Zi Chen,1 Yapei Li,1 Xiaoling Zhu1,2 

1Health Management Medicine Center, The Third Xiangya Hospital, Central South University, Changsha, 410013, People’s Republic of China; 2Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, 410013, People’s Republic of China

Correspondence: Xiaoling Zhu, Email 13357217077@163.com

Background: The neutrophil-to-high-density lipoprotein–cholesterol ratio (NHR) has been recommended as an alternative biomarker in metabolic syndrome and cardiovascular diseases such as coronary artery disease (CAD). However, there is a lack of data on the association between NHR and the incidence of diabetes. This study aimed to investigate the potential value of NHR as a predictor of incident diabetes among Chinese adults.
Methods: This retrospective cohort study analyzed data from 16658 participants who had received annual health checkups at the Third Xiangya Hospital of Central South University from 2017 to 2024. The participants were split into four groups (Q1, Q2, Q3, and Q4) based on NHR levels. The cumulative diabetes incidence was assessed by Kaplan–Meier survival curves, compared using the Log rank test. The receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off point of NHR for predicting diabetes risk. Multivariate Cox proportional hazards regression models were used to explore the association of the NHR and diabetes incidence.
Results: A total of 12869 subjects were enrolled. The median followup period was 5.1 years. An incrementally higher NHR was associated with an increasingly higher cumulative incidence of diabetes (Log rank test, p < 0.001). Compared to Q1, the fully adjusted HRs (95% CIs) of the Q2, Q3, and Q4 groups for newonset diabetes were 1.43 (0.81– 2.53), 1.77 (1.03– 3.06), and 2.80 (1.64– 4.79), respectively. The AUCs obtained from receiver operating characteristic (ROC) analyses were 0.669 (95% CI: 0.63– 0.70, p< 0.001) for NHR. Based on the highest Youden’s index, the optimal threshold was 3.25 for NHR. In addition, there were interactions between NHR and age (≥ 40), and adverse emotions (anxiety or depression) in subgroup analyses.
Conclusion: The NHR was significantly associated with the incidence of diabetes, suggesting that the NHR may be a valid marker for risk stratification for T2DM.

Keywords: neutrophil-to-high-density-lipoprotein cholesterol ratio, incidence, risk, diabetes mellitus