Association between atherogenic index of plasma and risk of type 2 diabetes mellitus and the mediating effect of BMI: a comparative analysis in Chinese and Japanese populations
Abstract Objective The atherogenic index of plasma (AIP) has emerged as a promising predictor for type 2 diabetes mellitus (T2DM), but population-specific patterns and underlying mechanisms remain poorly understood. This study investigated the association between AIP and T2DM risk in Chinese and Jap...
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BMC
2025-08-01
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| Series: | Diabetology & Metabolic Syndrome |
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| Online Access: | https://doi.org/10.1186/s13098-025-01907-1 |
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| author | Yuheng Liao Yong Han Changchun Cao Haiying Song Haofei Hu |
| author_facet | Yuheng Liao Yong Han Changchun Cao Haiying Song Haofei Hu |
| author_sort | Yuheng Liao |
| collection | DOAJ |
| description | Abstract Objective The atherogenic index of plasma (AIP) has emerged as a promising predictor for type 2 diabetes mellitus (T2DM), but population-specific patterns and underlying mechanisms remain poorly understood. This study investigated the association between AIP and T2DM risk in Chinese and Japanese populations, focusing on non-linear relationships, population-specific thresholds, and the mediating role of body mass index (BMI). Methods We conducted a retrospective cohort study using data from the China Rich Healthcare Group (n = 112,483) and the Japanese NAGALA database (n = 15,453). AIP was calculated as log10[triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C)]. T2DM was defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/L, hemoglobin A1c (HbA1c) ≥ 6.5%, or self-reported diabetes during follow-up. Cox proportional hazards models with restricted cubic splines were used to examine non-linear relationships. Two-piecewise regression models identified population-specific thresholds, and formal mediation analyses quantified BMI’s mediating effect. Results During a median follow-up of 3.0 years, 1,801 participants (1.41%) developed T2DM. AIP demonstrated a significant positive association with T2DM risk in both populations: hazard ratio (HR) per unit increase: Chinese 1.84, 95% confidence interval (CI) 1.54–2.21; Japanese 2.42, 95% CI 1.67–3.52) after comprehensive adjustment. We identified distinct population-specific non-linear relationships with different threshold effects: in Chinese participants, T2DM risk increased significantly until AIP reached 0.436, while in Japanese participants, significant risk elevation began at AIP values exceeding − 0.449. BMI mediated a considerably higher proportion of the total effect in Chinese (39.84%) compared to Japanese participants (27.11%), indicating differential pathophysiological mechanisms. Conclusions Our findings reveal substantial population-specific differences in the AIP-T2DM relationship, including population-specific thresholds and mediation pathways. These results underscore the importance of population-tailored screening strategies and suggest that interventions targeting lipid metabolism and BMI management may have varying efficacy across East Asian populations. |
| format | Article |
| id | doaj-art-32b617f11a8c4b2fa13d1c7cefd6c770 |
| institution | Kabale University |
| issn | 1758-5996 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Diabetology & Metabolic Syndrome |
| spelling | doaj-art-32b617f11a8c4b2fa13d1c7cefd6c7702025-08-24T11:41:39ZengBMCDiabetology & Metabolic Syndrome1758-59962025-08-0117112510.1186/s13098-025-01907-1Association between atherogenic index of plasma and risk of type 2 diabetes mellitus and the mediating effect of BMI: a comparative analysis in Chinese and Japanese populationsYuheng Liao0Yong Han1Changchun Cao2Haiying Song3Haofei Hu4Department of Nephrology, The First Affiliated Hospital of Shenzhen UniversityDepartment of Emergency, Shenzhen Second People’s HospitalDepartment of Rehabilitation, Shenzhen Second People’s Hospital Dapeng HospitalDepartment of Nephrology, The First Affiliated Hospital of Shenzhen UniversityDepartment of Nephrology, The First Affiliated Hospital of Shenzhen UniversityAbstract Objective The atherogenic index of plasma (AIP) has emerged as a promising predictor for type 2 diabetes mellitus (T2DM), but population-specific patterns and underlying mechanisms remain poorly understood. This study investigated the association between AIP and T2DM risk in Chinese and Japanese populations, focusing on non-linear relationships, population-specific thresholds, and the mediating role of body mass index (BMI). Methods We conducted a retrospective cohort study using data from the China Rich Healthcare Group (n = 112,483) and the Japanese NAGALA database (n = 15,453). AIP was calculated as log10[triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C)]. T2DM was defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/L, hemoglobin A1c (HbA1c) ≥ 6.5%, or self-reported diabetes during follow-up. Cox proportional hazards models with restricted cubic splines were used to examine non-linear relationships. Two-piecewise regression models identified population-specific thresholds, and formal mediation analyses quantified BMI’s mediating effect. Results During a median follow-up of 3.0 years, 1,801 participants (1.41%) developed T2DM. AIP demonstrated a significant positive association with T2DM risk in both populations: hazard ratio (HR) per unit increase: Chinese 1.84, 95% confidence interval (CI) 1.54–2.21; Japanese 2.42, 95% CI 1.67–3.52) after comprehensive adjustment. We identified distinct population-specific non-linear relationships with different threshold effects: in Chinese participants, T2DM risk increased significantly until AIP reached 0.436, while in Japanese participants, significant risk elevation began at AIP values exceeding − 0.449. BMI mediated a considerably higher proportion of the total effect in Chinese (39.84%) compared to Japanese participants (27.11%), indicating differential pathophysiological mechanisms. Conclusions Our findings reveal substantial population-specific differences in the AIP-T2DM relationship, including population-specific thresholds and mediation pathways. These results underscore the importance of population-tailored screening strategies and suggest that interventions targeting lipid metabolism and BMI management may have varying efficacy across East Asian populations.https://doi.org/10.1186/s13098-025-01907-1Atherogenic index of plasmaType 2 diabetes mellitusHazard ratioBody mass indexPopulation comparisonMediation analysis |
| spellingShingle | Yuheng Liao Yong Han Changchun Cao Haiying Song Haofei Hu Association between atherogenic index of plasma and risk of type 2 diabetes mellitus and the mediating effect of BMI: a comparative analysis in Chinese and Japanese populations Diabetology & Metabolic Syndrome Atherogenic index of plasma Type 2 diabetes mellitus Hazard ratio Body mass index Population comparison Mediation analysis |
| title | Association between atherogenic index of plasma and risk of type 2 diabetes mellitus and the mediating effect of BMI: a comparative analysis in Chinese and Japanese populations |
| title_full | Association between atherogenic index of plasma and risk of type 2 diabetes mellitus and the mediating effect of BMI: a comparative analysis in Chinese and Japanese populations |
| title_fullStr | Association between atherogenic index of plasma and risk of type 2 diabetes mellitus and the mediating effect of BMI: a comparative analysis in Chinese and Japanese populations |
| title_full_unstemmed | Association between atherogenic index of plasma and risk of type 2 diabetes mellitus and the mediating effect of BMI: a comparative analysis in Chinese and Japanese populations |
| title_short | Association between atherogenic index of plasma and risk of type 2 diabetes mellitus and the mediating effect of BMI: a comparative analysis in Chinese and Japanese populations |
| title_sort | association between atherogenic index of plasma and risk of type 2 diabetes mellitus and the mediating effect of bmi a comparative analysis in chinese and japanese populations |
| topic | Atherogenic index of plasma Type 2 diabetes mellitus Hazard ratio Body mass index Population comparison Mediation analysis |
| url | https://doi.org/10.1186/s13098-025-01907-1 |
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