen","year":"2025","journal-title":"J Hazard Mater"},{"key":"R22-20260805","doi-asserted-by":"crossref","first-page":"119139","DOI":"10.1016\/j.atherosclerosis.2025.119139","article-title":"Discordance analyses comparing LDL cholesterol, Non-HDL cholesterol, and apolipoprotein B for cardiovascular risk estimation.","volume":"403","author":"Johannesen","year":"2025","journal-title":"Atherosclerosis"},{"key":"R23-20260805","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.trsl.2021.12.008","article-title":"Non-HDL cholesterol as a predictor for incident type 2 diabetes in community-dwelling adults: longitudinal findings over 12 years.","volume":"243","author":"Seo","year":"2022","journal-title":"Transl Res"},{"key":"R24-20260805","doi-asserted-by":"crossref","first-page":"e14927","DOI":"10.1111\/jch.14927","article-title":"Association between nontraditional lipid profiles and the risk of type 2 diabetes mellitus in Chinese adults with hypertension: findings from the China hypertension registry study.","volume":"27","author":"Tao","year":"2025","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"R25-20260805","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1186\/s12902-024-01764-5","article-title":"Lipids as the link between central obesity and diabetes: perspectives from mediation analysis.","volume":"24","author":"Lu","year":"2024","journal-title":"BMC Endocr Disord"},{"key":"R26-20260805","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s12933-022-01531-7","article-title":"Correlation between the triglyceride-to-high-density lipoprotein cholesterol ratio and other unconventional lipid parameters with the risk of prediabetes and Type 2 diabetes in patients with coronary heart disease: a RCSCD-TCM study in China.","volume":"21","author":"Yang","year":"2022","journal-title":"Cardiovasc Diabetol"},{"key":"R27-20260805","doi-asserted-by":"crossref","first-page":"107712","DOI":"10.1016\/j.jdiacomp.2020.107712","article-title":"Association of non-HDL-C\/HDL-C ratio and its dynamic changes with incident type 2 diabetes mellitus: the rural Chinese cohort study.","volume":"34","author":"Han","year":"2020","journal-title":"J Diabetes Complications"},{"key":"R28-20260805","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s12944-024-02143-8","article-title":"The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with type 2 diabetes mellitus: recent findings from NHANES 2007-2018.","volume":"23","author":"Tan","year":"2024","journal-title":"Lipids Health Dis"},{"key":"R29-20260805","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1373\/clinchem.2015.253757","article-title":"Increased remnant cholesterol explains part of residual risk of all-cause mortality in 5414 patients with ischemic heart disease.","volume":"62","author":"Jepsen","year":"2016","journal-title":"Clin Chem"},{"key":"R30-20260805","doi-asserted-by":"crossref","first-page":"e13592","DOI":"10.1111\/1753-0407.13592","article-title":"Remnant cholesterol is more positively related to diabetes, prediabetes, and insulin resistance than conventional lipid parameters and lipid ratios: a multicenter, large sample survey.","volume":"16","author":"Li","year":"2024","journal-title":"J Diabetes"},{"key":"R31-20260805","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1186\/s12944-023-01915-y","article-title":"Association of remnant cholesterol with hypertension, type 2 diabetes, and their coexistence: the mediating role of inflammation-related indicators.","volume":"22","author":"Wu","year":"2023","journal-title":"Lipids Health Dis"},{"key":"R32-20260805","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1186\/s12967-022-03470-z","article-title":"Evaluation of the value of conventional and unconventional lipid parameters for predicting the risk of diabetes in a non-diabetic population.","volume":"20","author":"Sheng","year":"2022","journal-title":"J Transl Med"},{"key":"R33-20260805","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12933-023-02103-z","article-title":"Nonlinear relationship between untraditional lipid parameters and the risk of prediabetes: a large retrospective study based on Chinese adults.","volume":"23","author":"Li","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"R34-20260805","doi-asserted-by":"crossref","first-page":"2661","DOI":"10.2147\/DMSO.S414673","article-title":"The relationship between non-HDL-C\/HDL-C Ratio (NHHR) and vitamin D in type 2 diabetes mellitus.","volume":"16","author":"Zhen","year":"2023","journal-title":"Diabetes Metab Syndr Obes"},{"key":"R35-20260805","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1007\/s12020-009-9275-y","article-title":"Cholesterol induces mitochondrial dysfunction and apoptosis in mouse pancreatic beta-cell line MIN6 cells.","volume":"37","author":"Zhao","year":"2010","journal-title":"Endocrine"},{"key":"R36-20260805","doi-asserted-by":"crossref","first-page":"2524","DOI":"10.1194\/jlr.M800238-JLR200","article-title":"Cholesterol accumulation and diabetes in pancreatic beta-cell-specific SREBP-2 transgenic mice: a new model for lipotoxicity.","volume":"49","author":"Ishikawa","year":"2008","journal-title":"J Lipid Res"},{"key":"R37-20260805","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s12192-011-0265-7","article-title":"Cholesterol induces pancreatic \u03b2 cell apoptosis through oxidative stress pathway.","volume":"16","author":"Lu","year":"2011","journal-title":"Cell Stress Chaperones"},{"key":"R38-20260805","doi-asserted-by":"crossref","first-page":"294","DOI":"10.4162\/nrp.2021.15.3.294","article-title":"Allomyrina dichotoma larva extract attenuates free fatty acid-induced lipotoxicity in pancreatic beta cells.","volume":"15","author":"Kim","year":"2021","journal-title":"Nutr Res Pract"},{"key":"R39-20260805","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1007\/s00125-018-4633-z","article-title":"Effects of acute NEFA manipulation on incretin-induced insulin secretion in participants with and without type 2 diabetes.","volume":"61","author":"Astiarraga","year":"2018","journal-title":"Diabetologia"},{"key":"R40-20260805","doi-asserted-by":"crossref","first-page":"32413","DOI":"10.1074\/jbc.M506000200","article-title":"Palmitate inhibits insulin gene expression by altering PDX-1 nuclear localization and reducing MafA expression in isolated rat islets of Langerhans.","volume":"280","author":"Hagman","year":"2005","journal-title":"J Biol Chem"},{"key":"R41-20260805","doi-asserted-by":"crossref","first-page":"E1390","DOI":"10.1152\/ajpendo.00519.2011","article-title":"A role for aberrant protein palmitoylation in FFA-induced ER stress and \u03b2-cell death.","volume":"302","author":"Baldwin","year":"2012","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"R42-20260805","doi-asserted-by":"crossref","first-page":"8727","DOI":"10.1007\/s11033-022-07717-2","article-title":"Acacetin antagonized lipotoxicity in pancreatic \u03b2-cells via ameliorating oxidative stress and endoplasmic reticulum stress.","volume":"49","author":"Wang","year":"2022","journal-title":"Mol Biol Rep"},{"key":"R43-20260805","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1053\/meta.2002.35200","article-title":"Chronic exposure to free fatty acids or high glucose induces apoptosis in rat pancreatic islets: possible role of oxidative stress.","volume":"51","author":"Piro","year":"2002","journal-title":"Metabolism"},{"key":"R44-20260805","doi-asserted-by":"crossref","first-page":"e70178","DOI":"10.1096\/fj.202402008R","article-title":"Non-lethal sonodynamic therapy inhibits high glucose and palmitate-induced macrophage inflammasome activation through mtROS-DRP1-mitophagy pathway.","volume":"38","author":"Wang","year":"2024","journal-title":"FASEB J"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/MD.0000000000048552","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T16:02:47Z","timestamp":1785945767000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/MD.0000000000048552"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,8]]},"references-count":44,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000048552","relation":{},"ISSN":["0025-7974","1536-5964"],"issn-type":[{"value":"0025-7974","type":"print"},{"value":"1536-5964","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,8]]},"assertion":[{"value":"2025-10-12","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}