APH: Interaction of lipid accumulation products and family history of diabetes on impaired fasting blood glucose and diabetes risk in normotensive people in eastern China

Background: Type 2 diabetes is considered one of the most prevalent noncommunicable diseases globally, with an estimated 366 million adults living with diabetes worldwide in 2011 and 552 million
by 2030.
The etiology of diabetes is not well defined, and it is considered a polygenic disease that involves the interaction
between environmental and genetic risk factors.
At the same time, most patients often go undiagnosed for years, and patients progress asymptomatically through early diabetes called impaired fasting glucose (IFG), a manifestation of
early glucose metabolism disorders.
A report from China shows that nearly 148.
2 million adults have IFG, and people with IFG are more likely to progress to diabetes
.
There is substantial evidence that IFG and diabetes are strongly associated with cardiovascular events, and a cohort study conducted in rural China showed significantly higher
cumulative incidence of hypertension in the IFG and diabetes groups compared to the normosmic group.
Therefore, it is necessary to look for risk factors and analyze how the synergy between them affects the development of
IFG and diabetes.

Body mass index (BMI) is a recommended measure for assessing and diagnosing obesity and is relevant to diabetes in adults, but there is growing evidence that BMI is not an ideal body mass index, that it has limitations in differentiating fat from muscle mass, and does not reflect central obesity
.
A study conducted in the United States showed that 33% of normal-weight older adults with a body mass index definition have prediabetes
.
Schulze et al.
reported that waist circumference and waist-hip ratio were used instead of body mass index given that waist circumference and waist-hip ratio were positively correlated with IFG and diabetes, however, waist circumference and waist-hip ratio did not show excessive body fat
in circulating blood.
However, it is unclear whether body mass index affects diabetes, and a study conducted in older Americans from 1991 to 2010 showed that elevated body mass index was associated
with an increased risk of diabetes.
In addition, in another population-based cohort study, body mass index was not associated
with diabetes.
Therefore, there is an urgent need to explore other valuable predictors of diabetes to improve the accuracy of
screening.

Kahn et al.
based on WC and serum triglycerides (TG), lipid accumulation products (LAP) are powerful parameters
for predicting diabetes in adults.
This is an emerging indicator of indirect expression of central fat accumulation and has been developed to be independently associated
with impaired fasting blood glucose, type 2 diabetes, coronary heart disease, and metabolic syndrome.
Several population-based studies have highlighted the link between LAP and metabolic diseases in different countries, but few studies in China have investigated the link between
LAP and diabetes.
Anhui is a developing province in central China with rapid
economic development.
At the same time, the lifestyle of Anhui residents has undergone great changes, such as high-fat diet, reduced physical activity and long-term sedentary lifestyle, which are considered to be the main risk factors for diabetes, so the applicability of LAP in predicting IFG and diabetes is worth studying
.

Over the past few decades, it has been established that people with a family history of diabetes are at high risk of developing diabetes, however, there is controversy
as to whether family history has a significant impact on diabetes progression.
Family history of diabetes is considered an indicator of genetic predisposition, and people with a family history of diabetes are significantly at higher risk than others
.
In addition, because IFG and diabetes are polygenic inheritance patterns, the combined effects of risk factors may exacerbate the disease, but the interaction between family history of diabetes and other risk factors is less
studied.
At the same time, hypertension is also a relatively independent risk factor for diabetes, so we conducted a cross-sectional study in a large population without hypertension to evaluate the interaction of family history of diabetes and LAP on IFG and diabetes, and to provide new initiatives
for the prevention of IFG and diabetes.

Objective: In this study, we aimed to (1) analyze the association between LAP and IFG and diabetes risk in Bengbu City, (2) compare the predictive power of body mass index, waist circumference, waist-hip ratio and LAP, and (3) evaluate the possible interaction of LAP and family history on IFG and diabetes risk
.

Methods: A multi-stage stratified cluster sampling method was used to sample urban residents
in Bengbu City.
For each qualified participant, data from
questionnaires, anthropometric and laboratory tests were obtained.
The effects of body mass index (body mass index), waist circumference (WC), waist height ratio (WHtR), and waist circumference (LAP) on predicting IFG and diabetes were performed
using multiple logistic regression and subject operating characteristics (ROC) analyses.
Interaction effects are evaluated
using the relative excess risk of interaction (RERI), the proportion of interaction attribution (AP), and the synergy index (SI).

Results: Among 6467 normal-blood pressure patients (2695 males and 3772 females), the prevalence of IFG and diabetes was 9.
37% and 14.
33%,
respectively.
When assessed using ROC curve analysis, LAP showed higher diagnostic accuracy than body mass index in identifying IFG and diabetes, with an area under the AUC curve of 0.
650 (95% CI: 0.
637 to 0.
662).

。 After adjusting for age, sex, education level, and other confounders, multivariate logistic regression analysis showed that participants in the fourth quartile of LAP were more likely to develop IFG disease (adjusted OR: 2.
735, 95% CI: 1.
794–4.
170) and diabetes (adjusted OR: 1.
815, 95% CI: 1.
297–2.
541)
than participants in the first quartile 。 A significant interaction between LAP and family history of diabetes was observed in participants (RERI = 1.
538, 95% confidence interval, CI: 0.
167 to 3.
612; AP = 0.
375, 95% CI: 0.
118 to 0.
631; SI = 1.
980, 95% confidence interval, CI: 1.
206 to 3.
251).

。 However, a significant interaction
between LAP and abdominal obesity was indicated by the values of RERI (1.
492, 95% confidence interval, CI: 0.
087 to 3.
723) and AP (0.
413, 95% CI: 0.
014 to 0.
756), rather than the values of SI (1.
824, 95% CI: 0.
873 to 3.
526).

Table 1 Comparison of four-quartile cardiovascular risk factors for lipid accumulation products in rural study populations in Bengbu City, Anhui Province, China, in 2018

Fig.
1 Impaired fasting blood glucose and prevalence of diabetes in different quartiles of lipid accumulation products in the national (Bengbu City, Anhui Province, China) in 2018 (trend P < 0.
001 in the fasting blood glucose impaired and diabetes group) (Q1:< 18.
17; Q2:18.
17 to 28.
79; Q3: 28.
80 to 46.
19; Q4: ≥ 46.
20)

Table 2 Comparison of obesity index prediction of fasting blood glucose impairment and diabetes risk in the national (Bengbu City, Anhui Province, China) in 2018

Fig.
2 Working characteristic curves of subjects with different obesity indicators predicting fasting blood glucose impairment and diabetes risk in rural study population in Bengbu City, Anhui Province, China, in 2018

Table 3 Logistic regression analysis of lipid accumulation products and family history of fasting blood glucose and diabetes in rural areas (Bengbu City, Anhui Province, China) in 2018

Conclusions: Our findings suggest that LAP and family history of diabetes may have a synergistic effect
on the risk of IFG and diabetes.

Original source:

Shu L, Zhao Y, Shen Y, et al.
Interaction analysis of lipid accumulation product and family history of diabetes on impaired fasting glucose and diabetes risk in population with normotension in Eastern China: a community-based cross-sectional survey.
Arch Public Health 2022 Oct 01; 80(1)