Stronger association of triglyceride glucose index than the HOMA-IR with arterial stiffness in patients with type 2 diabetes: a real-world single-centre study

Relationship between insulin resistance surrogate markers with diabetes and dyslipidemia: A Bayesian network analysis of Korean adults

Insulin resistance (IR) can be optimally assessed using the euglycemic clamp, but practical clinical limitations necessitate surrogate markers. This study leveraged the Bayesian network analysis to evaluate three established IR markers: the Homeostatic Model Assessment of IR (HOMA-IR) using insulin level and fasting blood glucose (FBG), TG-Glucose (TyG) index using triglycerides (TG) and FBG, and TG-to-HDL ratio (TG/HDL ratio) using TG and high-density lipoprotein (HDL), based on the Korean National Health and Nutrition Examination Survey data (2019-2021). Our analysis revealed a sequential association pattern (TG/HDL ratio → TyG index → HOMA-IR), positioning the TyG index as a central connecting marker. The HOMA-IR exhibited strong predictive power for diabetes, while the TG/HDL ratio was most effective for assessing dyslipidemia. However, both had limited crossover utility. In contrast, the TyG index bridged this gap, demonstrating robust predictive capability for both conditions. The Markov blanket analysis illuminated the distinctive metabolic signatures of each marker: The TyG index displayed balanced glucose-lipid metabolic contributions, the HOMA-IR predominantly reflected glucose metabolism and obesity characteristics, and the TG/HDL ratio emphasized lipid metabolism. Notably, the TyG index's predictive performance showed significant enhancement when integrated with obesity information, contrasting with the HOMA-IR's minimal response owing to its inherent incorporation of obesity characteristics. These findings position the TyG index as a superior clinical marker, offering both comprehensive predictive capability and enhanced performance through synergistic integration with obesity measures. While each marker demonstrated reliability, the TyG index's unique combination of versatility and scalability establishes it as an effective tool for comprehensive metabolic risk assessment.

Inverse association of triglyceride-glucose and triglyceride/HDL-c indexes with serum 25(OH) vitamin D levels in US adults

The triglyceride-glucose index (TyG) and the triglyceride to high-density lipoprotein ratio (TG/HDL-c) are novel indicators for assessing insulin resistance (IR) in epidemiological studies. This study aimed to evaluate the association between 25-hydroxy-vitamin D [25(OH)D] levels and these two indicators in the adult population of the United States. 14,380 participants aged 20 years and older were included from the National Health and Nutrition Examination Survey (NHANES). Multivariable linear regression models were used to analyze the association between 25(OH)D and TyG, as well as TG/HDL-c. Smooth fitting curves were employed to identify potential non-linear relationships between 25(OH)D, TyG, and TG/HDL-c. The findings revealed a negative association between 25(OH)D and TyG, with the effect being more pronounced in males and individuals with diabetes (p < 0.01). Similarly, 25(OH)D was negatively associated with TG/HDL-c, with a stronger impact observed in males compared to females. The study population was divided into four quartiles based on 25(OH)D concentration, and TyG and TG/HDL-c levels in Q3 and Q4 were lower than those in Q1. Furthermore, a non-linear relationship was observed between 25(OH)D and TyG, with an inflection point at 19.352 ng/mL. A non-linear relationship was also found between TG/HDL-c and 25(OH)D, with an inflection point at 37.211 ng/mL. 25(OH)D is an independent factor significantly associated with TyG and TG/HDL-c indexes. This negative association may be related to the role of 25(OH)D in insulin resistance.

Enhanced Stroke Risk Stratification Using Triglyceride-Glucose-Waist Circumference in Chinese Adults Without Diabetes

INTRODUCTION

Insulin resistance is a well-establsihed risk factor for stroke. However, the relationship between triglyceride-glucose (TyG) index; its modified indices‒TyG-waist circumference (TyG-WC); TyG-waist-to-height ratio (TyG-WHtR); and TyG-BMI and the risk of stroke in populations without diabetes remains underexplored.

METHODS

Data from the CHARLS on 4,029 participants without diabetes aged 45+ years at baseline (2011‒2012) were analyzed, with follow-ups through 2020. Statistical analysis and modeling were performed in 2024. Incident strokes occurring between 2015 and 2020 were examined. TyG and its modified indices were categorized into tertiles and analyzed based on baseline levels, changes over time, and cumulative measures. Changes in TyG and its modified indices were identified using K-means clustering, while cumulative indices were calculated using a formula: (TyG2012+TyG2015)/2 × time (2015-2012).

RESULTS

Between 2015 and 2020, 225 participants (5.6%) experienced a stroke. After full adjustment, for cofounders only TyG-WC remained significantly associated at each level across its baseline levels, changes, and cumulative measures (p<0.05), outperforming TyG, TyG-WHtR and TyG-BMI. Compared to Tertile 1, AORs (95% CIs) for stroke associated with TyG-WC were 1.64 (1.10, 2.47) in Tertile 2 and 1.79 (1.15, 2.82) in Tertile 3. For changes in TyG-WC, ORs (95% CIs) were 1.70 (1.14, 2.60) in Class 2 and 1.80 (1.11, 2.97) in Class 3. Regarding cumulative TyG-WC, the ORs (95% CIs) were 1.61 (1.08, 2.41) for Tertile 2 and 1.70 (1.10, 2.66) for Tertile 3. Additionally, TyG-WC demonstrated superior predictive performance for stroke compared to other indices.

CONCLUSIONS

TyG-WC is strongly associated with stroke risk in populations without diabetes, offering superior risk stratification compared to other TyG indices.

Stronger associations of the phase angle than the TyG index with micro- and macrovascular complications in patients with type 2 diabetes

BACKGROUND

Identifying micro- and macrovascular damage through microalbuminuria and arterial stiffness is essential for preventing renal and cardiovascular complications in patients with type 2 diabetes mellitus (T2D). The primary goal of this research is to investigate the association of the phase angle (PA), triglyceride‒glucose (TyG) index, and homeostasis model assessment for insulin resistance (HOMA-IR) with microalbuminuria and arterial stiffness in patients with T2D.

METHODS

In this retrospective cross-sectional study, 938 participants with T2D were enrolled. The PA was calculated from bioelectrical impedance analysis. Logistic regression was used to analyze the association of PA, the TyG index and HOMA-IR with microalbuminuria (urinary albumin-to-creatinine ratio [UACR] > 30 mg/g using overnight urine) and increased arterial stiffness (brachial-ankle pulse wave velocity [baPWV] > 1400 cm/s), respectively. Potential nonlinear relationships between PA, the TyG index, and the prevalence of microalbuminuria and increased arterial stiffness were assessed via restricted cubic splines (RCS). Subgroup analysis evaluated the robustness of the association.

RESULTS

PA was inversely correlated with the UACR (r = -0.29, P < 0.001) and baPWV (r = -0.37, P < 0.001). Confounder-adjusted analyses revealed that the highest tertile of PA was significantly associated with lower prevalences of both microalbuminuria and increased arterial stiffness than the lowest tertile, with ORs of 0.305 and 0.467 and P trends < 0.001 and 0.017, respectively. Conversely, the highest TyG tertile was associated with increased prevalences of microalbuminuria and increased arterial stiffness, with ORs of 1.727 and 1.625, respectively, but the P trends were not statistically significant. There were no significant associations between HOMA-IR and microalbuminuria and increased arterial stiffness. RCS analysis further confirmed a significant linear relationship between PA and both vascular complications. Subgroup analyses consistently demonstrated the association between PA and microalbuminuria across all subgroups stratified by sex, age, BMI, HbA1c, and duration of diabetes (all P < 0.01).

CONCLUSIONS

Compared with the TyG index and HOMA-IR, PA is independently and more strongly associated with microalbuminuria and increased arterial stiffness in patients with T2D.

Association between estimated glucose disposal rate and metabolic syndrome: a cross-sectional analysis of the National Health and Nutrition Examination Survey

Metabolic syndrome (MS) is a complex metabolic disorder that is often closely associated with the development of chronic diseases such as cardiovascular disease and diabetes. This study aimed to explore the relationship between estimated glucose metabolic rate (eGDR) and MS. The correlation between eGDR levels and the prevalence of metabolic syndrome was analyzed here based on data from the National Health and Nutrition Examination Survey from 2005 to 2020. The study sample consisted of 63,131 adult participants, and the results showed that lower eGDR levels were significantly associated with a higher prevalence of metabolic syndrome. Further regression analyses showed that eGDR acted as a protective factor and that the risk of MS significantly decreased as its level increased. Subgroup analyses showed that this trend held across gender, age, and BMI categories, and that the protective effect of eGDR was weaker in the higher BMI group. Based on the nonlinear relationship between subjects' eGDR levels and MS prevalence, RCS analyses further confirmed a significant correlation between lower eGDR levels and increased risk of MS. In conclusion, the present study suggests that eGDR levels could serve as a potential biomarker for predicting metabolic syndrome, providing new perspectives for early screening and intervention of MS.

Assessing the impact of insulin resistance trajectories on cardiovascular disease risk using longitudinal targeted maximum likelihood estimation

BACKGROUND

Cardiovascular disease (CVD) is closely associated with Insulin Resistance (IR). However, there is limited research on the relationship between trajectories of IR and CVD incidence, considering both time-invariant and time-varying confounders. We employed advanced causal inference methods to evaluate the longitudinal impact of IR trajectories on CVD risk.

METHODS

The data for this study were extracted from a Chinese nationwide cohort, named China Health and Retirement Longitudinal Study (CHARLS). Triglyceride-glucose (TyG) index and TyG body mass index (BMI) were used as surrogate markers for IR, and their changes were recorded as exposures. Longitudinal targeted maximum likelihood estimation (LTMLE) was used to study how dynamic shifts in IR trajectories (i.e., increase, decrease, etc.) influence long-term CVD risk, adjusting for both time-invariant and time-varying confounders.

RESULTS

A total of 3,966 participants were included in the analysis, with 2,152 (54.3%) being female. The average age at baseline was 58.28 years. Over the course of a 7-year follow-up period, 499 (12.6%) participants developed CVD. Four distinct trajectories of TyG index and TyG-BMI were identified: low stable, increasing, decreasing, and high stable. LTMLE analyses revealed individuals in the 'high stable' and 'increasing' groups had a significantly higher risk of developing CVD compared to those in the 'low stable' group, while the 'decreasing' group showed no significant differences. Specifically, when the exposure was set as TyG-BMI, the odds of CVD in the 'high stable' group were 1.694 (95% CI: 1.361-2.108) times higher than in the 'low stable' group. Similar trends were observed across other models, with ORs of 1.708 (95% CI: 1.367-2.134) in Model 2, 1.389 (1.083-1.782) in Model 3, 1.675 (1.185-2.366) in Model 4, and 1.375 (95% CI:1.07 - 1.768) in Model 5. When the exposure was changed to the TyG index, the results remained consistent, with a slightly lower magnitude of the odds ratios.

CONCLUSIONS

High stable and increasing TyG-BMI and TyG index trajectories were associated with the risk of CVD. TyG-BMI consistently exhibited higher odds ratios (ORs) of CVD risk when comparing with TyG index. Early identification of IR trajectories could provide insights for preventing CVD later in life.

Association between metabolic visceral fat score and left ventricular hypertrophy in individuals with type 2 diabetes

BACKGROUND

Left ventricular hypertrophy (LVH), a hallmark of early-stage heart failure (HF), is a common complication in individuals with type 2 diabetes mellitus (T2DM). Metabolic Visceral Fat Score (METS-VF), a novel metric for estimating visceral adiposity, may provide valuable insights into LVH risk. This study explores the association between METS-VF and LVH in T2DM and compare its predictive performance to traditional abdominal obesity indices.

METHODS

This cross-sectional study included 4,988 adults with T2DM. Participants were stratified into quartiles based on METS-VF. Logistic regression models assessed the association between METS-VF and LVH. Restricted cubic spline analyses evaluated nonlinear relationships, while stratified analyses explored subgroups effects. Receiver operating characteristic (ROC) curves compared the predictive performance of METS-VF with other indices.

RESULTS

LVH prevalence increased across METS-VF quartiles (Quartile 1: 7.9%; Quartile 2: 13.0%; Quartile 3: 20.0%; Quartile 4: 31.0%; P < 0.001). Higher METS-VF was independently associated with LVH (OR: 9.79; 95% CI: 6.16-15.76; P < 0.001). A nonlinear relationship was observed between METS-VF and LVH, with a steeper risk increase above specific thresholds. Stratified analyses showed that the positive association between METS-VF and LVH was consistent. METS-VF outperformed traditional indices in predicting LVH (AUC: 0.68; 95% CI: 0.66-0.70).

CONCLUSIONS

METS-VF is strongly associated with LVH in T2DM, demonstrating superior predictive performance compared to traditional indices. METS-VF is a practical, cost-effective tool for early cardiac risk stratification, facilitating timely interventions to mitigate HF risk in T2DM populations.

Sex-specific optimal cut-off points for metabolic health indicators to predict incident type 2 diabetes mellitus

BACKGROUND AND AIM

We aimed to determine the optimal cut-off points for metabolic health indicators, including insulin resistance (IR), glucose, insulin, BMI, and waist circumference, in middle-aged nondiabetic people to predict future type 2 diabetes mellitus (T2DM).

METHODS AND RESULTS

The data came from 12,543 Atherosclerosis Risk Communities Study participants, including 5758 men and 6785 women. They did not have diabetes at baseline and were followed for incident T2DM within 3, 6, and 9 years. IR was estimated using four IR metrics: HOMA-IR, METS-IR, TyG index, and TG/HDL-C. We used the Youden index to determine the optimal cut-off values. In females, the cut-off points for glucose to predict incident T2DM ranged from 96 to 102 mg/dL, with Area Under the Curve (AUC) values of 0.64-0.85. In males, the cut-off points ranged from 102 to 106 mg/dL, with AUC values of 0.60-0.83. For HOMA-IR, the cut-off points in females varied from 2.4 to 3.2, with AUC values of 0.69-0.78, while they ranged from 2.8 to 3.2 in males. The optimal cut-off values for METS-IR, TyG index, TG/HDL-C, insulin, BMI, and waist circumference were 40-43, 8.6-8.9, 2.0-3.2, 9-15 μU/mL, 28-29 kg/m2, and 91-97 cm in women, and 44-45, 8.8-8.9, 2.9-3.2, 11-12 μU/mL, 27-29 kg/m2, and 99-103 cm in men.

CONCLUSIONS

The optimal threshold for each predictor's prediction of incident T2DM varied by sex. The eight predictors' order of predictive performance were fasting glucose, HOMA-IR, METS-IR, insulin, BMI, waist circumference, TyG index, and TG/HDL-C.

Association between METS-IR index and obstructive sleep apnea: evidence from NHANES

Insulin resistance (IR) is strongly associated with obstructive sleep apnea (OSA). Whereas, few studies have focused on the potential association between the Metabolic Score for Insulin Resistance (METS-IR), a novel non-insulin-dependent IR index, and OSA. Subjects from the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2008 and 2015-2018 were recruited. The potential relationship between METS-IR and other IR indices with OSA was explored through three logistic regression analysis models and restricted cubic spline (RCS) curves. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of these indicators for OSA. On the basis of age, sex, race, body mass index (BMI), hypertension, diabetes， and cardiovascular disease (CVD), subgroup analyses were conducted to test the robustness of the METS-IR and OSA relationship. A total of 8,306 participants were enrolled, with an OSA prevalence of 30.69%. After adjusting for potential confounders, METS-IR, the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, the triglyceride glucose Index (TyG), and the homeostatic model assessment of insulin resistance (HOMA-IR) showed positive associations with OSA prevalence. In the highest tertile of METS-IR, TG/HDL-C, TyG index, and HOMA-IR, OSA prevalence was 2.96-fold, 1.42-fold, 1.29-fold, and 1.41-fold higher, respectively, compared to the lowest tertile (METS-IR: OR = 2.96, 95% CI: 2.50, 3.52, P < 0.0001; TG/HDL-C: OR = 1.42, 95% CI: 1.17, 1.73, P < 0.001; TyG index: OR = 1.29, 95% CI: 1.07, 1.55, P = 0.008; HOMA-IR: OR = 1.41, 95% CI: 1.18, 1.69, P < 0.001). ROC analysis revealed that METS-IR had the highest diagnostic accuracy for OSA (AUC = 0.652). The positive associations between these four IR indices and OSA remain stable across most cases (P for interaction > 0.05); however, all of them show significant interactions with diabetes (P for interaction < 0.05). The METS-IR index is positively associated with the prevalence of OSA and shows superior diagnostic accuracy compared to HOMA-IR, TG/HDL-C, and TyG index.

Association Between Triglyceride-Glucose Related Index and Endometriosis Varies According to Educational Level

BACKGROUND

The association between the triglyceride-glucose (TyG) level, its obesity-related derivatives, and the occurrence of endometriosis (EMS) remains ambiguous, particularly in individuals with higher levels of education. This study sought to explore the relationship between TyG, its obesity-related derivatives, and EMS across various educational backgrounds.

METHODS

This study utilized a substantial dataset obtained from four cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2006. To explore the relationship between TyG, its obesity-related derivatives, and EMS, we employed a variety of analytical methods, including multivariable logistic regression models, smooth curve fitting, threshold effect analysis, and subgroup analysis, which were applied to participants with varying educational levels.

RESULTS

Among the 2347 participants, 203 (8.65%) were diagnosed with EMS. In the overall population, only the TyG, TyG-waist-to-height ratio (TyG-WHtR), and TyG-waist circumference (TyG-WC) variables demonstrated a positive association with EMS. However, within the group with high educational attainment, TyG, TyG-WHtR, TyG-WC, and TyG-body mass index (TyG-BMI) all exhibited positive correlations with EMS. These associations remained robust after adjustment for multiple potential confounding variables. The subgroup analysis demonstrated that these associations were consistent across different subgroups (p > 0.05). Furthermore, both linear and nonlinear relationships were observed between TyG and its obesity-related derivatives and EMS, as evidenced by the smooth curve fittings and threshold effect analyses. In contrast, no significant associations were identified in the group with lower levels of education.

CONCLUSIONS

Our study suggests that there is variation in the association between TyG and its obesity-related derivatives and EMS across different educational levels, warranting further investigation. In individuals with higher education, elevated levels of TyG and its obesity-related derivatives were associated with a higher prevalence of EMS. Conversely, this correlation was not observed among those with lower educational levels.

Association of different insulin resistance surrogates with all-cause and cardiovascular mortality among the population with cardiometabolic multimorbidity

BACKGROUND

The coexistence of cardiometabolic diseases (CMDs), defined as cardiometabolic multimorbidity (CMM), has been shown to significantly elevate mortality risk. Insulin resistance (IR) is one of the main contributing factors to the pathogenesis of CMM. Although several surrogates for IR are employed in clinical evaluations, their relationship with mortality in individuals with CMM remains unclear. This study aimed to investigate the associations between various IR surrogates and mortality in individuals with CMM, and to evaluate their prognostic value.

METHODS

This study enrolled 1093 patients diagnosed with CMM. We developed five surrogate markers to assess IR levels: triglyceride-glucose (TyG) index, TyG-waist circumference (TyG-WC), TyG-waist height ratio (TyG-WHtR), homeostatic model assessment of insulin resistance (HOMA-IR), and metabolic score for insulin resistance (METS-IR). To investigate the associations between different IR surrogates and both all-cause and cardiovascular mortality, multivariable Cox proportional hazards models were applied. We employed restricted cubic splines to examine non-linear associations, and Cox models were developed on either side of the inflection point for additional investigation. Meanwhile, the predictive values of five IR surrogates were further assessed.

RESULTS

Of the 477 all-cause deaths that occurred during a median follow-up of 5.8 years, 197 were related to cardiovascular disease. Among five surrogate markers of IR, the TyG index was the only one that significantly correlates with both all-cause and cardiovascular mortality. The threshold value for both types of mortality was 8.85. A TyG index beneath the inflection point exhibits an inverse correlation with cardiovascular mortality (HR 0.483; 95% CI = 0.281-0.831) and all-cause mortality (HR 0.519; 95% CI = 0.368-0.732). On the other hand, when the TyG index surpassed the inflection point, it demonstrated a positive correlation with cardiovascular mortality (HR 1.413; 95% CI = 1.075-1.857) and all-cause mortality (HR 1.279; 95% CI = 1.070-1.529). Based on the analysis of receiver operating characteristics, the TyG index has been recognized as a dependable predictor of survival outcomes.

CONCLUSIONS

This study emphasizes the prognostic significance of IR surrogates, particularly the TyG index, in predicting mortality among individuals with CMM. The TyG index constitutes a crucial element in the development of management and intervention strategies for these patients.

Triglyceride-glucose-body mass index and the incidence of cardiovascular diseases: a meta-analysis of cohort studies

BACKGROUND

Numerous studies have shown that insulin resistance (IR) is closely related to the pathogenesis of cardiovascular disease (CVD). This study aims to summarize the correlation between the triglyceride-glucose-body mass index (TyG-BMI index), a novel surrogate indicator of insulin resistance, and the incidence of CVD in patients without CVD at baseline through meta-analysis.

METHOD

Cohort studies assessing multivariate-corrected hazard ratios (HRs) for associations between the TyG-BMI index and cardiovascular disease (CVD) were obtained by searching PubMed, Cochrane Library, EMBASE, and Web of Science. Results were combined using a random-effects model to account for heterogeneity among the included studies. Robust error meta-regression was used to fit the nonlinear dose-response relationship. Statistical analysis was performed using Review Manager 5.4 and STATA 18.0.

RESULT

Ten cohort studies involving a total of 871,728 subjects were included. The results indicated that Compared with the lowest TyG-BMI index category, the highest TyG-BMI index was related to a higher incidence of cardiovascular diseases (CVD) (HR = 1.62; 95% confidence interval (CI): 1.35-1.95; I2 = 94%),coronary artery disease (CAD) (HR = 1.69; 95% (CI): 1.23-2.31; I2 = 94%). stroke(HR = 1.57; 95% (CI): 1.11-2.23; I2 = 94%).In the dose-response analysis, there was a linear association of the TyG-BMI index with the risk of CVD (Pnonlinear = 0.223), CAD (Pnonlinear = 0.693), and stroke (Pnonlinear = 0.122)No significant effects were observed regarding participants' gender, length of follow-up, sample size or mean age(P > 0.05).

CONCLUSION

Higher TyG-BMI may be independently associated with an increased risk of CVD in individuals without CVD at baseline. Numerous cohort studies are needed to further validate and elucidate the pathologic role between Tyg-BMI and CVD and to determine whether it can be incorporated into CVD risk prediction tools to enhance predictive accuracy.

Prediction of MASLD using different screening indexes in Chinese type 2 diabetes mellitus

BACKGROUND

Formerly known as non-alcoholic fatty liver disease (NAFLD), metabolic dysfunction-associated steatotic liver disease (MASLD) has now become the most widespread chronic liver disease worldwide. The primary goal of this study is to assess the ability of different indexes (including VAI, TyG, HOMA-IR, BMI, LAP, WHtR, TyG-BMI, TyG-WC, and TyG-WHtR) to predict MASLD in individuals diagnosed with type 2 diabetes mellitus (T2DM), particularly within the Chinese population.

METHODS

This cross-sectional study involved 1,742 patients with T2DM, recruited from the Metabolic Management Centers (MMC) at Suzhou Municipal Hospital. Abdominal ultrasonography was employed for MASLD diagnosis in patients with T2DM. The predictive accuracy of various screening indexes for MASLD in the Chinese T2DM population was evaluated using logistic regression and receiver operating characteristic (ROC) curve analyses.

RESULTS

Among the 1,742 participants, 996 were diagnosed with MASLD. After adjusting for potential confounding factors, positive associations with the risk of MASLD were found for all the nine indexes. The lipid accumulation product (LAP) exhibited the greatest predictive value for detecting MASLD, with an area under the curve (AUC) of 0.786(95%CI 0.764,0.807), followed by BMI(AUC = 0.785), VAI(AUC = 0.744), TyG(AUC = 0.720), WHtR(AUC = 0.710) and HOMA-IR(AUC = 0.676). The composite Indexes (TyG-BMI, TyG-WC, TyG-WHtR) also showed considerable predictive ability with AUCs of 0.765, 0.752 and 0.748, respectively.

CONCLUSION

Our results indicated that all nine indexes have favorable correlations with the risk of MASLD, and most of them have a good performance in predicting MASLD. According to our study, LAP was a reliable index for predicting MASLD among Chinese T2DM patients. The exploration of non-invasive screenings will provide significant support for the early detection and diagnosis of MASLD.

A comparison between lipid-based vs. glycemic-based insulin sensitivity indices for the association with abnormal ECG findings and 20-year mortality among older adults

BACKGROUND

A direct comparison between glycemic-based and lipid-based insulin sensitivity indices (ISIs) for ECG findings and all-cause and cardiovascular mortality is lacking.

METHODS

963 community-dwelling older adults, examined as part of the third phase of the Glucose intolerance, Obesity, and Hypertension study between 1999 and 2008, were followed until December 2016 and December 2019 for cardiovascular and all-cause mortality, respectively. Eleven different ISIs were calculated and evaluated against ECG findings, all-cause, and cardiovascular mortality with multivariable regression models. The area under the receiver operating curve (AUC) and net reclassification improvement (NRI) analysis were implemented to compare ISIs performance.

RESULTS

Mean age was 72.3 ± 7 years and 471 (49%) were females. Ischemic ECG changes were observed in 107 (11.2%) individuals. Upper quartile (Q4) of triglyceride-glucose waist-to-height ratio (TyG-WTHR) was associated with 220% greater odds for ischemic changes on ECG compared with lower quartiles (Q1-3) (95%CI:1.3-3.7, p = 0.004), an association that was not observed with other ISIs. During a median follow-up of 13 [IQR-8] and 11 [IQR-6] years for all-cause and CV mortality, respectively, 466 (48.4%) participants died, of them, 179 (38.4%) were attributed to cardiovascular causes. TyG-WTHR was the only ISI that was associated with both all-cause (HR = 1.3, 95%CI:1.0-1.6, p = 0.04) and cardiovascular (HR = 1.7, 95%CI:1.2-2.4, p = 0.004) mortality. Lipid based and glycemic ISIs showed similar predicative ability with slightly better predictive performance for TyG-WTHR for all-cause mortality (AUC = 0.46, 95%CI:0.4-0.5, p = 0.02). The NRI analysis revealed better reclassification ability for triglyceride-high-density-lipoprotein ratio (95%CI: 0.02-0.27, p = 0.03) and TyG-WTHR (95%CI: 0.0004-0.01, p = 0.03) for all-cause mortality while TyG-WTHR-based model correctly reclassified 19% of participants (95%CI: 0.02-0.36, p = 0.03) for cardiovascular mortality compared with model unadjusted for any ISIs and correctly reclassified 3% (95%CI:0.003-0.05, p = 0.02) compared with QUICKI based-model for all-cause mortality.

CONCLUSIONS

TyG-WTHR was the only ISI associated with ischemic changes on ECG and all-cause and cardiovascular mortality and significantly improved the predictive performance for all-cause cardiovascular mortality. While most glycemic-based and lipid-based ISIs showed similar predictive ability, TyG-WTHR stands as the preferred ISI and should be considered for screening at-risk individuals for cardiovascular morbidity and mortality.

[Association between the triglyceride-glucose index and the incidence of nephrolithiasis in male individuals]

OBJECTIVE

To analyze the association between the triglyceride-glucose (TyG) index and the risk of nephrolithiasis across various demographic and clinical subgroups, aiming to enhance early diagnosis and treatment of nephrolithiasis and promote personalized care in diverse populations.

METHODS

This cross-sectional study analyzed the medical records of 84 968 adults, stratified into three categories (low, middle, high) according to their TyG index scores. To evaluate the association between the TyG index and nephrolithiasis risk, multivariable Logistic regression models were employed, adjusting for potential confounders. Additionally, piecewise linear regression models were used to investigate the non-linear dynamics of the TyG index's relationship with nephrolithiasis risk. Subgroup analyses were performed to explore variations in the effects of the TyG index across different demographic and clinical populations.

RESULTS

Increasing TyG index was associated with a higher risk of nephrolithiasis, rising from 4.36% in the low group to 8.96% in the high group (P < 0.001). In adjusted models, males in the middle and high TyG index categories demonstrated significantly elevated risks of nephrolithiasis, with odds ratios of 1.18 (95%CI: 1.07-1.31, P=0.002) and 1.29 (95%CI: 1.15-1.45, P < 0.001), respectively. Conversely, in females, the association was not statistically significant post-adjustment (OR=0.98, 95%CI: 0.82-1.16, P=0.778). Among males, for each unit increment in the TyG index below the critical threshold of 8.98, there was a notable 40% escalation in the risk of developing nephrolithiasis (OR=1.40, 95%CI: 1.24-1.58, P < 0.001). Surpassing this threshold, the TyG index no longer conferred a significant increase in risk (OR=0.91, 95%CI: 0.78-1.06, P=0.24). Subgroup analyses indicated that this association remained stable regardless of age, BMI, or hypertension status.

CONCLUSION

The TyG index is positively associated with the risk of nephrolithiasis in males, demonstrating a nonlinear dose-response relationship that becomes especially pronounced at certain index levels. This biomarker could potentially serve as a valuable clinical tool for identifying males who are at a high risk of developing nephrolithiasis, thereby enabling targeted preventive strategies. Further research is urgently needed to explore the underlying mechanisms and to verify the applicability of these results across different populations.

Correlations of the triglyceride-glucose index and modified indices with arterial stiffness in overweight or obese adults

Background

Insulin resistance (IR) contributes substantially to the development of cardiovascular disease (CVD) and metabolic disorders, particularly obesity. The homeostatic model assessment of IR is a prevalent IR indicator, but insulin measurement is quite impractical for widely use. Given its convenience and accessibility, the triglyceride-glucose (TyG) index, along with modified indices such as the triglyceride-glucose-waist circumference (TyG-WC) and triglyceride-glucose-waist-height ratio (TyG-WHtR), are gaining recognition as practical tools for assessing IR. This study aimed to investigate the specific correlation between the TyG index and its modified indices with arterial stiffness in an overweight or obese population and to explore novel, self-defined modified TyG indices for identifying individuals at elevated risk for such conditions.

Methods

This retrospective study included 1,143 overweight or obese individuals from 2021 to 2023. Medical data, including brachial-ankle pulse wave velocity (baPWV), were collected. Two novel modified TyG indices, TyG-1h and TyG-2h, were defined by substituting the fasting glucose level in the TyG formula with 1-hour and 2-hour post-load plasma glucose levels, respectively. Multivariate logistic regression analyses were conducted to identify parameters that demonstrated a statistically significant correlation with arterial stiffness, defined as a baPWV threshold of ≥ 1400 cm/s. Additionally, restricted cubic spline (RCS) modelling was employed to further explore these relationships in a visually interpretable manner. To evaluate and compare the diagnostic accuracy of the conventional TyG index and its novel modified versions, receiver operating characteristic (ROC) curve analyses were performed.

Results

Our findings revealed that individuals with arterial stiffness presented significantly elevated TyG index and all its modified versions (P< 0.05). By utilizing a binary logistic regression model and adjusting for potential confounders, we determined that all TyG-related parameters independently correlated with an increased risk of developing arterial stiffness. Moreover, TyG-WHtR displayed the best correlation (OR 3.071, 95% CI 1.496-6.303) when stratified by quartiles, followed by TyG-1h (OR 2.298, 95% CI 1.248-4.234) and TyG-2h (OR 2.115, 95% CI 1.175-3.807). ROC curves suggested that TyG-1h and TyG-2h demonstrated superior diagnostic performance compared to TyG, with AUCs of 0.685, 0.679 and 0.673, respectively.

Conclusions

The modified TyG indices exhibited strong effectiveness in identifying arterial stiffness in Chinese overweight or obese individuals.

Association of HOMA-IR Versus TyG Index with Diabetes in Individuals Without Underweight or Obesity

Background: There are higher numbers of Asian individuals with metabolically obese, normal weight (MONW) who are susceptible to diabetes than other ethnic groups. The homeostatic model assessment for insulin resistance (HOMA-IR) has been used for years to evaluate IR; however, the triglyceride-glucose (TyG) index has been highlighted as a reliable and cost-effective insulin resistance indicator. Thus, this study explored the association of the HOMA-IR versus the TyG index with diabetes in individuals without underweight or obesity. Methods: This cross-sectional study included 10,471 Korean individuals whose body mass index was ≥18.5 and <25.0 kg/m2. Depending on metabolic syndrome criteria, subjects with no conditions, one or two conditions, and three or more conditions were assigned to the metabolically healthy and normal weight (MHNW), pre-MONW, and MONW groups, respectively. Diabetes was diagnosed based on HbA1C and medication information. Results: The HOMA-IR and TyG index discriminated between each group, showing an increasing trend from the MHNW group to the MONW group. However, this trend was more robust for the TyG index. The cut-off values in the TyG index and HOMA-IR were >8.9 and >1.6 in males and >8.7 and >1.6 in females, respectively. The TyG index's area under the curve was higher than that of the HOMA-IR in both sexes. MONWs distinguished by the cut-off values of the TyG index and HOMA-IR were 2.370 and 1.726 for males and 2.249 and 1.710 for females times more likely to develop diabetes. Conclusions: The TyG index showed a stronger association with diabetes in Korean individuals without underweight or obesity than the HOMA-IR.

Non-Insulin-Based Indices of Insulin Resistance for Predicting Incident Albuminuria: A Nationwide Population-Based Study

BACKGROUND

Studies have shown that incident albuminuria is associated with insulin resistance (IR); however, an IR marker that best predicts the prevalence of albuminuria has not yet been established. This study explored the association between IR and incident albuminuria using various IR indices, including the homeostasis model assessment of IR (HOMA-IR), metabolic score for IR (METS-IR), and triglyceride-glucose (TyG) index, and compared their predictive abilities for the prevalence of albuminuria.

METHODS

A total of 4,982 Korean adults from the 2019 Korea National Health and Nutritional Examination Survey were analyzed. The odds of albuminuria were determined using the quartiles of the IR indices. Receiver operating characteristic (ROC) curves were used to calculate the area under the ROC curve and predictability. The cutoff values for albuminuria detection were also computed.

RESULTS

An increase in the quartiles of all three IR indices was associated with incident albuminuria, even after full adjustment for covariates (HOMA-IR: odds ratio [OR], 1.906; 95% confidence interval [CI], 1.311-2.772; P=0.006; METS-IR: OR, 2.236; 95% CI, 1.353-3.694; P=0.002; TyG index: OR, 1.757; 95% CI, 1.213-2.544; P=0.003). The area under the ROC curve for incident albuminuria based on the HOMA-IR, METS-IR, and TyG indices was 0.594 (95% CI, 0.568-0.619), 0.633 (95% CI, 0.607-0.659), and 0.631 (95% CI, 0.606-0.656), respectively. The optimal cutoff values for predicting albuminuria were 2.38, 35.38, and 8.72 for the HOMA-IR, METS-IR, and TyG indices, respectively.

CONCLUSION

The METS-IR and TyG indices outperformed HOMA-IR in predicting incident albuminuria.

The Relationship Between Age at Diabetes Onset and Clinical Outcomes in Newly Diagnosed Type 2 Diabetes: A Real-World Two-Center Study

Purpose

This study was developed with the goal of clarifying whether there is any relationship between type 2 diabetes mellitus (T2DM) age of onset and clinical outcomes for patients in National Metabolic Management Centers (MMC).

Patients and Methods

From September 2017 - June 2022, 864 total T2DM patients were recruited in MMC and assigned to those with early-onset and late-onset diabetes (EOD and LOD) based on whether their age at disease onset was ≤ 40 or > 40 years. All patients received standardized management. Baseline and 1-year follow-up data from these two groups of patients were assessed. Associations between onset age and other factors were evaluated with a multivariate linear regression approach, adjusting for appropriate covariates. Outcomes in particular subgroups were also assessed in stratified analyses.

Results

Markers of dysregulated glucose metabolism and BMI values were significantly higher among EOD patients as compared to LOD patients. Subjects in both groups exhibited significant improvements in several disease-related parameters on 1-year follow-up after undergoing metabolic management. EOD patients exhibited significantly greater percentage reductions in HbA1c levels (-28.49 (-44.26, -6.45)% vs -13.70 (-30.15,-1.60)%, P =0.017) relative to LOD patients following adjustment for confounders. Significant differences were also detected between these groups when focused on subgroups of patients who were male, exhibited a BMI ≥ 25, an HbA1c ≥ 9, or had a follow-up frequency < 2.

Conclusion

Data from a 1-year follow-up time point suggest that a standardized metabolic disease management model can promote effective metabolic control in newly diagnosed T2DM patients, particularly among individuals with EOD.

Associations of the TyG index with albuminuria and chronic kidney disease in patients with type 2 diabetes

OBJECTIVE

Diabetes-related kidney disease reduces patients' quality of life, increases the risk of death, and is associated with insulin resistance (IR). The triglyceride-glucose (TyG) index is a simple and inexpensive alternative to IR measurement. Furthermore, the relationship between albuminuria and chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) remains unclear. Therefore, we aimed to investigate the association of TyG index with albuminuria and CKD in patients with T2DM.

METHODS

Data from 01/2013-12/2017 period were obtained from the Population Health Data Archive's Diabetes Complications Data Set. A total of 1048 patients with T2DM were included in this study. CKD is defined as an estimated glomerular filtration rate < 60 ml/min-1.1.73 m-2 or a urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g. Albuminuria is defined as a UACR ≥ 30 mg/g. The TyG index is calculated by measuring the triglyceride and fasting blood glucose levels. Logistic regression models were used to analyze the association between albuminuria, CKD with T2DM and TyG index.

RESULTS

We identified 1048 subjects, 63.03% of whom were men. The mean age was 46.21 years, and the mean body mass index was 26.742 kg/m2. CKD and albuminuria detection rates showed an increasing trend in the different TyG subgroups. (p = 0.008, p = 0.006). Using the Q1 group as a baseline, the risk of albuminuria and CKD was significantly greater in the group Q3 (OR = 1.514, 95% CI 1.121-2.047 P = 0.05), and the same result was obtained after adjusting for covariates (OR = 2.241, 95% CI 1.245-4.034, P = 0.007). Subgroup analyses revealed a significant increase in the incidence of albuminuria and CKD in the group Q3 compared to that in the Q1 group.

CONCLUSIONS

The TyG index is positively associated with albuminuria and CKD in patients with T2DM and may be a marker for predicting the occurrence of early kidney injury in patients with T2DM. Clinicians should test this indicator early to detect lesions and improve patient prognosis.

Combined effect of triglyceride glucose-body mass index and hypertension on new-onset stroke: evidence from the China health and retirement longitudinal study

Objective

The aim of this study is to investigate the combined impact of the triglyceride glucose-body mass index (TyG-BMI) and hypertension on the risk of stroke among the middle-aged and older adult population in China.

Methods

This study included 6,922 participants aged 45 and above from the China Health and Retirement Longitudinal Study, utilizing a multivariate Cox proportional hazards regression model to explore the relationship between TyG-BMI, hypertension, and the incidence of new-onset stroke events, as well as conducting Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) analyses to evaluate the predictive utility of TyG-BMI.

Results

During a 7-year follow-up period, a total of 401 stroke events were recorded. Compared to patients with lower TyG-BMI (TyG-BMI < 199.74) levels and non-hypertension, those with elevated TyG-BMI levels and non-hypertension had an adjusted hazard ratio (HR) and 95% confidence intervals (95%CI) were 1.47 (1.05-2.05). The adjusted HR and 95%CI for the group with lower TyG-BMI levels and hypertension was 2.99 (2.17-4.12), and for those with elevated TyG-BMI levels and hypertension, the adjusted HR and 95%CI was 3.49 (2.63-4.62). In a multivariate Cox proportional hazards regression model, the combination of elevated TyG-BMI levels and hypertension, treated as routine variables, was still significantly associated with the risk of stroke. NRI and IDI analyses showed significant improvements in risk prediction with the inclusion of TyG-BMI. Furthermore, in all subgroup analyses conducted, individuals with elevated TyG-BMI levels and hypertension nearly exhibited the highest risk for incident stroke.

Conclusion

Our study reveals that the combined effect of TyG-BMI and hypertension may increase the risk of incident stroke in the middle-aged and older adult Chinese population. TyG-BMI correlates with comorbid conditions and enhances traditional risk assessment. Future research will require validation through larger sample sizes or diverse populations to further confirm this finding.

Predictive Value of Triglyceride-Glucose Index for All-Cause and Cardiovascular Mortality in Patients With Diabetes Mellitus: A Retrospective Study: TyG Index and Mortality in Diabetes

Objective: To determine the associations between triglyceride-glucose (TyG) index and mortality from all causes and cardiovascular causes in diabetic population. Methods: 3349 participants with diabetes mellitus (DM) from the 1999-2014 National Health and Nutrition Examination Surveys (NHANES), aged 18-85 years were included and grouped based on the TyG index in quintiles. Mortality was followed up through December 31th, 2015. Cox proportional hazards models were used to assess the hazard ratios (HRs) and 95% confidence intervals (CIs). We clarified the shape of association between TyG index and mortality using restricted cubic splines and piecewise linear regression. Results: After a median follow-up period of 82 months, 800 (23.9%) deaths occurred, of which 190 (5.7%) were due to cardiovascular causes. Participants in the top quintile had higher risks of all-cause mortality (HR, 1.38; 95% CI, 1.04-1.48) and cardiovascular mortality (HR, 2.43; 95% CI, 1.32-4.45) than those in the lowest quintile. TyG index and all-cause mortality had a J-shaped relationship with a threshold value of 9.32, while TyG index and cardiovascular mortality had a reversed L-shaped relationship with a threshold value of 9.37. Higher TyG index was associated with increased risks of all-cause mortality (per SD increment, HR, 1.52; 95% CI, 1.27-1.82) and cardiovascular mortality (per SD increment, HR, 2.17; 95% CI, 1.54-3.04) when above the threshold values. The sensitivity analyses demonstrated similar findings. Conclusions: TyG index in diabetic patients was nonlinearly correlated with mortality risks, potentially predicting all-cause and cardiovascular mortality.

Trajectories of triglyceride-glucose index changes and their association with all-cause and cardiovascular mortality: a competing risk analysis

BACKGROUND

The association between changes in insulin resistance, reflected by the triglyceride-glucose (TyG) index, and mortality remains unclear. This study investigated whether longitudinal trajectories of TyG index changes are associated with all-cause and cardiovascular disease (CVD) mortality.

METHODS

This retrospective cohort study analyzed data from 233,546 adults aged ≥ 19 years from the Korea National Health Insurance Service-National Sample Cohort. Participants were categorized as having increasing, stable, or decreasing TyG index changes during a 4-year exposure period (2009-2014). Mortality outcomes were assessed during an 8.13-year follow-up period (2015-2021). Cox proportional hazards regression and competing risk analysis were used to evaluate all-cause and CVD mortality.

RESULTS

A total of 7918 mortality events, including 651 CVD deaths, were recorded. Compared with the stable group, adjusted hazard ratios for all-cause mortality were 1.09 (95% CI 1.03-1.15) in the increasing group and 1.23 (95% CI 1.01-1.50) for CVD mortality. An increased TyG index was significantly associated with all-cause mortality in individuals aged < 50 years; men; and individuals with obesity, hypertension, diabetes, and/or dyslipidemia. For CVD mortality, significant associations were found in individuals aged 50-69 years, with obesity, with diabetes, or without dyslipidemia.

CONCLUSION

An increasing TyG index from baseline during follow-up was independently associated with higher risks of all-cause and CVD mortality. Serial monitoring of TyG index changes could enhance risk stratification and inform targeted interventions to reduce insulin resistance, and ultimately lower mortality risk.

The association between triglyceride glucose index and suicidal ideation in American adults: Results from NHANES 2005 to 2018

Previous studies have shown a significant association between the triglyceride glucose index (TyG) and suicidal ideation in Korean women. However, this association has not yet been examined among American adults. This study aims to investigate the association between TyG and suicidal ideation using data from the National Health and Nutrition Examination Survey. The National Health and Nutrition Examination Survey database from 2005 to 2018 was used, including samples ≥20 years old. Suicidal ideation was assessed through questionnaires, and the TyG was derived from fasting triglyceride and glucose measurements. Weighted logistic regression models were used to analyze the relationship between the TyG and suicidal ideation. Generalized additive model curves explored the nonlinear relationship, while stratified and sensitivity analyses assessed potential interactions and the robustness of the findings. A significance level of P < .05 was considered statistically significant. A total of 15,694 participants were enrolled, of whom 3.67% participants showed suicidal ideation. The mean TyG index for participants with or without suicidal ideation was 8.82 ± 0.76, 8.65 ± 0.68, respectively (P < .001). Multivariable logistic regression showed that a higher level of TyG were associated with a higher likelihood of suicidal ideation (OR = 1.20; 95% CI, 1.05-1.38) after full adjustment. Subgroup analysis and interaction tests showed no significant correlation between gender, age, race, marital status, education, body mass index, poverty income ratio, smoking status, drinking status, diabetes, hypertension, stroke, and cancer (P > .05 for all interactions). Our findings confirm a significant and positive association between the TyG and suicidal ideation among American adults. Further large-scale prospective studies are needed to analyze the role of TyG in suicidal ideation.

Biomarkers of insulin sensitivity/resistance

In recent years, remarkable advancements in elucidating the intricate molecular underpinnings of type 2 diabetes mellitus (T2D) have been achieved. Insulin resistance (IR) has been unequivocally acknowledged as the driving pathogenetic mechanism of T2D, preceding disease onset by several years. Nonetheless, diagnostic tools for ascertaining IR are lacking in current clinical practice, representing a critical unmet need; use of the hyperinsulinemic-euglycemic glucose clamp, widely accepted as the gold standard method for evaluating IR at present, is cumbersome in a clinical setting. Thus, the development of well-validated, reliable, and affordable biomarkers of IR has attracted considerable attention from the research community. The biomarkers under investigation can be divided into two major categories: (1) indices or ratios, comprising parameters obtained from a basic or comprehensive metabolic panel and/or derived from anthropometric measurements, and (2) circulating molecules implicated in pathophysiological processes associated with IR. Furthermore, numerous novel biomarkers, including markers of β-cell dysfunction, radiographic quantification of excess visceral adipose tissue, T2D prediction models, certain microRNAs and metabolomic biomarkers, have also provided promising preliminary results. This narrative review aims to present current evidence pertaining to the most notable and exciting biomarkers of IR that are under rigorous evaluation.

Berberine directly targets AKR1B10 protein to modulate lipid and glucose metabolism disorders in NAFLD

ETHNOPHARMACOLOGICAL RELEVANCE

Berberine (BBR) is the main active component from Coptidis rhizome, a well-known Chinese herbal medicine used for metabolic diseases, especially diabetes for thousands of years. BBR has been reported to cure various metabolic disorders, such as nonalcoholic fatty liver disease (NAFLD). However, the direct proteomic targets and underlying molecular mechanism of BBR against NAFLD remain less understood.

AIM OF THE STUDY

To investigate the direct target and corresponding molecular mechanism of BBR on NAFLD is the aim of the current study.

MATERIALS AND METHODS

High-fat diet (HFD)-fed mice and oleic acid (OA) stimulated HepG2 cells were utilized to verify the beneficial impacts of BBR on glycolipid metabolism profiles. The click chemistry in proteomics, DARTS, CETSA, SPR and fluorescence co-localization analysis were conducted to identify the targets of BBR for NAFLD. RNA-seq and shRNA/siRNA were used to investigate the downstream pathways of the target.

RESULTS

BBR improved hepatic steatosis, ameliorated insulin resistance, and reduced TG levels in the NAFLD models. Importantly, Aldo-keto reductase 1B10 (AKR1B10) was first proved as the target of BBR for NAFLD. The gene expression of AKR1B10 increased significantly in the NAFLD patients' liver tissue. We further demonstrated that HFD and OA increased AKR1B10 expression in the C57BL/6 mice's liver and HepG2 cells, respectively, whereas BBR decreased the expression and activities of AKR1B10. Moreover, the knockdown of AKR1B10 by applying shRNA/siRNA profoundly impacted the beneficial effects on the pathogenesis of NAFLD by BBR. Meanwhile, the changes in various proteins (ACC1, CPT-1, GLUT2, etc.) are responsible for hepatic lipogenesis, fatty acid oxidation, glucose uptake, etc. by BBR were reversed by the knockdown of AKR1B10. Additionally, RNA-seq was used to identify the downstream pathway of AKR1B10 by examining the gene expression of liver tissues from HFD-fed mice. Our findings revealed that BBR markedly increased the protein levels of PPARα while downregulating the expression of PPARγ. However, various proteins of PPAR signaling pathways remained unaffected post the knockdown of AKR1B10.

CONCLUSIONS

BBR alleviated NAFLD via mediating PPAR signaling pathways through targeting AKR1B10. This study proved that AKR1B10 is a novel target of BBR for NAFLD treatment and helps to find new targets for the treatment of NAFLD by using active natural compounds isolated from traditional herbal medicines as the probe.

Investigating the association between the triglyceride-glucose index and peripheral artery disease: a systematic review and meta-analysis

BACKGROUND

Peripheral artery disease (PAD) is a common disease associated with atherosclerosis, leading to significant mortality and morbidity worldwide. Our study focuses on the association between insulin resistance (IR) and PAD, specifically investigating the triglyceride-glucose index (TyG) as a potential surrogate marker of IR in the context of PAD by pooling the existing studies on this topic.

METHODS

Online databases, including PubMed, Embase, Scopus, and the Web of Science, were searched to find the studies comparing the TyG index in PAD vs. control, reporting the TyG index among PAD severities, and assessing the association of increase in TyG with PAD prevalence. Random-effect meta-analysis was performed to calculate the standardized mean difference (SMD) and 95% confidence interval (CI) for TyG level comparison and to calculate pooled odds ratio (ORs) for a 1-unit increase in TyG and higher vs. lower quartile/tertile of TyG association with PAD.

RESULTS

In the final review, 22 studies comprising 73,168 cases were included. Random-effect meta-analysis showed that patients with PAD had significantly higher levels of the TyG index compared with controls (SMD 0.76, 95%CI 0.65-0.88, P < 0.001). Also, higher severities of PAD were associated with higher TyG levels (SMD 0.48, 95%CI 0.22-0.74, P = 0.0003). Additionally, a 1-unit increase in TyG was associated with a 60% increase in odds of PAD (OR 1.60, 95%CI 1.41-1.80, P < 0.001). Finally, the highest quartile (Q4) of TyG had significantly higher odds of PAD compared to Q1 (OR 1.94, 95%CI 1.49-2.54, P < 0.001).

CONCLUSION

Our meta-analysis has identified a significant association between TyG levels and PAD and its severity. These findings not only contribute to our understanding of the role of IR in PAD pathology but also offer clinicians an exact index for evaluating PAD risk and its complications. This could potentially lead to more effective prevention and management strategies in the future.

Association of triglyceride-glucose index with sarcopenia: NHANES 2011-2014

Background

A newly developed technique, the Triglyceride-glucose (TyG) index, supplies a more straightforward method to identify IR than the HOMA-IR (Homeostasis Model Assessment of Insulin Resistance). Yet no methodical analysis has looked into the link involving the TyG index and low muscle mass (LMM), low muscle strength (LMS), and sarcopenia within the US. Thus, this study intended to find any connection concerning the TyG index and LMM, LMS, and sarcopenia.

Methods

Between 2011 to 2014, data from the NHANES were used to conduct a nationally representative study involving 2,504 participants. LMM, LMS, and sarcopenia were the outcome variables. Moreover, this positive correlation persists irrespective of age and gender.

Results

The TyG index revealed a significant correlation with the prevalence of developing LMM (OR = 1.63(1.26-2.11), p=0.001), LMS (OR = 1.61(1.36-1.91), p<0.001) and sarcopenia (OR = 1.59 (1.23-2.07), p<0.001), after correcting for all variables. Utilizing smooth curve fitting alongside two-piecewise linear regression models, an inverted U-shaped correlation between the TyG index and the prevalence of LMM, LMS, and sarcopenia. Finally, subgroup analysis revealed that the association between the TyG index and LMM, LMS, and sarcopenia was particularly evident in all gender, age subgroups, and individuals with a normal BMI of 25.

Conclusion

Sarcopenia and the TyG index reveal an essential positive link. It highlights the potential utility of the TyG index as a screening tool for identifying individuals at risk of sarcopenia earlier.

Relationship between the Mediterranean Diet and Vascular Function in Subjects with and without Increased Insulin Resistance

(1) The main aim of this study was to analyze the relationship of the Mediterranean diet (MD) with vascular function in participants with and without increased insulin resistance (IR) in the Spanish population. A secondary aim was to study differences by gender. (2) Methods: Data were analyzed from 3401 subjects in the EVA, MARK, and EVIDENT studies (mean age = 60 years and 57% men). IR was evaluated with the triglyceride and glucose index (TyG index). TyG index = Ln [(fasting triglyceride mg/dL × fasting glucose mg/dL)/2]. The MD was measured against the MEDAS questionnaire, with the 14 items used in the PREDIMED study. Vascular stiffness was estimated with the brachial-ankle pulse wave velocity (baPWV) and the cardio ankle vascular index (CAVI) using the Vasera VS-1500®. (3) Results: The mean MEDAS value was 5.82 ± 2.03; (men: 5.66 ± 2.06; women: 6.04 ± 1.99; p < 0.001). MD adherence was 36.8% (men: 34.2%; women: 40.3%; p < 0.001). The mean baPWV value was 14.39 ± 2.78; (men: 14.50 ± 2.65; women: 14.25 ± 2.93; p = 0.005). A baPWV value ≥ 14.5 m/s was found in 43.4% (men: 43.6%; women: 40.0%; p = 0.727). The mean CAVI value was 8.59 ± 1.28; (men: 8.75 ± 1.28; women: 8.37 ± 1.26; p < 0.001). CAVI values ≥ 9 were present in 39.0% (men: 44.4%; women: 31.7%; p < 0.001). The mean value of the TGC/G index was 10.93 ± 1.39; (men: 11.08 ± 1.33; women: 10.73 ± 1.43; p < 0.001). IR was found in 49.9%. The average value of the MD score value was negatively associated with baPWV and CAVI in all groups analyzed (<0.05), except in the group of women with insulin resistance. (4) Conclusions: The results suggest that MD adherence is negatively associated with the vascular stiffness parameters analyzed in all the groups studied except the group of women with insulin resistance.

Prognostic effect of the TyG index on patients with severe aortic stenosis following transcatheter aortic valve replacement: a retrospective cohort study

BACKGROUND

The triglyceride glucose (TyG) index, as a reliable marker of insulin resistance, is associated with the incidence and poor prognosis of various cardiovascular diseases. However, the relationship between the TyG index and clinical outcomes in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR) remains unclear.

METHODS

This study consecutively enrolled 1569 patients with AS underwent TAVR at West China Hospital of Sichuan University between April 2014 and August 2023. The outcomes of interest included all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Multivariate adjusted Cox regression and restricted cubic splines (RCS) regression analyses were used to assess the associations between the TyG index and the clinical outcomes. The incremental prognostic value of the TyG index was further assessed by the time-dependent Harrell's C-index, integrated discrimination improvement (IDI) and the net reclassification improvement (NRI).

RESULTS

During a median follow-up of 1.09 years, there were 146, 70, and 196 patients experienced all-cause death, cardiovascular death, and MACE, respectively. After fully adjusting for confounders, a per-unit increase of TyG index was associated with a 441% (adjusted HR: 5.41, 95% CI: 4.01-7.32), 385% (adjusted HR: 4.85, 95% CI: 3.16-7.43), and 347% (adjusted HR: 4.47, 95% CI: 3.42-5.85) higher risk of all-cause mortality, cardiovascular mortality and MACE, respectively. The RCS regression analyses revealed a linear association between TyG index and endpoints (all P for non-linearity > 0.05) with 8.40 as the optimal binary cutoff point. Furthermore, adding TyG index to the basic risk model provided a significant incremental value in predicting poor prognosis (Time-dependent Harrell's C-index increased for all the endpoints; All-cause mortality, IDI: 0.11, P < 0.001; NRI: 0.32, P < 0.001; Cardiovascular mortality, IDI: 0.043, P < 0.001; NRI: 0.37, P < 0.001; MACE, IDI: 0.092, P < 0.001; NRI: 0.32, P < 0.001).

CONCLUSIONS

In patients with severe AS receiving TAVR, there was a positive linear relationship between TyG index and poor prognosis, with 8.4 as the optimal bivariate cutoff value. Our findings suggest TyG index holds potential value for risk stratification and guiding therapeutic decisions in patients after TAVR.

Development of a comprehensive risk prediction model for arterial stiffness assessment in individuals with obesity

Introduction

Obesity in adults is a known risk factor for cardiovascular events and is associated with a decline in arterial elasticity. This study aims to evaluate the utility of pulse wave analysis (PWA) parameters in routine clinical practice for the primary prevention of cardiovascular events by developing a prediction model for arterial stiffness among obese and overweight individuals.

Methods

The study enrolled 84 adult patients, aged 18 to 85 years, with varying degrees of weight status, including optimal weight, overweight, and obesity. The lifestyle habits, the personal and family history of cardiometabolic diseases, as well the clinical evaluation that included BMI (body mass index), WHR (waist-to-hip ratio), WC (waist circumferance) were performed. PWA evaluation was conducted using the Mobil-O-Graph device, assessing the following parameters: pulse wave velocity (PWV), augmentation index (AIx), heart rate (HR), central pulse pressure (cPP), peripheral and central blood pressure (SBP, DBP, cSBP, cDBP). Body composition analysis was performed using the TANITA BC-418 body analyzer. Laboratory results from the past 3 months were also collected during initial nutritional consultations for each patient.

Results

Family history of cardiovascular events showed positive correlations with all PWA parameters, while diabetes history only with PWV and family history of obesity with PWV, DBP, and cSBP. Insufficient sleep duration showed positive associations with all arterial stiffness parameters except cDBP. Smoking status correlated with significantly elevated PWV and Aix values, while insufficient physical activity was associated solely with PWV. Positive correlations were showed between current weight and PWV, while WC demonstrated positive associations with PWV, SBP, and cSBP. Body composition analysis revealed significant associations between trunk adipose tissue mass (%) and PWV, SBP, and cSBP. Hydration status (%) emerged as an independent predictor for PWV, exhibiting an inverse relationship. HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) showed a strong positive correlation with PWV. Negative associations were observed with HDL-c and vitamin D. Threshold values for age, cDBP and Cardiac Index providing positive diagnostic for vascular impairment.

Conclusion

The assessment of arterial stiffness can be considered a reliable approach to prevent obesity-related cardiovascular events and facilitate the comprehensive management of such pathologies.

Association between insulin resistance and vascular damage in an adult population in China: a cross-sectional study

There is a relative scarcity of large-scale population studies investigating the relationship between the insulin resistance index of homeostasis model assessment (HOMA-IR) and vascular damage. Therefore, we assessed the association between HOMA-IR and vascular damage in adults aged 18 years and older in China. A total of 17,985 research subjects were included. Vascular damage markers and relevant laboratory tests were measured. HOMA-IR was calculated as (fasting insulin * fasting blood glucose)/22.5. Vascular damage included arteriosclerosis (ba-PWV > 1800 cm/s), peripheral artery disease (ABI < 0.9), and microalbuminuria (UACR > 30 mg/g). The relationship between HOMA-IR and vascular damage was analyzed using the RCS. The restricted cubic spline (RCS) analysis suggested that HOMA-IR was nonlinearly associated with arteriosclerosis (P for no-liner < 0.01), peripheral artery disease (P for no-liner < 0.01), and microalbuminuria (P for no-liner < 0.01). Further segmented regression analyses revealed that in study subjects with HOMA-IR < 5, we found that HOMA-IR was associated with an increased OR for arteriosclerosis (OR: 1.36, 95% CI (1.28, 1.45), P < 0.01), peripheral artery disease (OR: 1.33, 95% CI (1.10, 1.60), P < 0.01) and microalbuminuria (OR: 1.59, 95% CI (1.49, 1.70), P < 0.01). HOMA-IR is an independent risk factor for vascular damage, both macrovascular and microvascular. The phenomenon of saturation of HOMA-IR with vascular damage needs further investigation.

Association between triglyceride-glucose index and depression in patients with type 2 diabetes: A cross-sectional study from NHANES

This cross-sectional study aimed to examine the association between the triglyceride-glucose (TyG) index and the prevalence of depression in individuals with type 2 diabetes. A nationally representative sample of 3225 individuals with type 2 diabetes was enrolled in this study. Multivariable logistic regression models were used to assess the association between the TyG index and depression, adjusting for potential confounding factors. After adjusting for age, gender, BMI, smoking, alcohol consumption, congestive heart failure, and coronary heart disease, a significant positive association was found between the TyG index and the prevalence of depression in individuals with type 2 diabetes (OR = 1.54, 95% CI: 1.21-1.95). Subgroup analyses showed consistent associations across various demographic and clinical subgroups. This study provides evidence of a significant independent positive association between the TyG index and the prevalence of depression in individuals with type 2 diabetes.

Relationship between triglyceride-glucose index and endometriosis: a cross-sectional analysis

BACKGROUND

The link between insulin resistance and endometriosis is not well established. The triglyceride-glucose (TyG) index serves as a straightforward and economical indicator of insulin resistance. This study examines the link between the TyG index and the prevalence of endometriosis in a U.S.

COHORT

METHODS

This cross-sectional study analyzed data from the NHANES conducted between 1999 and 2006. Reproductive health was assessed through questionnaires, and the TyG index was derived from fasting triglyceride and glucose measurements. Weighted logistic regression models were used to analyze the relationship between the TyG index and endometriosis. Restricted cubic spline (RCS) curves explored the linear relationship, while stratified and sensitivity analyses assessed potential interactions and the robustness of the findings.

RESULTS

The study included 2,346 women, with 176 diagnosed with endometriosis and 2,170 without. Women with endometriosis exhibited an elevated TyG index compared to those without the condition. The weighted logistic regression analysis revealed that the TyG index is an independent risk factor for endometriosis (OR = 1.58, 95% CI 1.17-2.14, p = 0.004). RCS analysis indicated a significant positive linear association between the TyG index and endometriosis, with a turning point at 8.51. Subgroup analysis indicated a stronger association in certain populations. The post-propensity score matching analysis confirmed the robustness of these findings.

CONCLUSION

In the U.S. population, a higher TyG index is positively and linearly associated with endometriosis prevalence. Effective management of blood glucose and lipid levels may reduce the prevalence of endometriosis.

An overview of the application and potential mechanism on the triglyceride glucose index with multi-vessel coronary disease

Multi-vessel coronary disease (MVCD) is a severe form of coronary artery disease (CAD) that significantly increases the risk of acute coronary syndrome (ACS) and heart attacks. The triglyceride glucose (TyG) index is a reliable and convenient marker for insulin resistance (IR). Recent studies have demonstrated its predictive value for CAD in patients with MVCD. This review aims to explore the application of the TyG index in managing MVCD and its underlying pathogenesis to enhance risk stratification and improve therapeutic decision-making.

Triglyceride-glucose index and mortality risk in individuals with or without chronic kidney disease: Insights from a national survey of United States adults, 1999-2018

BACKGROUND AND AIMS

The Triglyceride-Glucose Index (TyG) has been proposed as a predictor to mortality, yet its association remains incompletely understood for individuals with or without chronic kidney disease (CKD).

METHODS AND RESULTS

We analyzed data from the National Health and Nutrition Examination Survey spanning the years 1999-2018. CKD was defined as eGFR level <60 ml/min/1.73 m2 or urinary albumin creatinine ratio ≥30 mg/g. We employed the Cox proportional-hazards model to evaluate the incident risk of mortality associated with TyG among both non-CKD and CKD individuals. In the current analysis, 19,426 individuals were without CKD, while 2975 individuals had CKD. The overall mean TyG was 8.65, with significant difference between non-CKD and CKD individuals (8.60 vs 8.95, P < 0.001). The TyG index exhibited linear associations with incident cardiovascular disease (CVD) mortality and all-cause mortality among non-CKD and CKD individuals, respectively. A per-unit increase in the TyG index was significantly associated with CVD mortality for both non-CKD (HR = 1.24, 95%CI = 1.09-1.41) and CKD participants (HR = 1.19, 95%CI = 1.04-1.36), with no significant difference in the associations between the two groups (P = 0.091). For both non-CKD and CKD participants, TyG index was significantly associated with CVD mortality and all-cause mortality among those with age <65, but not for those with age ≥65.

CONCLUSIONS

Our findings underscore the TyG index's as a valuable predictive tool for assessing the risk of all-cause and CVD mortality in both individuals with and without CKD.

Role of HOMA-IR and IL-6 as screening markers for the metabolic syndrome in patients with chronic schizophrenia: a psychiatric hospital-based cross-sectional study

This study starts from the metabolic related indexes and cellular inflammatory factors in patients with chronic schizophrenia to find out that it can be used as an effective screening index of metabolic syndrome. 320 patients with chronic schizophrenia (course of disease > 5 years) and 165 healthy subjects were selected. The mental symptoms of the patients were measured by positive and negative syndrome scale. Blood samples from patients and healthy controls were collected to detect blood glucose, triglyceride, HDL and fasting insulin. The serum levels of IL-1β, IL-2, IL-6, IL-17, IFN-γ and TNF-α were determined repeatedly by sandwich enzyme-linked immunosorbent assay. The levels of HOMA-IR, plasma inflammatory factors IL-2, IL-6, IL-17 and TNF-α in patient group were higher than those in healthy group. It was found that there were differences in age and related metabolic indexes between patients with chronic schizophrenia with and without metabolic syndrome. In addition, HOMA-IR, plasma cytokines IL-2 and IL-6 still showed differences between groups. In the Spearmen correlation analysis of insulin resistance index, cytokines and metabolic indexes, it was found that there was a significant correlation between HOMA-IR, IL-6 and related metabolic indexes and metabolic syndrome. ROC curve analysis showed that HOMAIR and IL-6 could be used as screening indexes for MS in male and female patients with schizophrenia.Metabolic syndrome is an important risk factor for cardiovascular disease in patients with chronic schizophrenia. HOMA-IR and IL-6 can be used as effective biological indicators to screen MS in patients with chronic schizophrenia.

Association between the triglyceride-glucose (TyG) index and stroke risk in Chinese normal-weight adults: a population-based study

BACKGROUND

Identifying high-risk populations and promoting stroke prevention measures can be achieved through studies on stroke and its risk factors. As a new alternative indicator of insulin resistance (IR), the triglyceride glucose (TyG) index may potentially increase stroke risk. However, the evidence confirming this association is inadequate and inconsistent, possibly due to variations in stroke assessment criteria or characteristics of the study populations. This study aims to evaluate the association between the TyG index and stroke risk level among individuals with normal-weight.

METHODS

A total of 30,895 participants aged ≥ 40 years with normal-weight were enrolled in this study. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Normal-weight was described as a body mass index (BMI) of 18.5-<24.0 kg/m2. Stroke risk was assessed by the Stroke Risk Assessment Scale, developed by the China National Stroke Screening and Prevention Project. To evaluate the associations between the TyG index and stroke risk level, multivariate logistic regression models were employed.

RESULTS

Results showed that when the TyG index was considered as a continuous variable, each one unit increase in the TyG index was associated with a significantly higher risk of stroke [Moderate-risk (OR, 2.15; 95% CI, 2.03-2.28; P<0.001); High-risk (OR, 3.83; 95% CI, 3.57-4.10; P<0.001)]. Compared with Q1 of the TyG index, Q4 was significantly associated with moderate stroke risk (OR, 2.73; 95% CI, 2.50-2.99; P<0.001) and high stroke risk (OR, 5.39; 95% CI, 4.83-6.01; P<0.001). The continuous TyG index was an important risk factor for high stroke risk in the metabolically obese, normal-weight (MONW) individuals (OR, 3.44;95% CI, 2.92-4.06; P < 0.001). In the MONW individuals, when Q1 was used as a reference, participants in Q4 (OR, 5.33; 95% CI, 4.19-6.78; P < 0.001) was significantly associated with high stroke risk. Subgroup analysis showed significant interaction in the age and sex subgroups in the overall population (Pinteraction <0.001).

CONCLUSION

The risk of stroke is increased with the TyG index among Chinese adults of normal weight; hence, the index may be an important indicator for identifying high-risk stroke populations among individuals with normal body weight.

Relationship of triglyceride-glucose index to gallstone prevalence and age at first gallstone surgery in American adults

The triglyceride-glucose (TyG) index is a novel marker of insulin resistance that has been strongly associated with many diseases related to metabolic disorders, such as diabetes, coronary heart disease, myocardial infarction, obesity, nonalcoholic fatty liver disease, and stroke. However, whether the TyG index is associated with the prevalence of gallstones has not been determined. Therefore, the purpose of this study was to evaluate the relationship between the TyG index and the prevalence of gallstones in American adults, as well as the age at which adults in America undergo their first gallstone surgery. We selected individuals from the National Health and Nutrition Examination Survey (NHANES) database from 2017 to March 2020. Based on the goal of our study, comprehensive inclusion and exclusion criteria were created. A logistic regression analysis, dose-response curve, and subgroup analysis were computed to assess the relationship between the TyG index and gallstone prevalence and age at first surgery for gallstone. A total of 3905 participants aged > 20 years were included in our study, of whom 421 had a self-reported history of gallstones. A total of 1884 (48.2%) males and 2021 (51.8%) females were included. After confounders adjustment, it was found single-unit increases in the TyG index were linked with a 25.0% increase in gallstone prevalence (odds ratio [OR] = 1.25, 95% confidence interval [95%CI]: 1.04, 1.51). After conversion of the TyG index values from continuous to categorical variables with tertiles, a marked 48% increase in gallstone incidence was found in tertile 3 relative to tertile 1 (OR = 1.48, 95% CI: 1.09, 1.99). The dose-response curve results indicated positive associations between gallstone prevalence and the TyG index, while the latter was negatively associated with age at first gallstone surgery. Based on subgroup analysis, the positive association between TyG index and high-incidence of gallstones was more significant in females (OR = 1.39, 95% CI: 1.09, 1.77), age < 40 years (OR = 2.02, 95% CI: 1.23, 3.29), and other race (OR = 1.46, 95% CI: 1.06, 2.02). A higher TyG index is associated with a higher incidence of gallstones and may lead to an earlier age of first gallstone surgery. However, a causal relationship between TyG and gallstones cannot be established.

The association between the triglyceride-glucose index and sarcopenia: data from the NHANES 2011-2018

BACKGROUND

The Triglyceride-glucose (TyG) index is a marker of insulin resistance, but its role in sarcopenia is controversial. The purpose of this study was to investigate the association of the TyG index with sarcopenia.

METHODS

4030 participants aged 20 years and above were selected from National Health and Nutrition Examination Survey for cross sectional study. Weighted logistic regression model was used to estimate the association between TyG index and sarcopenia. Threshold effect analysis and restricted cubic spline were employed to describe nonlinear link, with interaction tests and subgroup analyses performed.

RESULTS

It was found in the fully adjusted model that the TyG index was positively associated with sarcopenia (per 1-unit increase in the TyG index: OR = 1.31, 95%CI: 1.07, 1.60). This association was further highlighted in groups characterized by the absence of MetS or diabetes, as well as the absence of vigorous or moderate work activity. Furthermore, analysis of the curve fitting and threshold effects indicated a nonlinear relationship, which exhibited a turning point at 9.14.

CONCLUSION

The study results indicated that the TyG index was positively associated with sarcopenia. Enhancing the management of insulin resistance could help reduce the risk of developing sarcopenia.

Value of the triglyceride-glucose index and related parameters in heart failure patients

The triglyceride-glucose (TyG) index, proven to be a crucial insulin resistance biomarker (better than the Homeostasis Model Assessment for Insulin Resistance), is simple and non-invasive. Recently, indisputable evidence has shown that the TyG index is strongly associated with cardiovascular disease [CVD, including atherosclerosis, heart failure (HF), and hypertension] prognosis and mortality. Nevertheless, the value of the TyG index in HF patients treated with sodium-glucose cotransporter 2 inhibitors (SGLT2is) has not been systematically evaluated. Therefore, in this review, we summarized the value of the TyG index and its related parameters as markers of CVD, especially HF. Furthermore, we addressed the use of SGLT2is and GLP-1 receptor antagonists in HF patients. Finally, we summarized the mechanism of the "obesity paradox."

A 3-year follow-up analysis of renal function in elderly patients with type 2 diabetes mellitus and an estimated glomerular filtration rate <90 mL/min/1.73m2: A retrospective cohort study

Type 2 diabetes mellitus (T2DM) is a risk factor for patients with impaired renal function. The onset of T2DM-induced diabetic kidney disease (DKD) is frequently sub-clinical, potentially culminating in end-stage renal disease. In the current study the factors influencing DKD in elderly patients diagnosed with T2DM were determined. A retrospective cohort study was conducted involving patients ≥60 years of age with T2DM from June 2019 to December 2022. The Cockcroft-Gault formula was used to estimate the glomerular filtration rate. The clinical information and biochemical indicators of patients with an estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73m2 were collected. Patients were grouped based on a 3-year eGFR decline < 15% and ≥ 15%. The differences between the two groups were compared and the factors influencing the 3-year eGFR decline ≥ 15% were analyzed. A total of 242 patients were included, including 154 in the group with a 3-year eGFR decline < 15% and 88 in the group with a three-year eGFR decline ≥ 15%. Univariate logistic regression analysis showed that smoking cigarettes, and triglycerides (TG) and high-density lipoprotein levels were related to a 3-year eGFR decline ≥ 15% (P = .039, P < .001, and P = .011, respectively). Multivariate logistic regression analysis showed that the TG level was independently related to a 3-year eGFR decline ≥ 15% (P = .004; OR = 2.316). There was a significant linear relationship between the eGFR decline and TG level (P = .002). Patients with a TG concentration > 1.7 mmol/L had a more apparent decrease in the eGFR (P < .05). For elderly patients with T2DM and an eGFR < 90 mL/min/1.73m2, the TG level may be an important risk factor for deteriorating renal function that warrants actively intervention.

Associations between different triglyceride glucose index-related obesity indices and periodontitis: results from NHANES 2009-2014

BACKGROUND

This study aimed to explore the associations between triglyceride glucose (TyG) index-related obesity indices and periodontitis within the American population.

METHODS

This cross-sectional investigation utilized data from the National Health and Nutrition Examination Survey (NHANES) for 2009-2014. The association between the TyG-waist-to-height ratio (TyG-WHtR), TyG-weight-adjusted-waist index (TyG-WWI), TyG-waist circumference (TyG-WC), or TyG-body mass index (TyG-BMI) and periodontitis was investigated utilizing multivariable logistic regression model, subgroup, and dose-response curve analyses.

RESULTS

This study enrolled 4,808 adult participants. Except for TyG-BMI, which did not exhibit a relationship with periodontitis, TyG-WHtR, [odds ratio (OR) (95% confidence interval (CI))] = 2.83 [1.58-5.10], P = 0.002], TyG-WWI [OR (95% CI) = 7.50 (3.06-18.34), P < 0.001], and TyG-WC [OR (95% CI) = 2.12 (1.23-3.64), P = 0.011] were all associated with periodontitis. Participants in the highest quartile displayed an elevated risk of periodontitis relative to their counterparts in the lowest quartile, as evidenced for TyG-WWI [OR (95% CI) = 1.72 (1.26-2.33), P = 0.001] and TyG-WC [OR (95% CI) = 1.50 (1.13-1.99), P = 0.009] in the full adjustment model. Subgroup analyses suggested more pronounced positive associations between these indices and periodontitis in participants who were < 60 years old, had a BMI ≥ 25, and did not have diabetes. The dose-response curve indicated linear responses in these associations.

CONCLUSIONS

This investigation identified a significant and stable association between TyG-WHtR, TyG-WWI, or TyG-WC and periodontitis, which implies a robust correlation between high insulin resistance and susceptibility to periodontitis in the American population.

Association between Triglyceride-Glucose Index and risk of all-cause and cardiovascular mortality in adults with prior cardiovascular disease: a cohort study using data from the US National Health and Nutrition Examination Survey, 2007-2018

OBJECTIVE

The association between the Triglyceride-Glucose (TyG) Index and mortality rates in patients with cardiovascular disease (CVD) remains unclear. This study investigates the association between the TyG index and the incidence of all-cause and CVD-specific mortality among individuals with a history of CVD.

DESIGN

Population-based cohort study.

SETTING

Data were sourced from the US National Health and Nutrition Examination Survey (2007-2018) and linked mortality data, with follow-up continuing until 31 December 2019.

PARTICIPANTS

The study population comprised 3422 individuals aged 20 years or older with a documented history of CVD.

OUTCOME MEASURES

We examined the association between the TyG index and the risk of all-cause and cardiovascular mortality.

RESULTS

Over a median follow-up of 5.79 years, 1030 deaths occurred, including 339 due to CVD. Cox regression analysis, adjusted for multiple confounders, showed that individuals in the highest TyG index quartile, compared with those in the lowest, had HRs of 0.76 (95% CI: 0.60 to 0.96) for all-cause mortality and 0.58 (95% CI: 0.39 to 0.89) for CVD mortality. There was a significant inverse relationship between higher TyG index levels and lower mortality risks. For each unit increase in the TyG index, the adjusted HRs for all-cause and CVD mortality decreased by 18% (HR 0.82; 95% CI: 0.71 to 0.94) and 27% (HR 0.73; 95% CI: 0.57 to 0.92), respectively.

CONCLUSIONS

TyG index values are negatively associated with all-cause and CVD mortality risks among individuals with previous CVD. Further interventional studies are needed to clarify the impact of TyG levels on cardiovascular health.

Association between triglycerideglucose index and arterial stiffness progression A retrospective cohort study

OBJECTIVES

Insulin resistance (IR) is closely associated with atherosclerosis and adverse cardiovascular events. The triglyceride-glucose (TyG) index is an effective indicator for assessing IR. This study aims to explore the relationship between the TyG index and the risk of arterial stiffness progression.

METHODS

This retrospective cohort study included adults who had undergone at least 2 health examinations with arteriosclerosis testing at the Health Management Medical Center of the Third Xiangya Hospital, Central South University, between January 2012 and December 2022. Clinical data were collected. The TyG index was calculated using the formula of ln (triglycerides×fasting blood glucose/2). The baseline TyG index was assessed as both a continuous variable and as a quartile-based categorical variable. The progression of arteriosclerosis was evaluated by the annual change rate of brachial-ankle pulse wave velocity (baPWV) and the new onset of increased arterial stiffness. Linear regression model and Cox proportional hazard model were used to explore whether the TyG index is an independent risk factor for arterial stiffness progression. Subgroup analyses were performed based on age, gender, body mass index (BMI), and the presence of type 2 diabetes, hypertension, or hyperlipidemia to determine the characteristics of the association between the TyG index and arterial stiffness progression.

RESULTS

A total of 4 971 participants were included, with a follow-up period of (3.01±1.98) years. During follow-up, the annual baPWV change rate was (24.94±81.15) cm/s, and 278 cases of new onset of increased aterial stiffness were recorded. After fully adjusting for confounding factors, the baseline TyG index was independently positively correlated with both the annual baPWV change rate (β=17.5, 95% CI 9.00 to 25.94, P<0.001) and the risk of new onset of increased aterial stiffness [hazard ratio (HR)=1.43, 95% CI 1.18 to 1.74, P<0.001] when the TyG index was treated as a continuous variable. When treated as a categorical variable, higher TyG index quartiles were associated with progressively higher baPWV change rates and new onset of increased arterial stiffness (all P<0.05). In subgroups of participants aged ≥45 years, males, BMI<28 kg/m2, those with or without hypertension, and those without type 2 diabetes or hyperlipidemia, the baseline TyG index (both continuous and categorical) was significantly associated with new onset of increased arterial stiffness (all P<0.05), with no significant interactions observed across subgroups (all P>0.05).

CONCLUSIONS

The TyG index is independently associated with an increased risk of arterial stiffness progression and may serve as a useful indicator for assessing arterial stiffness progression risk in health check-up populations.

The roles of lipids and inflammation in the association between the triglyceride-glucose index and arterial stiffness: evidence from two large population-based surveys

BACKGROUND

The triglyceride-glucose (TyG) index is a risk marker for arterial stiffness; however, the extent to which the TyG index is associated with arterial stiffness via lipids and inflammation remains unknown. The first aim was to probe the relationship between the TyG index and arterial stiffness in two surveys. The second aim was to clarify whether lipids and inflammation mediate this relationship.

METHODS

The sample size of 13,726 U.S. individuals from the National Examination Survey (NHANES) and 3,964 Chinese individuals from the China Health and Retirement Longitudinal Study (CHARLS 2015) were enrolled. Weighted multivariate logistic and linear regression models, as well as restricted cubic spline (RCS) and mediation analyses, were utilized to estimate complex relationships between the TyG index, arterial stiffness, lipids (non-high-density lipoprotein cholesterol [non-HDL-C]) and inflammation (C-reactive protein [CRP]) biomarkers.

RESULTS

A total of 3,420 U.S. patients and 992 Chinese patients were diagnosed with increased arterial stiffness. Regression analyses demonstrated that higher quartiles of the TyG index were associated with a greater incidence of increased arterial stiffness (NHANES: OR = 2.610, 95% CI = 2.043-3.334, P < 0.001; CHARLS: OR = 1.579, 95% CI = 1.057-2.360, P < 0.001). Participants with a higher TyG index/higher CRP level or with a higher TyG index/higher non-HDL-C level had the highest incidence of increased arterial stiffness in the two surveys. The results were still consistent when the sensitivity analysis was implemented with stricter clinical cut-off values of non-HDL-C. Mediation analysis verified that lipids (mediated effect: β = 0.012, P < 0.001 in NHANES; β = 0.020, P < 0.001 in CHARLS) and inflammation (mediated effect: β = 0.003, P < 0.001 in NHANES; β = 0.006, P < 0.001 in CHARLS) partially mediated this relationship.

CONCLUSIONS

These results indicated a positive linear correlation between the TyG index, non-HDL-C level, CRP level and increased arterial stiffness in two surveys. Furthermore, lipids and inflammation could partly mediate the correlation of the TyG index with arterial stiffness in both surveys.

Association between the triglyceride glucose index and depression: a meta-analysis

Background

Obesity and diabetes have been associated with depressive symptoms. The aim of this systematic review and meta-analysis was to evaluate the association between the triglyceride glucose index (TyG index) a novel indicator of insulin resistance (IR) and depression in the adult population.

Methods

Relevant observational studies were acquired through comprehensive searches of the Medline, Web of Science, Embase, Wanfang, and China National Knowledge Internet databases. To account for heterogeneity, a random-effects model was employed to combine the findings. Additionally, multiple subgroup analyses were conducted to assess the impact of various study characteristics on the outcome.

Results

The meta-analysis comprised eight datasets from six cross-sectional studies, encompassing a total of 28,973 adults. The pooled findings suggested that subjects with a high TyG index, compared to those with a low TyG index, were associated with a higher prevalence of depression (odds ratio [OR]: 1.41, 95% confidence interval (CI): 1.28-1.56, p<0.001; I2 = 19%). Sensitivity analyses, by omitting one dataset at a time, showed consistent results (OR: 1.39-1.45, p<0.05). Further subgroup analyses showed consistent results in participants aged <50 years old and in those aged ≥50 years old, in men and in women, in studies with different cutoff values for the TyG index, and in studies with different methods for the diagnosis of depression (for each subgroup difference, p>0.05).

Conclusion

A high TyG index may be associated with a higher prevalence of depression in the adult population.

The threshold effect of triglyceride glucose index on diabetic kidney disease risk in patients with type 2 diabetes: unveiling a non-linear association

Background

Previous studies have confirmed that the triglyceride glucose (TyG) index, recognized as a reliable marker of insulin resistance, is an important risk factor for diabetic kidney disease (DKD). However, it is still unclear whether the DKD risk continues to increase linearly with the elevation of TyG index. This study aimed to thoroughly investigated the intrinsic relationship between TyG index and DKD risk in type 2 diabetes (T2D).

Methods

This cross-sectional study included 933 patients with T2D in China, who were categorized into DKD and non-DKD groups and stratified by TyG index levels. Logistic regression analysis identified the independent risk factors for DKD. The association between DKD risk and TyG index was evaluated using the restricted cubic spline (RCS) curves analysis. The R package 'CatPredi' was utilized to determine the optimal cut-off point for the relationship between DKD risk and TyG index, followed by threshold effect analysis.

Results

The prevalence of DKD was 33.01%. After adjusting for confounding factors, TyG index was identified as a prominent clinical risk factor for DKD, showing the highest odds ratio (OR 1.57 (1.26 - 1.94), P<0.001). RCS analysis revealed a non-linear relationship with a threshold interval effect between the TyG index and DKD risk. When TyG index ≤ 9.35, DKD risk plateaued at a low level; however, when TyG index > 9.35, DKD risk increased gradually with rising TyG index. Among patients with TyG index > 9.35, each 1-unit increase was associated with a 1.94-fold increased DKD risk (OR=1.94 (1.10 - 3.43), P=0.022).

Conclusion

The DKD risk presented a threshold effect with the increase of TyG index, initially stable at a low level, and then gradually rising when the TyG index is above 9.35.

Association between estimated glucose disposal rate and atrial fibrillation recurrence in patients undergoing radiofrequency catheter ablation: a retrospective study

OBJECTIVE

Previous studies have shown a clear link between insulin resistance (IR) and an elevated risk of atrial fibrillation (AF). However, the relationship between the estimated glucose disposal rate (eGDR), which serves as a marker for IR, and the risk of AF recurrence after radiofrequency catheter ablation (RFCA) remains uncertain. Therefore, this study aimed to examine the potential association between the eGDR and the risk of AF recurrence following RFCA.

METHODS

This retrospective study was conducted at Nanchang University Affiliated Second Hospital. The study enrolled 899 patients with AF who underwent RFCA between January 2015 and January 2022. The formula used to calculate the eGDR was as follows: 19.02 - (0.22 * body mass index) - (3.26 * hypertension) - (0.61 * HbA1c). Cox proportional hazard regression models and exposure-effect curves were used to explore the correlation between the baseline eGDR and AF recurrence. The ability of the eGDR to predict AF recurrence was evaluated using the area under the receiver operating characteristic curve (AUROC).

RESULTS

The study observed a median follow-up period of 11.63 months, during which 296 patients experienced AF recurrence. K‒M analyses revealed that the cumulative incidence AF recurrence rate was significantly greater in the group with the lowest eGDR (log-rank p < 0.01). Participants with an eGDR ≥ 8 mg/kg/min had a lower risk of AF recurrence than those with an eGDR < 4 mg/kg/min, with a hazard ratio (HR) of 0.28 [95% confidence interval (CI) 0.18, 0.42]. Additionally, restricted cubic spline analyses demonstrated a linear association between the eGDR and AF recurrence (p nonlinear = 0.70). The area under the curve (AUC) for predicting AF recurrence using the eGDR was 0.75.

CONCLUSIONS

The study revealed that a decrease in the eGDR is associated with a greater AF recurrence risk after RFCA. Hence, the eGDR could be used as a novel biomarker for assessing AF recurrence risk.

Visceral fat area is more strongly associated with arterial stiffness than abdominal subcutaneous fat area in Chinese patients with type 2 diabetes

BACKGROUND

Few studies have compared the correlation between visceral fat area (VFA) and abdominal subcutaneous fat area (SFA) with arterial stiffness (AS) in patients with type 2 diabetes (T2D). In addition, there is currently controversy regarding the correlation between VFA and SFA with AS. We aimed to investigate the relationship between VFA and SFA with AS in patients with T2D.

METHODS

In this cross-sectional study, 1475 Chinese T2D patients with an average age of 52.32 ± 10.96 years were included. VFA and SFA were determined by a dual bioelectrical impedance analyzer, and AS was determined by measurement of brachial-ankle pulse wave conduction velocity (baPWV). Atherosclerosis was deemed present in study participants with baPWV values higher than 75th percentile (1781 cm/s). Independent correlations of logVFA and logSFA with AS were assessed using multiple linear regression and multivariate logistic regression.

RESULTS

The baPWV was linked with VFA, waist circumference, and women's SFA in a general linear correlation study (P < 0.05), but not with body mass index (P = 0.3783) or men's SFA (P = 0.1899). In both men and women, VFA and SFA were positively correlated with AS, according to the generalized additive model (GAM). After fully adjusting for confounders, multiple linear regression analyses showed that for every 1-unit increase in logVFA, the beta coefficient of baPWV increased by 63.1 cm/s (95% CI: 18.4, 107.8) (P < 0.05). logSFA did not correlate significantly with baPWV (P = 0.125). In the multiple logistic regression analysis, the odds ratio (OR) of elevated baPWV was 1.8 (95% CI: 1.1, 3.1) (P = 0.019) per 1-unit increase in logVFA. logSFA did not correlate significantly with AS (P = 0.091). In the subgroup analysis, the correlation between logVFA and baPWV did not interact across subgroups (P-interaction > 0.05).

CONCLUSIONS

Compared with SFA, VFA had a stronger independent positive correlation with AS in Chinese T2D patients. Patients with T2D should pay more attention to monitoring VFA and lowering it to minimize cardiovascular events.