ZJU Index as a Predictive Tool for Diabetes Incidence: Insights from a Population-Based Cohort Study

Background: In previous studies, the ZJU index was reported to be a superior predictor of nonalcoholic fatty liver disease in the Chinese population compared to the Fatty Liver Index. However, whether the ZJU Index is significantly associated with diabetes among Asian populations has not been determined. Methods: The NAGALA study was carried out at Murakami Memorial Hospital (Gifu, Japan) beginning in 1994. This study included the data of the subjects who underwent health check-ups from 2004 to 2015. The ZJU Index comprises body mass index (BMI), fasting plasma glucose, triglyceride, and alanine aminotransferase-to-aspartate aminotransferase (ALT) levels and an adjustment point for females. We conducted Cox proportional hazard regression to evaluate the association between quartiles of the ZJU Index and the risk of incident diabetes. Participants: A total of 15,464 individuals who underwent health check-ups were included in this study. Results: A total of 373 cases of incident diabetes were documented during 93,350 person-years of follow-up. As the ZJU index increased, the incidence of diabetes gradually increased (P <0.001). According to the multivariable model adjusted for metabolic covariates, the fourth quartile of the ZJU Index was positively associated with the risk of diabetes compared to the first quartile (HR=2.519, 95% CI=1.297 -4.891). Subgroup analysis revealed that the association between the ZJU index and diabetes risk was significant in subjects aged younger than 40 years (HR=3.327, 95% CI=1.544-7.171), in females (HR=4.480, 95% CI=1.302-15.419), in individuals with a BMI<25 kg/m(2 )(HR=3.812, 95% CI=1.992-7.293) and in individuals with a nonregular exercise (HR=2.479, 95% CI=1.193-5.152). Conclusion: We observed a positive association between the ZJU Index and incident diabetes in the general population.