Work

Estimated small dense LDL cholesterol and the risk of impaired fasting glucose in Chinese adults: a multicentre retrospective cohort study

Year: 2026

Type: article

Abstract: Diabetes poses a growing global public health burden, with impaired fasting glucose (IFG) representing a key prediabetic stage. Small dense low-density lipoprotein cholesterol (sdLDL-C) is an atherogenic lipid subfraction implicated in dysglycemia pathogenesis. Compared to the direct measurement of sdLDL-C, estimated small dense LDL cholesterol (EsdLDL-C) can be calculated using low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) through a formula, making it highly suitable for large-scale initial screening. However, evidence regarding its association with the risk of IFG in Chinese populations remains relatively limited. This study aims to explore the relationship between EsdLDL-C and the risk of incident IFG in Chinese adults. The study analyzed data from 101084 Chinese adults with normal fasting glucose, derived from a multicenter health screening database. The exposure was EsdLDL-C. The outcome was new-onset IFG. The relationship between EsdLDL-C and IFG risk was examined using multivariable Cox proportional hazards regression. Restricted cubic splines (RCS) explored nonlinearity, and subgroup analyses assessed consistency. Over a median follow-up of 3.0 years, 12.41% of participants developed IFG. The absolute incidence of IFG increased markedly from 7.71% in Q1 to 18.00% in Q4. Higher EsdLDL-C levels were significantly associated with increased IFG risk (per 1-SD increase: HR = 1.35, 95% CI: 1.31 – 1.39 in the fully adjusted model). A dose-response relationship was observed across quartiles. RCS analysis revealed a statistically nonlinear association with an inflection point at EsdLDL-C = 24.48 (HR 1.026 vs. 1.031). Given the similar HRs, this threshold is considered an exploratory finding rather than a definitive clinical cut-off. Results remained consistent in sensitivity and subgroup analyses. Elevated EsdLDL-C, as a derived lipid marker, is significantly associated with an elevated risk of incident IFG in Chinese adults, exhibiting a continuous dose-response relationship, with statistical nonlinearity suggesting an exploratory risk gradient. EsdLDL-C, derived from routine lipid parameters, may serve as a practical biomarker for early identification of high-risk individuals, informing targeted diabetes prevention strategies. Not applicable.

Source: BMC Endocrine Disorders

DOI: 10.1186/s12902-026-02510-9