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Association between the triglyceride to high-density lipoprotein cholesterol ratio and the risk of type 2 diabetes mellitus among Chinese elderly: the Beijing Longitudinal Study of Aging
  1. Deqiang Zheng1,2,
  2. Haibin Li1,2,
  3. Feiling Ai1,
  4. Fei Sun3,
  5. Manjot Singh4,
  6. Xue Cao1,
  7. Jiajia Jiang1,2,
  8. Yan He1,2,
  9. Zhe Tang3,
  10. Xiuhua Guo1,2
  1. 1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
  2. 2Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
  3. 3Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing, China
  4. 4School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
  1. Correspondence to Dr Xiuhua Guo; statguo{at}; Professor Zhe Tang; tangzhe{at}


Objective Time-dependent covariates are generally available as longitudinal data were collected periodically in the cohort study. To examine whether time-dependent triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio could predict the future risk of type 2 diabetes mellitus (T2DM) and assess its potential impact on the risk of T2DM incidence.

Research design and methods This study enrolled 1460 participants without T2DM aged 55 or above in 1992 in the Beijing Longitudinal Study of Aging during 25 years. The questionnaire data were collected in nine surveys from 1992 to 2017. Physical examination and blood laboratory tests including TG and HDL-C concentrations were measured in five surveys. Incident T2DM cases were confirmed via a self-reported history of T2DM or the fasting plasma glucose level.

Results 119 new cases of T2DM were identified. In the Cox regression analysis with time-dependent TG/HDL-C ratios and covariates, the adjusted hazard ratios (95% confidence interval) of T2DM incidence were 1.90 (1.12 to 3.23), 2.75 (1.58 to 4.80) and 2.84 (1.69 to 4.77), respectively, for those with TG/HDL-C ratios (both TG and HDL-C were expressed in millimole per liter) in the ranges of 0.87–1.30, 1.31–1.74 and ≥1.75, compared with individuals with TG/HDL-C ratios <0.87. The similar results of subdistribution hazard ratios were obtained by performing the Fine-Gray model with time-dependent TG/HDL-C ratios. This positive association and the statistically significant trend with increased risk of T2DM incidence in the three categories of elevated TG/HDL-C ratio was confirmed by multiple sensitivity analyses. Furthermore, the T2DM discriminatory power of TG/HDL-C ratio combining with other risk factors was moderately high.

Conclusions We found that time-dependent TG/HDL-C ratios were positively associated with the risk of T2DM risk. The elevated TG/HDL-C ratios increased the future risk of T2DM incidence. Lowering the TG/HDL-C ratio could assist in the prevention of diabetes for older adults.

  • type 2 diabetes
  • triglycerides
  • HDL cholesterol
  • association analysis

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  • Contributors DZ, ZT and XG contributed to the study concept and design. ZT, FS, XG and DZ contributed to the acquisition of data. DZ, HL, FA and XC performed the statistical analysis. MS, JJ, YH and XG were involved in interpretation of the data. All authors contributed to drafting, modifying and approving the manuscript, and took the responsibility for accuracy and integrity of the manuscript.

  • Funding This study was supported by grants from the National Natural Science Foundation of China (grants nos 81703317 and 81530087) and the Natural Science Foundation of Beijing Municipal (grant no 7202011).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Ethics Committee of Capital Medical University, China (No Z2019SY008).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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