Routine lipid and glucose index flags prediabetes risk in Chinese adults

A simple index calculated from three routine blood test results—total cholesterol, high-density lipoprotein (HDL) cholesterol, and fasting glucose—may help identify adults at risk of developing impaired fasting glucose, a common form of prediabetes, according to a retrospective cohort analysis published in BMC Endocrine Disorders.

The study, led by Dan Ye and colleagues, drew on 108,152 Chinese adults who had normal blood glucose at baseline, using data from the Rich Healthcare Group cohort collected between 2010 and 2016. The researchers followed participants for a median of 3.1 years, during which 4,021 people—3.72 percent of the cohort—developed impaired fasting glucose, defined as a fasting plasma glucose level of 6.1 to 6.9 mmol/L at any follow-up assessment.

The Cholesterol, High-Density Lipoprotein, Glucose (CHG) index is calculated as the natural logarithm of total cholesterol multiplied by fasting blood glucose, divided by twice the HDL value. Because all three components are already measured in standard lipid panels and glucose tests, the index requires no additional testing, which is central to its appeal as a potential screening tool.

In Cox proportional hazards models, each 1-unit increase in the CHG index was associated with a higher incidence of impaired fasting glucose, with a hazard ratio of 2.57 (95 percent confidence interval, 2.29 to 2.88; P < 0.001). The association followed a graded pattern across quartiles of the index: participants in the highest quartile had a hazard ratio of 3.05 (95 percent confidence interval, 2.67 to 3.50) compared with those in the lowest quartile.

Restricted cubic spline analysis indicated that the relationship was not strictly linear. The association was nonlinear (P < 0.001), with an inflection point at approximately 5.047 on the index, suggesting the risk gradient changes in character above and below that threshold.

Notably, the relative association was not uniform across the population. It was stronger among women, among younger adults, and among individuals with a body mass index of 18.5 to 23.99 kg/m²—people of normal body weight. Multiplicative interactions were significant for sex, age, and body mass index (all P < 0.001). Positive additive interactions were observed for sex (relative excess risk due to interaction, 0.47; 95 percent confidence interval, 0.29 to 0.64) and age (relative excess risk due to interaction, 0.90; 95 percent confidence interval, 0.49 to 1.32), but not for body mass index.

The subgroup findings matter because the study’s authors note that conventional fasting plasma glucose cutoffs may miss individuals with subtle metabolic dysfunction, particularly younger adults and those of normal body weight. Impaired fasting glucose is reported to be the most common prediabetes subtype among Chinese health-screening populations, and identifying it earlier could allow closer monitoring in people who would otherwise appear unremarkable on standard testing.

The index also appeared to add informational value beyond fasting glucose alone. Adding total cholesterol and HDL to fasting plasma glucose improved discrimination between people who did and did not develop impaired fasting glucose, with the area under the curve rising from 0.772 to 0.781 (P < 0.001). In an analysis using a composite outcome, the association remained robust, with a hazard ratio of 2.40 (95 percent confidence interval, 2.18 to 2.65) per 1-unit increase in the index.

The authors conclude that the CHG index is associated with incident impaired fasting glucose and, as a measure derived from routine lipid and glucose measurements, may complement fasting plasma glucose for early risk stratification. They caution in their conclusions that the association is strongest in relative terms among women, younger adults, and normal-weight individuals.

Several limitations should be kept in view. This was a secondary analysis of an existing health-screening cohort rather than a randomized or prospective study designed to test the index, and an observational association of this kind does not establish that the index causes diabetes risk or that acting on it improves outcomes. The findings come from a Chinese health-screening population followed for a median of just over three years, so their applicability to other populations and longer time horizons remains to be established. The article was published as an open-access research paper on 29 October 2026, and the published version notes it is being shared early as a peer-reviewed, accepted manuscript subject to further edits before the final version of record.

Subject of Research: Association between the CHG lipid-glucose index and incident impaired fasting glucose in Chinese adults

Article Title: Relationship between the cholesterol, high-density lipoprotein, and glucose (CHG) index and incident impaired fasting glucose in normoglycemic Chinese adults: a retrospective cohort analysis

Article References: Ye, D., He, Q., Li, G., & Sun, Y. (2026). Relationship between the cholesterol, high-density lipoprotein, and glucose (CHG) index and incident impaired fasting glucose in normoglycemic Chinese adults: a retrospective cohort analysis. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02698-w

Image Credits: AI Generated

DOI: 10.1186/s12902-026-02698-w

Keywords: CHG index, impaired fasting glucose, prediabetes, fasting plasma glucose, HDL cholesterol, total cholesterol, retrospective cohort, Cox proportional hazards, risk stratification, Chinese adults, health screening cohort, BMC Endocrine Disorders