Linear relationship between triglyceride to high-density lipoprotein cholesterol ratio and kidney stones: a mediating role for diabetes

Objective To investigate the correlation between triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) and kidney stone risk and to determine the potential mediating role of diabetes.Methods Laboratory examination data and questionnaire data from 59,843 adults from the National Health and Nutrition Examination Survey (NHANES) database were downloaded and collated. Multiple logistic regression was used to analyze the relationship between TG/HDL-C and kidney stone incidence. The presence of a nonlinear association between TG/HDL-C and the risk of kidney stones was assessed by using a restricted cubic spline function combined with smoothed curve fitting for saturation threshold effects. In addition, the robustness of the results was demonstrated by subgroup analysis and sensitivity analysis. Finally, mediation effect analysis was performed to determine the mediating role of diabetes and to calculate the proportion of mediation effects.Results A total of 10,629 participants with complete data were included in this study. Of these, 50.3% were male and the mean age was 48.4±17.2 years. The overall prevalence of kidney stones was 9.12%, which tended to increase with increasing TG/HDL-C (P < 0.001). Multiple logistic regression analysis showed a 0.43-fold increased risk of kidney stones in the highest TG/HDL-C group compared with those in the lowest TG/HDL-C group after adjusting for relevant confounders (OR = 1.43; 95% CI: 1.05 - 1.71; P = 0.002). Subgroup analyses and interaction tests showed that the positive association between TG/HDL-C and kidney stones was stable and consistent across the population (P > 0.05). Mediation analysis showed that diabetes mellitus played a mediating role in the positive association between TG/HDL-C and kidney stones, with a mediating effect of 11.7%.Conclusion This study suggests that TG/HDL-C is associated with an increased risk of kidney stone formation, with diabetes playing a mediating role. The results of this study suggest that maintaining TG/HDL-C in the lower range and addressing glycemic regulation can significantly reduce the risk of developing kidney stones in the future.