The association between a novel visceral lipoprotein risk index and new-onset diabetes in middle-aged and older Chinese adults
The global health burden of diabetes continues to grow. While the Chinese Visceral Adiposity Index (CVAI) and low-density lipoprotein cholesterol (LDL-C) are well-established risk factors for diabetes, the potential compounding effect of these factors is not well characterized. This study aimed to explore the relationship between a novel integrative index, the Visceral Lipoprotein Risk (VLR) index, and incident diabetes. This prospective cohort study included 7,559 participants aged ≥ 45 years without diabetes at baseline from the China Health and Retirement Longitudinal Study (CHARLS). The VLR index was calculated as the product of the CVAI and LDL-C (mg/dL). The association between the VLR index and incident diabetes was evaluated using Kaplan-Meier analysis, multivariable Cox proportional hazards models, and restricted cubic splines (RCS). Subgroup analyses were performed to test the robustness of our findings. Over a median follow-up of 9 years, 1,264 incident diabetes cases (16.7%) were documented. The incidence of diabetes showed a marked gradient across increasing VLR tertiles (T1: 11.7% vs. T3: 23.8%). After multivariable adjustment, each standard deviation (SD) increase in the VLR index was associated with a significantly higher risk of diabetes (HR: 1.30; 95% CI: 1.24–1.37), The association remained significant in both the prediabetes subgroup (HR: 1.24; 95% CI: 1.16–1.32) and the normoglycemic subgroup (HR: 1.25; 95% CI: 1.16–1.35). These findings remained robust across various subgroup analyses. Furthermore, RCS analysis demonstrated a non-linear positive association between the VLR index and incident diabetes. This study provides robust evidence linking the novel VLR index to an increased risk of diabetes among middle-aged and older adults. These findings suggest that the VLR index is independently associated with incident diabetes and may hold promise for risk stratification.