The ZJU index: a useful indicator for recognizing insulin resistance in the Chinese general population

Association of non-insulin-based insulin resistance indices, mean platelet volume and prostate cancer: a cross-sectional study

PURPOSE

Insulin resistance and prostate cancer (PCa) association results remain controversial. However, few studies have compared the role of various non-insulin-based insulin resistance (NI-IR) indices and mean platelet volume (MPV) in PCa.

METHODS

We conducted a cross-sectional study, the case group included 354 patients with PCa, and the control group included 1,498 non-PCa participants. We performed inverse probability weighting to reduce the impact of differences in baseline information between the case and control groups on results. Weighted logistic regression analysis for assessing the relationship between NI-IR indices and PCa risk. Fitting 4-point restricted cubic spline (RCS) plots to show the trend of NI-IR indices with PCa risk. The interaction between insulin resistance and platelet volume based on generalized additive model (GAM) to reveal the impact of the interaction between insulin resistance and cardiovascular risk on PCa. In the end, we performed three sensitivity analyses to verify the stability of results.

RESULTS

Weighted logistic regression analysis revealed that all NI-IR indices were associated with PCa. When NI-IR indices were evaluated as continuous variables, in the all variables adjusted model (model 3), the adjusted OR of ZJU index was 1.337 (95%CI: 1.296-1.379), the adjusted OR of TyG index was 5.300 (95%CI:4.208-6.675), the adjusted OR of TG/HDL-c was 1.431 (95%CI:1.335-1.534), and the adjusted OR of METS-IR was 1.129 (95%CI:1.110-1.149). When NI-IR indices were analyzed as categorical variables, also in model 3, using Q1 as reference, the adjusted OR of ZJU index in Q5 was 15.592 (95%CI:10.809-22.492), the adjusted OR of TyG index in Q5 was 7.306 (95%CI:5.182-10.301), the adjusted OR of TG/HDL-c in Q5 was 4.790 (95%CI:3.459-6.632), and the adjusted OR of METS-IR in Q5 was 9.844 (95%CI:6.862-14.121). RCS displayed that PCa risk tended to increase as the ZJU index, TyG index, TG/HDL-c, and METS-IR increased. The interaction test based on the GAM indicated that the value of the interaction between TG/HDL-c and MPV on the PCa risk was χ2 = 6.924(P = 0.009). With the increase in TG/HDL-c and the decrease in MPV, the PCa risk progressively increases. The sensitivity analysis further confirmed the robustness of the results.

CONCLUSIONS

NI-IR indices were associated with an increased PCa risk. The interaction between MPV and insulin resistance may further contribute to the PCa risk.

Association between ZJU index and kidney stone prevalence in the Chinese adult population: a retrospective propensity score-matched analysis

The study aimed to explore the association between the ZJU (Zhejiang University) index and the prevalence of kidney stones in Chinese adults. Electronic health records of individuals undergoing routine physical examinations at Wuhu Second People's Hospital between January 2021 and June 2024 were retrospectively analyzed. Participants were divided into kidney stone recurrence and non-recurrence groups. Data on biochemical parameters, hypertension, and diabetes history were collected, and group differences were assessed using the chi-square test or Kruskal-Wallis rank-sum test. Logistic regression, propensity score matching, and dose-response curve modeling were used to evaluate the relationship between the ZJU index and kidney stone prevalence. Among 5,104 participants aged over 18 years, 462 were diagnosed with kidney stones. After adjusting for confounders, a higher ZJU index was identified as an independent risk factor for kidney stone prevalence (odds ratio [OR] = 1.05, 95% confidence interval [CI]: 1.02-1.08). Propensity score-matched analysis further confirmed this association (OR = 1.09, 95% CI: 1.04-1.13). Dose-response analysis revealed a positive linear relationship between the ZJU index and kidney stone recurrence. These findings suggest that elevated ZJU index levels are associated with a higher prevalence and recurrence of kidney stones, highlighting its potential as a clinical tool for identifying and managing at-risk patients.

Analysis of the efficacy of the ZJU index and triglyceride‒glucose product index in identifying obstructive sleep apnea hypoventilation syndrome in patients with metabolic syndrome

PURPOSE

Metabolic syndrome (MS) and obstructive sleep apnea-hypopnea syndrome (OSAHS) are associated with an increased risk of cardiometabolic disease. The coexistence of OSAHS and metabolic disorders is common, but research on how to recognize OSAHS and how OSAHS risk exacerbates metabolic disorders is limited. This study aimed to analyze the correlations of the ZJU index and triglyceride‒glucose (TyG) index with OSAHS in MS patients and to investigate the ability to use the ZJU index and TyG-related indices to assess the presence and severity of OSAHS in MS patients.

METHODS

This retrospective study included 216 MS patients with perfect polysomnographic monitoring (PSG), who were categorized into MS combined with OSAHS (n = 142) and MS alone (n = 74) groups according to the sleep monitoring results. The MS combined with OSAHS group was further categorized into mild (n = 55), moderate (n = 34), and severe (n = 53) groups according to the apnea hypopnea index (AHI). The general clinical data, clinical biochemical indices, AHI, mean oxygen saturation (MSaO2), lowest oxygen saturation (LSaO2), and longest apnea duration were collected from all the included subjects. Composite indices such as the ZJU, TyG, and TyG-BMI indices were calculated. The differences in each metabolic index among the different groups were analyzed; logistic regression analysis was used to compare the correlations between each parameter and OSAHS, and the efficacy of each parameter in identifying OSAHS in the MS population was evaluated by receiver operating characteristic (ROC) curves.

RESULTS

The ZJU, TyG, and TyG-BMI indices were associated with OSAHS after adjusting for sex, age, history of hypertension, history of diabetes, and history of smoking (all P < 0.05). The odds ratios for the ZJU, TyG, and TyG-BMI indices were 1.472 (1.293-1.674), 9.811 (3.916-24.582), and 1.032 (1.020-1.044), respectively. The ZJU, TyG, and TyG-BMI indices are effective predictors of the occurrence of OSAHS in MS patients, and their cutoff values could be used for early screening of OSAHS. The ZJU index was the strongest predictor of OSAHS, (area under the curve 0.829, 95% CI 0.771-0.888), with an optimal cutoff value of 38.940.

CONCLUSIONS

The ZJU, TyG, and TyG-BMI indices are novel, valid, and practical indicators for early screening of OSAHS risk in MS patients.

Association between ZJU index and gallstones in US adult: a cross-sectional study of NHANES 2017-2020

BACKGROUND

Based on triglyceride, body mass index (BMI), alanine aminotransferase/ aspartate aminotransferase ratio, fasting blood glucose, the ZJU index is proven to be a novel and effective parameter for screening NAFLD in Chinese. This study aims to evaluate the correlation between ZJU values and the risk of developing gallstones.

METHODS

The data from the National Health and Nutrition Examination Survey (NHANES) database during the period from 2017 to 2020 were analyzed in this cross-sectional study. And 6155 participants were included to assess the correlation between the ZJU index and the formation of gallstones through multivariate logistic regression, receiver operating characteristic (ROC) curve, subgroup analysis, and restricted cubic spline regression (RCS) analyses.

RESULTS

In this population-based study, 6155 participants aged 18 years and older were included, among which, 671 had gallstones. Logistic regression and RCS regression analyses indicated a significant positive non-linearly correlation between the ZJU index and the prevalence of gallstones (OR = 1.044, 95% CI: 1.032, 1.056), with an inflection point of 40.6. Subgroup analysis further revealed a stronger correlation between the risk of developing gallstones and the ZJU index in females. ROC analysis indicated that the ZJU index (AUC = 0.653) can serve as a more robust predictor for developing gallstones compared to traditional indices, with a sensitivity of 55.9%, a specificity of 67.1% and a cutoff of 43.4.

CONCLUSION

This study provides evidence that elevated the ZJU index is correlated with an increased risk of developing gallstones.

Assessment of the clinical value of five noninvasive predictors of metabolic dysfunction-associated steatotic liver disease in Han Chinese adults

BACKGROUND

Fatty Liver Index (FLI), Triglyceride-Glucose Index (TyG), Lipid Accumulation Product (LAP), Zhejiang University Index (ZJU), and Visceral Adiposity Index (VAI) are five classical predictive models for fatty liver disease. Our cross-sectional study aimed to identify the optimal predictors by comparing the predictive value of five models for metabolic dysfunction-associated steatotic liver disease (MASLD) risk.

METHODS

Data on 2687 participants were collected from West China Hospital of Sichuan University. Controlled attenuation parameters assessed by transient elastography were used to effectively diagnose MASLD. Logistic regression analysis was used to estimate the odd ratios and 95% confidence intervals between indices and MASLD risk. Receiver operating characteristic curves were plotted to evaluate the predictive value of indices.

RESULTS

This study included 1337 normal and 1350 MASLD samples. The average age of MASLD patients is 47 years old, and the prevalence was higher in males (39.3%) than in females (10.9%). Five indices were positively correlated with MASLD risk, with the strongest correlation for TyG. Overall, the area under the curve of the indicators was: ZJU 0.988, FLI 0.987, LAP 0.982, TyG 0.942, and VAI 0.941. In the gender stratification, ZJU (0.989) performed best in males. FLI (0.988) and ZJU (0.987) had similar predictive ability in females. In the age stratification, FLI performed better in predicting the middle-aged group aged 30-40 years (0.991).

CONCLUSION

For Chinese Han adults, ZJU is the best predictive index for initial screening of MASLD. FLI can serve as an alternative tool for ZJU to predict females.

Correlation between ZJU index and hepatic steatosis and liver fibrosis in American adults with NAFLD

Background

ZJU index, a novel calculation combining blood glucose, body mass index (BMI), lipids and liver functions, is closely related with non-alcoholic fatty liver disease (NAFLD). However, the correlation between ZJU index and hepatic steatosis and liver fibrosis has not been reported in the studies. This study aims to examine the correlation between these variables.

Methods

Data from the 2017-2020 NHANES were collected for a cross-sectional study, to explore the linear relationship between ZJU, liver stiffness measurements (LSM) and controlled attenuation parameters (CAP) with multivariate linear regression models. Restricted cubic spline (RCS) regression and threshold effect analyses were utilized to describe the nonlinear relationship. The correlation in subgroups was analyzed based on race, gender, drinking, age, BMI, diabetes and moderate activities.

Results

In this population-based study, a total of 2,122 adults aged 18-80 years old with NAFLD were included. According to the multivariate linear regression analysis, ZJU had a significant positive correlation with liver fibrosis (LSM, β = 0.182, 95%CI = 0.154-0.211, p < 0.001) and hepatic steatosis (CAP, β = 2.35, 95%CI = 2.14-2.56, p < 0.001), which was stronger in males. According to the RCS analysis, an inverted L-shaped relationship between ZJU and CAP (inflection point at 60.56) and a J-shaped relationship between ZJU index and LSM (inflection point at 51.27) were observed.

Conclusion

ZJU had a positive correlation with CAP and LSM in American adults with NAFLD. The findings suggest that ZJU may be a valuable biomarker for assessing the severity of liver fibrosis and hepatic steatosis in individuals with NAFLD.

Association between the ZJU index and risk of new-onset non-alcoholic fatty liver disease in non-obese participants: a Chinese longitudinal prospective cohort study

Background

Non-alcoholic fatty liver disease (NAFLD) is increasingly observed in non-obese individuals. The ZJU (Zhejiang University) index has been established as a new and efficient tool for detecting NAFLD, but the relationship between the ZJU index and NAFLD within non-obese individuals still remains unclear.

Methods

A post-hoc evaluation was undertaken using data from a health assessment database by the Wenzhou Medical Center. The participants were divided into four groups based on the quartile of the ZJU Index. Cox proportional hazards regression, Kaplan-Meier analysis and tests for linear trends were used to evaluate the relationship between the ZJU index and NAFLD incidence. Subgroup analysis was conducted to test the consistency of the correlation between ZJU and NAFLD in subsgroups. Receiver operative characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the ZJU index, compared with the Atherogenic index of plasma (AIP) and Remnant lipoprotein cholesterol (RLP-C) index.

Results

A total of 12,127 were included in this study, and 2,147 participants (17.7%) developed NAFLD in 5 years follow-up. Participants in higher ZJU quartiles tended to be female and have higher liver enzymes (including ALP, GGT, ALT, AST), GLU, TC, TG, LDL and higher NAFLD risk. Hazard Ratios (HR) and 95% confidence intervals (CI) for new-onset NAFLD in Q2, Q3, and Q4 were 3.67(2.43 to 5.55), 9.82(6.67 to 14.45), and 21.67(14.82 to 31.69) respectively in the fully adjusted model 3. With increased ZJU index, the cumulative new-onset NAFLD gradually increased. Significant linear associations were observed between the ZJU index and new-onset NAFLD (p for trend all<0.001). In the subgroup analysis, we noted a significant interaction in sex, with HRs of 3.27 (2.81, 3.80) in female and 2.41 (2.21, 2.63) in male (P for interaction<0.01). The ZJU index outperformed other indices with an area under the curve (AUC) of 0.823, followed by AIP (AUC=0.747) and RLP-C (AUC=0.668).

Conclusion

The ZJU index emerges as a promising tool for predicting NAFLD risk in non-obese individuals, outperforming other existing parameters including AIP and RLP-C. This could potentially aid in early detection and intervention in this specific demographic.

Validation of non-invasive indicators in the screening of metabolic dysfunction-associated fatty liver disease: a cross-sectional study among Uighurs in rural Xinjiang

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common chronic liver disease in China. Our study aimed to evaluate the screening value of the fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation product (LAP), visceral adiposity index (VAI), and Zhejiang University index (ZJU), as well as other single indicators for MAFLD. We aimed to find the optimal screening tool and its appropriate cut-off values for rural Uyghur adults.

METHODS

We completed a survey of 14,321 Uyghur adults in 51 groups in Kashgar, Xinjiang, in 2016 using a typical sampling method, with 12,794 patients ultimately included in statistical analyses. Fatty liver was diagnosed using ultrasonography.

RESULTS

The prevalence of fatty liver disease (FLD) and MAFLD was 16.73% and 16.55%, respectively, and the FLI, HSI, LAP, VAI, and ZJU were all independently associated with an increased risk of MAFLD. The areas under the receiver operating characteristic curves (AUCs) of the FLI for diagnosing MAFLD in men and women were 0.853 and 0.847, respectively. The AUCs of the body mass index (BMI) for diagnosing MAFLD in men and women were 0.850 and 0.852, respectively. Compared with other metabolic-related markers, FLI had the largest AUC. In men, the optimal cut-off values of FLI and BMI for diagnosing MAFLD were 45 (sensitivity 84.83%, specificity 69.57%) and 27.4 (sensitivity 78.47%, specificity 76.30%), respectively. In women, the optimal cut-off values of FLI and BMI for diagnosing MAFLD were 45 (sensitivity 80.11%, specificity 74.23%) and 28.0 (sensitivity 79.56%, specificity 75.41%), respectively. In men and women, an FLI score of < 30 ruled out MAFLD, while a score of ≥ 50 was a basis for diagnosis.

CONCLUSION

FLI and BMI had good screening ability for MAFLD and were superior to HSI, LAP, VAI, and ZJU in both sexes.

The ZJU index is associated with the risk of obstructive sleep apnea syndrome in Chinese middle-aged and older people: a cross-sectional study

BACKGROUND

The ZJU index, a novel calculation that combines body mass index, triglycerides, fasting blood glucose and the ratio of alanine aminotransferase to aspartate aminotransferase, is a closely related measure of obesity and insulin resistance. Studies of the ZJU index in relation to obstructive sleep apnea syndrome (OSAS) have not been reported. This study assessed the correlation between the ZJU values and OSAS risk.

METHODS

A total of 2,130 participants who underwent polysomnographic monitoring were included in the study. The participants' basic information and laboratory biochemical indicators were collected, and the ZJU index was computed. The ZJU index was divided into quartiles. The correlation between the different ZJU index levels and OSAS risk was assessed using logistic regression. Drew a receiver operating characteristic (ROC) relationship curve, with prediction efficacy judged by the area under the curve (AUC), and found the optimum cut-off point for ZJU index to predict OSAS. Relative risks were presented as odds ratios (OR). The range of OR values is expressed in the form of 95% confidence intervals (95% CI).

RESULTS

The number of patients diagnosed with OSAS increased progressively with increasing ZJU index (T1: 9.4%; T2: 20.6%; T3: 28.3%; T4: 41.7%; P < 0.001). The additional confounders were adjusted by the logistic regression models, the study revealed an independent correlation between ZJU index and OSAS. (P < 0.001). The OSAS risk was notably higher at the highest ZJU index levels. (OR = 2.046 [95% CI: 1.057 to 3.964]). The ROC curve for the ZJU index showed an AUC of 0.64 (P < 0.001) for males and 0.75 (P < 0.001) for females, with a specificity of 64% and 55% and a sensitivity of 60% and 92% for males and females, respectively, with the optimum cut-off values of 36.568 and 34.722, respectively.

CONCLUSION

A high ZJU index was significantly associated with an increasing risk of OSAS. The ZJU is expected to be a meaningful index for detecting OSAS in the general population.

Dose-response association of the ZJU index and fatty liver disease risk: A large cohort in China

AIM

The aim of this study is to investigate the sex-specific association between the ZJU index and risk of fatty liver disease in a large Chinese cohort.

METHODS

A total of 28 729 adults without fatty liver disease at baseline and who completed at least one follow-up of annual examinations between 2009 and 2016 were included in this study. The Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for fatty liver disease risk associated with the ZJU index.

RESULTS

During a median follow-up of 3.01 years, 7373 developed fatty liver disease. There were significant associations between the ZJU index and fatty liver disease for women and men with increasing HRs as the quartiles increase across Q2-Q4, corresponding HRs (95% CIs) in M3 were 2.28 (1.98-2.64), 3.52 (3.07-4.04), and 4.87 (4.24-5.59) for women and 2.44 (2.17-2.75), 4.18 (3.73-4.68), and 6.23 (5.56-6.98) for men. The association between the ZJU index and fatty liver disease risk remained significant in all the subgroups except that of T2DM and abdominal obesity subgroups for men. However, the association became nonsignificant when comparing Q3 and Q2 of the ZJU index with reference in the subgroups of T2DM for men, and nonsignificant when comparing Q3 of the ZJU index with reference in the subgroups of participants with T2DM and abdominal obesity for women.

CONCLUSION

The ZJU index was significantly associated with the risk of fatty liver disease in Chinese population. It will be better to keep body mass index, alanine aminotransferase, aspartate aminotransferase, triglyceride, and fasting plasma glucose at a normal level for preventing fatty liver disease.

Risk for the development of non-alcoholic fatty liver disease: A prospective study

BACKGROUND AND AIM

Non-invasive assessment was widely used to identify the risk of non-alcoholic fatty liver disease (NAFLD) among individuals with increased metabolic risks. This study aimed to investigate the prospective relationship between ZJU index and the development of NAFLD in a Chinese population.

METHODS

A cohort of 6310 initially NAFLD-free participants was enrolled in this prospective study. Abdominal ultrasound was used to diagnosis NAFLD. NAFLD incidence was calculated among participants with different baseline ZJU index quintiles. Cox proportional hazards regression analyses were conducted to calculate the risks for incident NAFLD.

RESULTS

During 37 705 person-year follow-ups, 1071 incident NAFLD cases were identified. The baseline ZJU index was linear and positively correlated with NAFLD incidence. The incidence was 5.53, 11.75, 23.77, 43.28, and 85.60 cases per 1000 person-year follow-up for participants with baseline ZJU index in quintiles 1-5, respectively. Compared with participants with baseline ZJU index in quintile 1, the hazard ratios (95% confidence interval) for incident NAFLD were 2.092 (1.458-3.002), 4.094 (2.942-5.698), 7.095 (5.167-9.742), and 13.191 (9.684-17.968) for participants with baseline ZJU index in quintiles 2-5, respectively. Further analysis found that the changes of ZJU index during follow-up was also independently associated with risk for incident NAFLD.

CONCLUSIONS

Baseline ZJU index and absolute ZJU index changes independently predicts the risk for incident NAFLD in Chinese population.

Validation of simple indexes for nonalcoholic fatty liver disease in western China: a retrospective cross-sectional study

Various noninvasive algorithms have been developed for predicting the presence of nonalcoholic fatty liver disease (NAFLD). The evaluation of the indexes' diagnostic performance has been reported in Europe and Asia over the past decade; however, external validation of them in China is rare. This study was aimed to evaluate various indexes for NAFLD in western China. It was a retrospective cross-sectional study, using data from a large-scale health check-up project at Sichuan provincial hospital. Receiver operating characteristic (ROC) curves of eight indexes, including the fatty liver index (FLI), the hepatic steatosis index, lipid accumulation product and etc., were developed to predict ultrasonographic NAFLD. There were 13,122 subjects in this study (2,692 NAFLD patients and 10,430 non-NAFLD participants). The area under ROC curve of FLI for predicting NAFLD was 0.880 (95% confidence interval, 0.874-0.886), which was significantly higher than other seven indexes. Accuracy, sensitivity and specificity of FLI for NAFLD were good (cut-off value = 30, 0.782, 0.832, 0.770 and cut-off value = 60, 0.838, 0.443, 0.940, respectively). Furthermore, FLI also presented advantages in expenditure and accessibility, compared with other indexes. It supports FLI as an easily accessible index for physicians and a reliable predictor for NAFLD screening in western China.