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Abstract Aim This study aimed to investigate how blood lipids are associated with diabetes among older Chinese adults. Methods 3,268,928 older Chinese adults without known diabetes were included. Logistic regression and restricted cubic spline (RCS) models were conducted to study associations between blood lipids (total cholesterol TC, triglycerides TG, low-density lipoprotein cholesterol LDL-C, and high-density lipoprotein cholesterol HDL-C) and diabetes. Results 202,832 diabetes cases were included. Compared with the lowest quintiles, TC, TG, and LDL-C in the highest quintiles showed a higher diabetes prevalence risk and HDL-C presented a lower risk in multivariate-adjusted logistic regression models. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for the highest quintiles of TC, TG, and HDL-C were 1.39 (1.37–1.41), 2.56 (2.52–2.60), and 0.73 (0.72–0.74), respectively. For LDL-C, 3–5% lower risk was found in the second and third quintiles, and 4–23% higher risk was found in the fourth and fifth quintiles. RCS curves showed a non-linear relationship between each blood lipid parameters and diabetes ( P -non-linear < 0.001). TG and HDL-C curves presented monotonically increasing and L-shaped patterns, respectively, whereas TC and LDL-C curves exhibited a J-shaped pattern. When TC < 4.04 mmol/L or LDL-C < 2.33 mmol/L, ORs of diabetes increased with the decrease of corresponding indexes. However, after excluding participants with lower LDL-C, the J-shaped association with TC disappeared. Conclusions This study demonstrates non-linear associations between lipids and diabetes. Low cholesterol levels are associated with a high risk of diabetes. The cholesterol paradox should be considered during lipid-lowering treatments.
Lin et al. (Tue,) studied this question.