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. 2025 Jul 7;25(1):168.
doi: 10.1186/s12902-025-01995-0.

Association between remnant cholesterol and low-density lipoprotein cholesterol discordance and type 2 diabetes or prediabetes: results from NHANES

Yijing Xin  1 , Yimeng Wang  1 , Yuyuan Shu  1 , Hanyang Liang  1 , Yanmin Yang  2
Affiliations

Association between remnant cholesterol and low-density lipoprotein cholesterol discordance and type 2 diabetes or prediabetes: results from NHANES

Yijing Xin et al. BMC Endocr Disord. .

Abstract

Objective: There is limited evidence on the relationship between remnant cholesterol (RC) and low-density lipoprotein cholesterol (LDL-C) discordance and type 2 diabetes or prediabetes. This study aimed to investigate the association between RC and LDL-C discordance and type 2 diabetes or prediabetes in the general US adult population.

Methods: Data from 19,604 participants in the National Health and Nutrition Examination Surveys (NHANES) (2005-2018) were analyzed. The percentile difference between RC and LDL-C was used to define discordance. Logistic regression models were performed to assess the relationships between RC, LDL-C, RC and LDL-C percentile difference, LDL-C and RC discordant. Nonlinear relationships were explored using restricted cubic splines. Mediation analysis was conducted to evaluate the direct and indirect relationships between abdominal obesity and type 2 diabetes through RC.

Results: RC was non-linearly and J-shaped correlated with type 2 diabetes and prediabetes, whereas LDL-C was non-linearly and U-shaped correlated with type 2 diabetes and was S-shaped correlated with prediabetes. Compared to concordant participants, those with discordantly low RC population had lower type 2 diabetes odds, while those with the discordantly high RC population had higher type 2 diabetes and prediabetes odds. When a clinical LDL-C cut-off of 2.60 mmol/L was applied, participants in the high LDL-C and low RC group had the lowest odds of type 2 diabetes, while those in the low LDL-C and high RC group had the highest odds. Significant interactions between LDL-C and RC discordance and factors such as age, MetS, and lipid-lowering medications were observed in relation to type 2 diabetes odds. RC was found to mediate 15.86% of the association between abdominal obesity and type 2 diabetes, and 16.22% of the association between abdominal obesity and prediabetes in the non-diabetes population.

Conclusions: Discordantly high RC was associated with higher odds of type 2 diabetes and prediabetes, while discordantly low RC was associated with lower odds of type 2 diabetes.

Keywords: Low-density lipoprotein cholesterol; Prediabetes; Remnant cholesterol; Remnant cholesterol and low-density lipoprotein cholesterol discordance; Type 2 diabetes.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The NHANES study protocol was approved by the NCHS Research Ethics Review Board, and written informed consent was provided by all participants. Competing interests: The authors declare no competing interests. Consent to publication: Not applicable. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
A detailed flow chart of participant recruitment
Fig. 2
Fig. 2
The RCS analysis between RC/LDL-C and type 2 diabetes/prediabetes. (a) The nonlinear association between RC and type 2 diabetes in total population, P for overall < 0.001, P for nonlinear < 0.001, values of 0.497 was set as references (vertical dashed line); (b) The nonlinear association between LDL-C and type 2 diabetes in total population, P for overall < 0.001, P for nonlinear < 0.001, values of 2.712 and 3.646 were set as references (vertical dashed lines); (c) The nonlinear association between RC and prediabetes in non-diabetes population, P for overall < 0.001, P for nonlinear < 0.001, values of 0.467 was set as references (vertical dashed line); (d) The nonlinear association between LDL-C and prediabetes in non-diabetes population, P for overall < 0.001, P for nonlinear < 0.001, values of 2.742was set as references (vertical dashed line)
Fig. 3
Fig. 3
Subgroup analysis of the association between LDL-C and RC concordant/discordant groups by percentile difference and the odds of type 2 diabetes. Adjusted for gender, age, race, education, marital, hypertension, BMI, WC, smoking, and drinking. ‘***’: P < 0.001; ‘**’: P < 0.01; ‘*’: P < 0.05. RC, remnant cholesterol; LDL-C, low-density lipoprotein cholesterol; MetS, metabolic syndrome; OR, odds ratio; CI, confidence interval
Fig. 4
Fig. 4
Mediation effect of RC between abdominal obesity and type 2 diabetes/prediabetes. RC mediated 15.86% (P < 0.001) of the association between abdominal obesity and type 2 diabetes in the total population, and 16.22% (P < 0.001) of the association with prediabetes in the non-diabetic population
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References

    1. GBD 2021 Diabetes Collaborators. Global, regional, and National burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the global burden of disease study 2021. Lancet. 2023;402(10397):203–34. 10.1016/S0140-6736(23)01301-6. - PMC - PubMed
    1. Owei I, Umekwe N, Wan J, Dagogo-Jack S. Plasma lipid levels predict dysglycemia in a biracial cohort of nondiabetic subjects: potential mechanisms. Exp Biol Med (Maywood). 2016;241(17):1961–7. 10.1177/1535370216659946. - PMC - PubMed
    1. Li M, Zhang W, Zhang M, et al. Nonlinear relationship between untraditional lipid parameters and the risk of prediabetes: a large retrospective study based on Chinese adults. Cardiovasc Diabetol. 2024;23(1):12. 10.1186/s12933-023-02103-z. - PMC - PubMed
    1. Lin T, Zhao Y, Yang Q, Wang W, Jiang X, Qiu Y. Association between blood lipids and diabetes mellitus in older Chinese adults aged 65 years or older: a cross-sectional analysis of residents’ electronic health records. Lipids Health Dis. 2024;23(1):167. 10.1186/s12944-024-02160-7. - PMC - PubMed
    1. Athyros VG, Doumas M, Imprialos KP, et al. Diabetes and lipid metabolism. Horm (Athens). 2018;17(1):61–7. 10.1007/s42000-018-0014-8. - PubMed

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