The association between a novel visceral lipoprotein risk index and new-onset diabetes in middle-aged and older Chinese adults

Q: What are the key findings of this study?

Each standard deviation increase in the Visceral Lipoprotein Risk index was associated with a 30% higher risk of incident diabetes in middle-aged and older Chinese adults.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Without diabetes at baseline (n=7559). Intervention: Visceral Lipoprotein Risk (VLR) index vs. Lower VLR index levels. Primary outcome: Incident diabetes (HR 1.30, 95% CI 1.24–1.37).

Q: What does this research mean for the field?

The novel Visceral Lipoprotein Risk (VLR) index, which combines the Chinese Visceral Adiposity Index and LDL cholesterol, is independently associated with an increased risk of new-onset diabetes in middle-aged and older adults. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jin Dong; Fan Yang; Lei Luo; Jianhua Liu; Jian Chen; Xiangyang Shao

doi:10.1186/s13098-026-02286-x

August 22, 2026Diabetology & Metabolic SyndromeOpen Access

The association between a novel visceral lipoprotein risk index and new-onset diabetes in middle-aged and older Chinese adults

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Key result

Higher Visceral Lipoprotein Risk index is linked to ~30% greater incident diabetes risk per SD.

HR 1.30
95% CI 1.24–1.37
n=7,559

Why the study?

Does a higher Visceral Lipoprotein Risk (VLR) index predict incident diabetes in middle-aged and older Chinese adults?

Key Points

To investigate the association between the novel Visceral Lipoprotein Risk (VLR) index—integrating visceral adiposity and LDL cholesterol—and incident diabetes in middle-aged and older adults.
Followed 7,559 participants aged ≥ 45 years without diabetes at baseline from the China Health and Retirement Longitudinal Study (CHARLS) over a median follow-up of 9 years.
Calculated the VLR index as the product of the Chinese Visceral Adiposity Index (CVAI) and low-density lipoprotein cholesterol (LDL-C, mg/dL).
Evaluated diabetes risk using multivariable Cox proportional hazards models, restricted cubic splines (RCS), and Kaplan-Meier analyses across glycemic subgroups.
Over 9 years of median follow-up, 1,264 participants (16.7%) developed diabetes, with incidence climbing across tertiles from 11.7% in T1 to 23.8% in T3.
Each standard deviation increase in the VLR index was associated with incident diabetes (HR: 1.30; 95% CI: 1.24–1.37), and participants in T3 had a higher risk than T1 (HR: 2.03; 95% CI: 1.74–2.36).
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), displaying a non-linear positive association (P < 0.05).

Study Design

Type

Cohort (n=7,559)

Multicenter

Yes

Structured PICO

Does a higher Visceral Lipoprotein Risk (VLR) index predict incident diabetes in middle-aged and older Chinese adults?

P

Population

7,559 middle-aged and older Chinese adults without diabetes at baseline (mean age 59.2, 53.4% female) followed for a median of 9 years.

E

Exposure

Higher Visceral Lipoprotein Risk (VLR) index (calculated as the product of the Chinese Visceral Adiposity Index [CVAI] and LDL-C)

C

Comparator

Lower VLR index levels

O

Outcome

Incident diabetes (self-reported physician diagnosis, anti-diabetic medication use, fasting plasma glucose ≥7.0 mmol/L, or HbA1c ≥6.5%) at median 9 years follow-upcomposite

Main Result

Hazard Ratio: 1.3 (95% CI 1.24–1.37)

Limitations

Observational study, so residual confounding cannot be ruled out and causality cannot be inferred
Calculated from single baseline measurements, not capturing temporal changes
Restricted to middle-aged and older Chinese adults
Predictive accuracy was modest
Interval censoring due to discrete survey waves assessing diabetes status
RCS-derived thresholds are based on a single cohort and require external validation
Observational study with potential residual confounding
Single baseline measurement
Modest predictive accuracy
Interval censoring due to discrete survey waves
Thresholds require external validation

Implication

A novel risk index combining visceral adiposity and LDL-C serves as an independent predictor of new-onset diabetes, identifying high-risk individuals for earlier intervention.

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

Discussion

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Cite This Study

Dong et al. (2026) conducted a cohort in Without diabetes at baseline (n=7,559). Visceral Lipoprotein Risk (VLR) index vs. Lower VLR index levels was evaluated on Incident diabetes (HR 1.30, 95% CI 1.24–1.37). Each standard deviation increase in the Visceral Lipoprotein Risk index was associated with a 30% higher risk of incident diabetes in middle-aged and older Chinese adults.

synapsesocial.com/papers/6a8c0070bca056c88e6df381 https://doi.org/10.1186/s13098-026-02286-x

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The association between a novel visceral lipoprotein risk index and new-onset diabetes in middle-aged and older Chinese adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

The association between a novel visceral lipoprotein risk index and new-onset diabetes in middle-aged and older Chinese adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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