Jun JE, Hwang YC, Ahn HY, Jeong IK, Ahn KJ, Chung HY, Ryu HJ. Remnant cholesterol and the risk of incident type 2 diabetes: A community-based 14-year prospective cohort study. World J Diabetes 2026; 17(4): 117215 [DOI: 10.4239/wjd.v17.i4.117215]
Corresponding Author of This Article
You-Cheol Hwang, MD, PhD, Professor, Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, No. 892 Dongnam-ro, Gangdong-gu, Seoul 05278, South Korea. khmcilyong@naver.com
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Medicine, General & Internal
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Prospective Study
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Apr 15, 2026 (publication date) through Apr 14, 2026
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World Journal of Diabetes
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1948-9358
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Jun JE, Hwang YC, Ahn HY, Jeong IK, Ahn KJ, Chung HY, Ryu HJ. Remnant cholesterol and the risk of incident type 2 diabetes: A community-based 14-year prospective cohort study. World J Diabetes 2026; 17(4): 117215 [DOI: 10.4239/wjd.v17.i4.117215]
World J Diabetes. Apr 15, 2026; 17(4): 117215 Published online Apr 15, 2026. doi: 10.4239/wjd.v17.i4.117215
Remnant cholesterol and the risk of incident type 2 diabetes: A community-based 14-year prospective cohort study
Ji Eun Jun, You-Cheol Hwang, Hong Yup Ahn, In-Kyung Jeong, Kyu Jeung Ahn, Ho Yeon Chung, Hyun Jin Ryu
Ji Eun Jun, You-Cheol Hwang, In-Kyung Jeong, Kyu Jeung Ahn, Ho Yeon Chung, Hyun Jin Ryu, Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Seoul 05278, South Korea
Hong Yup Ahn, Department of Statistics, Dongguk University-Seoul, Seoul KS034, South Korea
Author contributions: Jun JE was responsible for writing - original draft and revised manuscript, software, formal analysis; Ahn HY was responsible for formal analysis, data curation; Ryu HJ was responsible for data curation; Jeong IK, Ahn KJ, and Chung HY were responsible for methodology and review; Hwang YC was responsible for review & editing, conceptualization, funding acquisition.
Supported by the National Research Foundation of Korea Grant, No. 2022R1A2C2009221.
Institutional review board statement: The study protocol was approved by the Ethics Committee of the Korean Center for Disease Control and the Kyung Hee University Hospital at Gangdong Institutional Review Board (Approval No. KHNMC 2023-05-010).
Informed consent statement: Participants signed a written informed consent form and agreed to participate in the trial after fully understanding the study.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Data sharing statement: The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.
Corresponding author: You-Cheol Hwang, MD, PhD, Professor, Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, No. 892 Dongnam-ro, Gangdong-gu, Seoul 05278, South Korea. khmcilyong@naver.com
Received: December 3, 2025 Revised: January 1, 2026 Accepted: February 9, 2026 Published online: April 15, 2026 Processing time: 134 Days and 4.8 Hours
Abstract
BACKGROUND
Remnant cholesterol, a marker of triglyceride-rich lipoproteins, has been implicated in cardiometabolic risk; however, its role in predicting incident type 2 diabetes remains incompletely defined, particularly in comparison with conventional lipid parameters.
AIM
To investigate the association between remnant cholesterol and incident type 2 diabetes and its predictive performance in a community-based cohort.
METHODS
This prospective study included 7702 Korean adults without diabetes at baseline, who were followed for up to 14 years. Incident diabetes was ascertained using repeated oral glucose tolerance tests in addition to fasting plasma glucose, glycosylated hemoglobin, and medical history.
RESULTS
During follow-up, 22.0% (1694/7702) of participants developed incident diabetes. In multivariable Cox proportional hazards models, higher remnant cholesterol levels were independently associated with an increased risk of diabetes after adjustment for established risk factors (hazard ratio per 1-SD increase = 1.25; 95%CI: 1.20-1.30). This association was consistently observed across subgroups defined by age, sex, body mass index, metabolic syndrome status, and baseline glycemic status, and appeared more evident in metabolically healthier individuals. Overall, the predictive performance of remnant cholesterol was comparable to that of triglycerides and superior to that of total and low density lipoprotein cholesterol. Notably, remnant cholesterol provided incremental risk reclassification value over non-high density lipoprotein cholesterol among individuals with triglyceride levels < 400 mg/dL.
CONCLUSION
These findings suggest that remnant cholesterol may serve as a complementary marker for refining diabetes risk stratification, particularly in individuals with relatively low baseline metabolic risk.
Core Tip: Remnant cholesterol, a surrogate of triglyceride-rich lipoprotein burden, has recently gained attention as a contributor to cardiometabolic disease. Our findings underscore its independent predictive value for incident type 2 diabetes, beyond conventional lipid indices and established metabolic risk factors. Given its robust performance across multiple subgroups, remnant cholesterol may serve as a clinically relevant biomarker for early metabolic risk stratification and complement current approaches in predicting diabetes development.
