Background: The monocyte-to-high-density lipoprotein cholesterol (MHR) ratio has been linked to metabolic disorders. However, there is limited research on the predisposition to MHR and prediabetes. Hence, we conducted a study to investigate the relationship between MHR and the prevalence of prediabetes.
Methods: In total, 85,293 participants were included in our cross-sectional observational study. Multivariable regression analysis, subgroup analyses, and interaction testing were used to determine the relationship between MHR and prediabetes. To explore the non-linear association of MHR with prediabetes risk, generalized additive model (GAM) and smoothing splines were applied. The threshold effect analysis of MHR on the risk of prediabetes was further employed to identify the turning point.
Results: After controlling for covariates, the results indicated that a positive correlation persisted between MHR and prediabetes (odds ratio (OR) =1.64, 95% confidence interval (CI), 1.48– 1.82), and subgroup analyses found a more robust correlation between MHR and prediabetes in individuals with lower age, SBP, DBP, TG, TC and higher values of BMI and LDL-C than in their counterparts. Additionally, the correlation between MHR and the risk of prediabetes was found to be non-linear, with a turning point of − 0.4 (Log-Likelihood Ratio, P< 0.001). The impact of variables on the two sides of the turning point were 1.94 (1.72, 2.19) and 0.88 (0.69, 1.14).
Conclusion: The positive correlation between MHR and the risk of prediabetes in Chinese participants was observed to be non-linear, and MHR ≤ − 0.4 was strongly positively correlated with prediabetes risk.

Keywords: prediabetes, monocyte-to-high-density lipoprotein ratio, non-linear relationship, inflammation