Key result
High cumulative exposure to non-traditional lipid-inflammatory parameters like LCI-CRP more than doubled diabetes progression risk (HR 2.18; 95% CI 1.63-2.91) and reduced normoglycemia regression.
Why the study?
Although the interplay between dyslipidemia and inflammation is increasingly recognized, no study had systematically evaluated the dynamic impact of cumulative exposure to non-traditional lipid parameters, alone or combined with hs-CRP, on prediabetes transitions in middle-aged and older adults.
Does higher cumulative exposure to non-traditional lipid parameters, alone and combined with hs-CRP, increase progression to diabetes and reduce regression to normoglycemia in middle-aged and older adults with prediabetes?
Cohort (n=2,544)
Yes
Does higher cumulative exposure to non-traditional lipid parameters, alone and combined with hs-CRP, increase progression to diabetes and reduce regression to normoglycemia in middle-aged and older adults with prediabetes?
Answers are grounded in this paper and cite their sources.
Cumulative exposure to non-traditional lipid parameters, particularly when combined with hs-CRP, is independently associated with a higher risk of progression to diabetes and a lower probability of regression to normoglycemia in middle-aged and older adults with prediabetes.
Background Non-traditional lipid parameters may more comprehensively reflect the atherogenic lipoprotein burden. While the interplay between dyslipidemia and inflammation is increasingly recognized, no study has systematically evaluated the dynamic impact of non-traditional lipid parameters, alone or combined with high-sensitivity C-reactive protein (hs-CRP), on the development of prediabetes in middle-aged and older adults. Objective This study aims to investigate the associations between cumulative exposure to non-traditional lipid parameters, alone and combined with hs-CRP, and the development of prediabetes in middle-aged and older adults. Methods Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) from Wave 1 to Wave 3. A total of 2544 participants aged ≥45 years with baseline prediabetes were included. Cumulative exposure was calculated for eight non-traditional lipid parameters including atherogenic index of plasma (AIP) and and non-high-density lipoprotein cholesterol (non-HDL-C), atherogenic coefficient (AC), Castelli risk index-I/II, lipoprotein combine index (LCI), remnant cholesterol (RC), and RC/HDL-C ratio. Non-traditional lipid-inflammatory parameters were constructed by non-traditional lipid parameters and hs-CRP. Cox proportional hazards models and restricted cubic splines (RCS) were used to analyze associations between these parameters and progression to diabetes and regression to normoglycemia. Results Over 3-year follow-up, 1606 (63.1%) remained prediabetic, 557 (21.9%) regressed to normoglycemia, and 381 (15.0%) progressed to diabetes. Cumulative exposures to non-traditional lipid parameters were independently associated with progression to diabetes (HR range: 1.14-1.26, P<0.05) and inversely associated with regression to normoglycemia (HR range: 0.71-0.90, P<0.05). Cumulative AC and CRI-I showed the strongest association with diabetes progression (highest vs. lowest tertile: HR=1.63, 95%CI: 1.24-2.14). After constructing lipid-inflammatory parameters, participants with highest tertile of cumulative AIP-CRP and LCI-CRP had more than double the risk of progression to diabetes (HR = 2.17, 95%CI: 1.63-2.90; HR = 2.18, 95%CI: 1.63-2.91), while those with highest tertile of cumulative non-HDL-C-CRP, AC-CRP and LCI-CRP had approximately 40% lower probability of regression to normoglycemia (HR range: 0.58-0.59, P<0.05). Restricted cubic spline analysis suggested non-linear dose-response relationships between cumulative exposure of non-traditional lipid-inflammatory parameters and diabetes progression. Conclusions Cumulative exposure to non-traditional lipid parameters is independently associated with the dynamic progression and regression of prediabetes. Their combination with hs-CRP further enhances this association, suggesting a synergistic effect of atherogenic lipid burden and chronic inflammation in driving the deterioration of prediabetes.
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Yu et al. (2026) conducted a cohort in Prediabetes (n=2,544). Cumulative exposure to non-traditional lipid parameters alone and combined with hs-CRP (highest tertile) vs. Lowest tertile of cumulative exposure was evaluated on Progression to diabetes and regression to normoglycemia (HR 2.18, 95% CI 1.63-2.91, p=<0.05). High cumulative exposure to non-traditional lipid-inflammatory parameters like LCI-CRP more than doubled diabetes progression risk (HR 2.18; 95% CI 1.63-2.91) and reduced normoglycemia regression.
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