Hypertriglyceridemic-waist phenotype is a risk factor for type 2 diabetes mellitus (T2DM). The risk of T2DM may vary in different genders, regions, age groups, and overweight /obese people.

To explore the risk of T2DM by hypertriglyceridemic-waist phenotype in different genders, regions, ages, and overweight /obese people, and to provide a scientific basis for the prevention and control of T2DM.

This was a prospective cohort study involving 9 280 permanent residents over 18 years in 12 districts (counties) of Guizhou province in 2010 selected by multi-stage stratified cluster random sampling. From 2016 to 2020, 8 163 residents were followed up, and finally 6 743 eligible participants were enrolled after excluding those with baseline T2DM, lacking sufficient clinical data, lost to follow-up and deaths. Participants were assigned into 4 groups based on their baseline waist circumference (WC) and serum triacylglycerol (TG) levels: Normal WC and TG group (NWNT, WC<90 cm in men and WC<85 cm in women, TG<1.7 mmol/L), normal WC and high TG group (NWHT, WC<90 cm in men and WC<85 cm in women, TG≥1.7 mmol/L), large WC and normal TG group (EWNT, WC≥90 cm in men or WC≥85 cm in women, TG<1.7 mmol/L) and large WC and high TG group (EWHT, WC≥90 cm in men or WC≥85 cm in women, TG≥1.7 mmol/L). A Cox proportional hazards regression model was used to analyze the correlation between hypertriglyceridemic-waist phenotype grouping and new-onset T2DM.

The median follow-up period was 6.58 years. Among 6 743 participants, new-onset T2DM was observed in 706 (10.47%) individuals. After adjusting confounding factors, the Cox proportional hazards regression analysis showed that the risk of T2DM was 1.486 times in the EWHT group than the NWNT group (HR=1.486, 95%CI=1.185-1.865, P=0.001). Multivariate Cox proportional hazards regression analysis showed that in the subgroups of male gender, rural region, aged<45 years, and overweight /obese, the risk of T2DM in the EWHT group was 1.792 (HR=1.792, 95%CI=1.297-2.476, P<0.001), 1.483 (HR=1.483, 95%CI=1.115-1.971, P=0.007), 1.540 (HR=1.540, 95%CI=1.083-2.190, P=0.016), and 1.614 (HR=1.614, 95%CI=1.123-2.321, P=0.010) times higher than the NWNT group, respectively.

After a median follow-up time of 6.58 years in a large cohort, the hypertriglyceridemic-waist phenotype is the risk of T2DM in Guizhou Province, which is more significant in males, rural areas, aged<45 years, and overweight /obese people. Therefore, health education should be strengthened for high-risk populations. Weight control through reasonable diet and appropriate exercise, and reducing serum triacylglycerol levels are necessary and effective methods to prevent the incidence of T2DM.