Predictive Effect of Triglyceride Glucose-Related Parameters, Obesity Indices, and Lipid Ratios for Diabetes in a Chinese Population: A Prospective Cohort Study

Associations of the triglyceride-glucose index and triglyceride-glucose/body mass index with all-cause mortality in Chinese centenarians

BACKGROUND

The triglyceride-glucose (TyG) index and triglyceride-glucose/body mass index (TyG-BMI) have been shown to be associated with cardiovascular and cerebrovascular disorders and the risk of death. The aim of this study was to explore the relationships of the TyG index and TyG-BMI with all-cause mortality among Chinese centenarians.

METHODS

Data from the China Hainan Centenarian Cohort Study (CHCCS) were analyzed. Eligible centenarians were divided into quartiles on the basis of their TyG and TyG-BMI indices. Kaplan‒Meier analysis was used to compare survival times across groups. The associations of the TyG index and TyG-BMI with all-cause mortality were investigated using restricted cubic splines (RCSs) and Cox proportional hazards regression models. Moreover, the concordance of the associations of the TyG index and TyG-BMI with all-cause mortality in different subgroups was further explored by subgroup analysis.

RESULTS

A total of 921 centenarian participants were included in this study. During a median follow-up of 29.70 months, 852 (92.5%) centenarians died. The results of the RCS analysis demonstrated that the TyG index and TyG-BMI were both linearly and negatively associated with all-cause mortality. Compared with that for the highest the TyG index and TyG-BMI quartile groups, higher risks of death were found for the lowest quartile groups (TyG Q1 vs. Q4, HR 1.27, 95% CI 1.03-1.56, P = 0.024; TyG-BMI Q1 vs. Q4, HR 1.60, 95% CI 1.30-1.96, P < 0.001). Centenarians with lower TyG index and TyG-BMI values had significantly greater mortality risks according to the Kaplan‒Meier analysis (log-rank P = 0.020, log-rank P < 0.001, respectively). Subgroup analysis demonstrated that blood pressure could influence the linear negative correlation between the TyG-BMI and all-cause mortality.

CONCLUSION

Both lower TyG and TyG-BMI indices were significantly associated with higher all-cause mortality in Chinese centenarians, whereas the TyG-BMI was superior to the TyG index in predicting the mortality risk of centenarians.

The relationship and differences in the triglyceride-glucose index and all-cause mortality in patients with coronary heart disease combined with cerebrovascular and other comorbidities: an analysis of the MIMIC-IV database

Objective

This study aims to investigate the predictive capability of the triglyceride-glucose index (TyG index) for all-cause mortality among patients with coronary heart disease (CHD), particularly in those with cerebrovascular disease (CVD) and other comorbidities, based on the MIMIC-IV database.

Methods

Using the ICD-9/10 coding standards, eligible CHD patients were identified from the MIMIC-IV database (version 3.0) with defined inclusion and exclusion criteria to ensure sample representativeness. Patients were categorized into CVD and other comorbidity groups. Data on mortality rates at 90 days, 1 year, and overall were collected, along with the TyG index and relevant covariates associated with survival risk. Baseline analyses, Spearman correlation, and restricted cubic splines (RCS) were employed to assess the nonlinear relationship between the TyG index and mortality. Kaplan-Meier curves and Cox proportional hazards models were utilized to evaluate survival risk.

Results

A total of 1,872 CHD patients were included, with 578 having CVD and a mortality rate of 50.17%; 1,294 had other comorbidities with a mortality rate of 64.91%. RCS analysis indicated a nonlinear relationship between the TyG index and mortality risk. For patients with concurrent CVD, the lowest mortality risk occurred at a TyG index of 9.37 mmol/L, while for those with other comorbidities, the lowest risk was observed at 9.36 mmol/L. Cox regression analysis revealed a significant association between the TyG index and survival risk in all CHD patients (HR = 1.15, 95%CI: 1.04-1.28, P < 0.01). In patients with other comorbidities, an increase in the TyG index was significantly correlated with elevated mortality risk (HR = 1.21, 95%CI: 1.02-1.34, P < 0.01).

Conclusion

The TyG index exhibits a nonlinear relationship with mortality risk in CHD patients, with elevated levels significantly increasing mortality risk in those with other comorbidities. These findings suggest that the TyG index may serve as a critical metabolic marker for prognostic evaluation in CHD patients, warranting further clinical attention.

Predictive role of insulin resistance surrogates in gallstone disease

Several studies have confirmed the association between insulin resistance (IR) surrogates and the risk of cardiovascular disease. This study aimed to investigate the correlation between 4 IR surrogates: triglyceride-glucose index (TyG), triglyceride-glucose index with waist circumference (TyG-WC), triglyceride-glucose index with body mass index (TyG-BMI), and triglycerides/high-density lipoprotein cholesterol ratio, and the risk of gallstone disease. This retrospective cross-sectional study involved a total of 19,696 participants who were divided into gallstone and non-gallstone groups based on ultrasound findings. Biochemical parameters and ultrasound results were collected and statistically analyzed. Nonparametric U test, Chi-square test, and subgroup analysis were used to examine the differences in expression of the 4 IR surrogates between the 2 groups. Logistic regression models and receiver operating characteristic curves were employed to evaluate the relationships and predictive ability of the 4 surrogates for gallstone disease. The levels of the 4 surrogates of IR were significantly higher in individuals with gallstone disease (GSD) compared to those without GSD (P < .001). After adjusting for age, gender, and personal medical history, TyG-WC and TyG-BMI emerged as significant predictors of gallstones in both genders. The predictive ability of these IR surrogates was stronger for gallstone disease in females than in males. In females, the area under the curve for TyG-WC and TyG-BMI were 0.683 and 0.629, respectively, while for males, these values were 0.544 and 0.528. When age was included with TyG-WC and TyG-BMI to predict GSD, the area under the curve values increased to 0.734 and 0.733 for females, and 0.684 and 0.682 for males. The study found that TyG-WC and TyG-BMI were identified as independent risk factors for the prevalence of GSD. Additionally, combined with age, TyG-WC and TyG-BMI showed good predictive value for the prevalence of GSD in females.

Nonlinear relationships between the triglyceride glucose-body mass index and cardiovascular disease in middle-aged and elderly women from NHANES (1999-2018)

This study aims to investigate the relationship between the triglyceride-glucose body mass index (TyG-BMI) and cardiovascular disease (CVD) among middle-aged and elderly women, using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. TyG-BMI was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2] × BMI. After applying the sampling weights from NHANES, the study sample of 6,343 participants is representative of approximately 59,174,898 American women. We categorized TyG-BMI into quartiles, using Q3 as the reference group. In the crude model, Q4 exhibited a 40% increased odds of CVD (odds ratio [OR] = 1.40, 95% confidence interval [CI] 1.09-1.79, P = 0.009). In the fully adjusted model, the increased odds of CVD for Q4 relative to Q3 was 39% (OR = 1.39, 95% CI 1.06-1.82, P = 0.019). Further analysis using restricted cubic splines (RCS) and threshold effect analysis confirmed a nonlinear relationship between them. Below a TyG-BMI threshold of 260, there was no significant association with CVD odds. However, above 260, each 10-unit increase in TyG-BMI was associated with a 2.4% increase in CVD odds in this demographic. Sensitivity analyses confirmed the stability of the results.

Association between cumulative average triglyceride glucose-body mass index and the risk of CKD onset

Background

Chronic kidney disease (CKD) has become a significant global public health challenge, which was reported to be highly correlated with the triglyceride glucose-body mass index (TyG-BMI). Nevertheless, literature exploring the association between changes in the TyG-BMI and CKD incidence is scant, with most studies focusing on individual values of the TyG-BMI. We aimed to investigate whether cumulative average in the TyG-BMI were associated with CKD incidence.

Methods

Data in our study were obtained from the China Health and Retirement Longitudinal Study (CHARLS), which is an ongoing nationally representative prospective cohort study. The exposure was the cumulative average TyG-BMI from 2011 to 2015. The TyG-BMI was calculated by the formula ln [TG (mg/dl) × FBG (mg/dl)/2] × BMI (kg/m2), and the cumulative average TyG-BMI was calculated as follows: (TyG-BMI2011+ TyG-BMI2015)/2. Logistic regressions were used to determine the association between different quartiles of cumulative average TyG-BMI and CKD incidence. Meanwhile, restricted cubic spline was applied to examine the potential nonlinear association of the cumulative average TyG-BMI and CKD incidence. In addition, subgroup analysis was used to test the robustness of results.

Results

Of the 6117 participants (mean [SD] age at baseline, 58.64 [8.61] years), 2793 (45.7%) were men. During the 4 years of follow-up, 470 (7.7%) incident CKD cases were identified. After adjusting for potential confounders, compared to the participants in the lowest quartile of cumulative average TyG-BMI, participants in the 3rd and 4th quartile had a higher risk of CKD onset. The ORs and 95%CIs were [1.509(1.147, 1.990)] and [1.452(1.085, 1.948)] respectively. In addition, restricted cubic spline showed the cumulative average TyG-BMI had a liner association (p-nonlinear = 0.139).

Conclusions

The cumulative average in the TyG-BMI was independently associated with the risk of CKD in middle-aged and older adults. Monitoring long-term changes in the TyG-BMI may assist with the early identification of individuals at high risk of CKD.

Exploring the nonlinear association between cardiometabolic index and hypertension in U.S. Adults: an NHANES-based study

BACKGROUND

Hypertension is a prevalent chronic disease affecting over 1.2 billion people worldwide, representing a major modifiable risk factor for cardiovascular diseases. The Waist-to-Height Ratio (WHtR) and Triglyceride to High-Density Lipoprotein Cholesterol (TG/HDL-C) ratio are established metabolic indicators linked to the risk of cardiovascular and metabolic diseases. Recently, a Cardiometabolic Index (CMI), combining WHtR and TG/HDL-C ratios, has been proposed to provide a comprehensive assessment of metabolic health. This study investigates the association between CMI and hypertension using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

The study utilized NHANES data from nine cycles spanning 2001 to 2018, encompassing 20,049 participants aged over 20. Exclusions were made for individuals with incomplete CMI or hypertension data, and pregnant women. CMI was calculated by multiplying the WHtR by the TG/HDL-C ratio. Hypertension was defined according to American Heart Association guidelines. The relationship between CMI and hypertension was evaluated using multivariate logistic regression analyses, with additional subgroup analyses conducted based on demographic factors. Nonlinear relationships were analyzed using smoothing curve fitting techniques.

RESULTS

The study identified a significant positive correlation between CMI and hypertension risk, with an increase of one unit in CMI associated with a 9% heightened risk of hypertension (OR: 1.09, 95% CI: 1.05, 1.13). The association remained significant across various demographic subgroups. A nonlinear relationship was observed, with a critical CMI threshold of 2.64. Below this threshold, higher CMI values were associated with a progressively higher prevalence of hypertension, whereas beyond this threshold, further increases in CMI did not significantly correlate with an elevated risk of hypertension.

CONCLUSION

The study demonstrates that CMI is significantly associated with hypertension risk and may serve as a valuable tool for early screening and risk assessment, particularly in identifying individuals at higher risk before reaching the critical CMI threshold. These results underscore the importance of addressing metabolic health in the prevention and management of hypertension. Future research should focus on longitudinal studies to establish causality, explore the clinical utility of CMI in hypertension screening, and examine its applicability in diverse populations.

Associations of triglyceride glucose-body mass index and the combination of sedentary behavior and physical activity with risks of all-cause mortality and myocardial infarction: a cohort study from the UK biobank

BACKGROUND

Triglyceride glucose-body mass (TyG-BMI) index, sedentary behavior (SB) and physical activity (PA) are independently associated with all-cause mortality and myocardial infarction (MI). However, it remains unclear whether TyG-BMI index and the combination of SB and PA exhibit joint effects on all-cause mortality and MI.

METHODS

Among 502 356 participants from the UK Biobank, 297 761 eligible participants were selected. The Cox proportional hazards model and the restricted cubic spline regression model were used to assess the associations of TyG-BMI with all-cause mortality and MI. To conduct stratified analysis, participants were classified into four groups by SB (<6 h/d and ≥ 6 h/d) and moderate to vigorous physical activity (MVPA) (<150 min/wk and ≥ 150 min/wk). Additionally, the multiplicative interaction was assessed between TyG-BMI and SB & MVPA. Furthermore, to estimate their joint associations, participants were conjointly classified into twelve new groups by TyG-BMI (tertiles) and SB & MVPA (four groups).

RESULTS

During a median follow-up of 13.8 and 13.6 years, 21 335 deaths and 9 116 MI were observed, respectively. The dose-response relationship of TyG-BMI with all-cause mortality was U-shaped with a cut-off point at 225.09, whereas the relationship with MI was positive nonlinear with a cut-off point at 266.87. A synergistic effect on all-cause mortality was observed between TyG-BMI tertile 1 and ≥ 6 h/d SB & <150 min/wk MVPA (P for interaction < 0.001). When MVPA ≥ 150 min/wk combined with SB either <6 h/d or not, TyG-BMI tertile 2 showed no significant association with all-cause mortality risk, with HRs(95%CIs) of 0.98 (0.93-1.03) for <6 h/d SB and 1.00 (0.94-1.07) for ≥ 6 h/d SB. When one of the two healthy behaviors was present (i.e., either <6 h/d SB with <150 min/wk MVPA, or ≥ 150 min/wk MVPA with ≥ 6 h/d SB), its combination with TyG-BMI tertile 1 showed no significant association with MI risk, with HRs(95%CIs) of 1.07(0.95-1.20) and 1.09(0.94-1.25), respectively.

CONCLUSIONS

TyG-BMI index and the combination of SB and PA were independently and jointly associated with risks of all-cause mortality and MI. Our findings highlight the importance of improving insulin resistance to reduce all-cause mortality risk, particularly in individuals with long-term SB and insufficient PA, who are more susceptible to the adverse effects of TyG-BMI index. In long-term sedentary individuals, meeting PA guidelines (≥ 150 min/wk of MVPA) effectively mitigated risks of all-cause mortality and MI associated with TyG-BMI index.

Association of the Triglyceride-Glucose Index and Obesity Indicators with Multiple Chronic Diseases: A Longitudinal Cohort Study Based on CHARLS

Objective

To explore the relationship between triglyceride glucose (TyG) and the obesity combined indexes and the occurrence of multiple chronic diseases (MCD), which will help to provide a basis for the prevention and treatment of this condition.

Methods

3037 participants in the China Health and Retirement Longitudinal Study, which was conducted from 2011 to 2015 were selected for this study. They were divided into four groups (Q1, Q2, Q3, Q4) based on the quartiles of TyG, TyG-BMI, TyGWC and TyGWHtR in the baseline data. A Cox proportional hazard model was used to analyze the risk of MCD associated with TyG and its obesity-related combined indicators. Dose-response relationships were analyzed using restricted cubic spline regression, and the predictive ability for detection of MCD was analyzed using ROC curve.

Results

At the end of the follow-up in 2015, 473 new cases of MCD were observed among the study population, with an incidence rate of 15.6%. After adjusting for confounding factors, the risk of MCD significantly increased in the Q4 TyG, TyG-BMI, TyG-WC and TyG-WHtR index groups compared to the Q1 groups (p<0.001 in all cases). A linear dose-response relationship was observed between the TyG index and the risk of MCD, indicating increased risks of CKD with higher TyG indexes. However, the TyG-BMI, TyG-WC and TyG-WHtR indexes exhibited nonlinear dose-response relationships with the risk of MCD (P-nonlinearity <0.0001 in all cases), indicating higher indexes were associated with higher risks of MCD. The areas under the ROC curves for the Cox regression models of TyG, TyG-BMI, TyG-WC and TyG-WHtR indices were 0.610, 0.590, 0.590 and 0.607, respectively.

Conclusion

The TyG, TyG-BMI, TyG-WC and TyG-WHtR indexes were found to be positively correlated with increased risk of developing MCD. Measurements and regulation of these indexes can be used to prevent and control the occurrence of MCD.

The association between estimated pulse wave velocity and cardio-cerebrovascular disease risk: a cohort study

BACKGROUND

Various measures of arterial stiffness have been linked to the risk of cardiovascular disease. However, the relationship between the estimated pulse wave velocity (ePWV), a novel indicator of arterial stiffness, and cardio-cerebrovascular disease risk remains unclear. This study investigated the relationship between the ePWV and the risk of cardio-cerebrovascular diseases.

METHODS

A total of 17,708 participants aged 45 years and older enrolled in the China Health and Retirement Longitudinal Study (CHARLS), conducted between 2011 and 2012, and participants with a 7-year follow-up were included. Ultimately, 8242 respondents were included in the study. The ePWV was calculated using age and mean blood pressure. Cardio-cerebrovascular diseases, including myocardial infarction, cerebral infarction, and intracerebral haemorrhage, were categorised as cardiovascular and cerebrovascular diseases. Clinical and demographic characteristics were collected. A Cox proportional hazards model was used to explore the relationship between ePWV and the risk of cardiovascular disease.

RESULTS

During the 7-year follow-up, 21.7% of the participants (1791/8242) developed cardio-cerebrovascular diseases. After adjusting for potential confounding factors, the ePWV was positively associated with the risk of cardio-cerebrovascular disease (adjusted hazard ratio: 1.16, 95% CI 1.11-1.22, P < 0.001). The ePWV was divided into quartiles, and regression analysis was performed. Participants in the highest ePWV quartile had a 128% higher risk of cardio-cerebrovascular disease than those in the lowest quartile. The subgroup analysis showed that the positive association between the ePWV and the risk of cardio-cerebrovascular disease remained consistent among middle-aged and older adults across different Chinese communities.

CONCLUSIONS

In middle-aged and older Chinese adults, the ePWV was significantly and positively associated with the risk of cardio-cerebrovascular disease, making it a reliable and innovative predictor of these conditions.

Association Between Triglyceride Glucose Index and Hypertension According to Different Diagnostic Criteria

Objective

To explore the association between triglyceride glucose index (TyG) and hypertension under different diagnostic thresholds.

Methods

This study analyzed data from routine occupational health examinations conducted at the First Affiliated Hospital of Xi'an Jiaotong University in 2019. TyG and TyG-BMI, indicators of insulin resistance (IR), were calculated using triglyceride (TG), fasting blood glucose (FPG), and body mass index (BMI). Hypertension was defined by thresholds of 140/90 mmHg and 130/80 mmHg. Logistic regression models were employed to investigate the association between TyG and hypertension.

Results

Among 4028 subjects, after adjusting for covariates, the risk of hypertension (diagnosed by 140/90 mmHg) was 2.87 times higher (OR=2.87, 95% CI: 2.11-3.91) in the Q4 group of TyG compared to the Q1 group. Similarly, the risk was 8.03 times higher (OR=8.03, 95% CI: 5.05-12.75) in the Q4 group of TyG-BMI than in the Q1 group. Furthermore, the risk of hypertension (diagnosed by 130/80 mmHg) was 2.93 times higher (OR=2.93, 95% CI: 2.34-3.68) in the Q4 group of TyG compared to the Q1 group, and 7.12 times higher (OR=7.12, 95% CI: 5.08-9.99) in the Q4 group of TyG-BMI than in the Q1 group. The restricted cubic spline further showed a dose-response relationship between TyG/ TyG-BMI and hypertension. In the population with a BMI of 24.0-27.9 kg/m2, the risk of developing hypertension (diagnosed by 140/90 mmHg) in the Q4 group of TyG was 2.79 times higher (OR=2.79, 95% CI: 1.67-4.66), while the Q4 group with TyG had a 3.07 times greater risk of hypertension (diagnosed by 130/80 mmHg) than the Q1 group (OR=3.07, 95% CI: 2.05-4.60).

Conclusion

TyG is an independent risk factor for hypertension across different thresholds, showing a clear dose-response relationship. BMI may influence this association, emphasizing the importance of managing insulin resistance early to aid hypertension prevention.

Perspective from NHANES data: synergistic effects of visceral adiposity index and lipid accumulation products on diabetes risk

This study aimed to explore the synergistic effect of lipid accumulation product (LAP) and visceral adiposity index (VAI) on diabetes risk, and to evaluate the potential associations of these novel metabolic markers with diabetes. The current cross-sectional survey utilised data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES). The relationship between LAP and VAI levels and diabetes was examined using multiple logistic regression analysis. Moreover, threshold effects analysis and smoothed curve fitting were used as analytical techniques. The diabetes group exhibited significantly higher LAP (90.1 ± 84.1) and VAI (2.8 ± 2.8) levels compared to the non-diabetes group (p < 0.0001).After adjusting for confounding factors, LAP (OR = 1.01, 95% CI: 1.00-1.01, p < 0.0001) and VAI (OR = 1.22, 95% CI: 1.16-1.28, p < 0.0001) were independently associated with diabetes risk. The interaction term (LAP x VAI) showed a significant synergistic effect (OR = 1.01, 95% CI: 1.00-1.07, p = 0.0042).Diabetes risk significantly increased when LAP was below 97.70 (OR = 1.03, 95% CI: 1.02-1.03, p < 0.0001) and when VAI was below 3.76 (OR = 1.88, 95% CI: 1.69-2.08, p < 0.0001). According to this study, LAP and VAI are independent predictors of diabetes risk and exhibit a significant synergistic effect. Combining these indices may improve the accuracy of diabetes screening.

Vitamin E Intake Attenuated the Association Between Elevated Blood Heavy Metal (Pb, Cd, and Hg) Concentrations and Diabetes Risk in Adults Aged 18-65 Years: Findings from 2007-2018 NHANES

The association between heavy metal exposure and diabetes is controversial and vitamin E (VE) may reduce diabetes risk. We aimed to examine the associations between blood heavy metals (BHMs) and diabetes risk and VE's role in the relationship. From the 2007-2018 NHANES, 10,721 participants aged ≥ 18 were included for multiple statistical analyses, which revealed that BHMs and dietary VE intake were negatively associated with diabetes and fasting plasma glucose (FPG). The diabetes prevalence in each quartile (Q) of heavy metal exposure increased with age, but within age Q4, it generally decreased with exposure quartiles. Moreover, BHMs were positively associated with all-cause and diabetes-related mortalities with aging, which induced an age breakpoint of 65 years for age-stratified analyses on the associations between BHMs and diabetes risk. In those aged > 65, BHMs were negatively correlated with diabetes risk and its biomarkers; however, in adults aged 18-65, the correlation was positive. At higher VE intake levels, blood lead was associated with a lower diabetes risk and all three BHMs demonstrated lower FPG levels than those at lower VE intake levels. In conclusion, consuming sufficient VE and avoiding heavy metal exposure are highly recommended to reduce diabetes risk.

Association of non-insulin-dependent insulin resistance indices with lower limb artery restenosis after drug-coated balloon angioplasty

BACKGROUND

This study aimed to investigate the associations between noninsulin-dependent insulin resistance indices (NI-IRIs), including the triglyceride-glucose (TyG) index, TyG-BMI, triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), and metabolic score for insulin resistance (METS-IR), as well as the occurrence of restenosis in patients with lower extremity atherosclerotic occlusive disease after drug-coated balloon (DCB) treatment.

METHODS

The primary endpoint was restenosis within one year after the procedure, which was defined as ≥ 50% stenosis of the treated artery segment. The association between NI-IRIs and restenosis was assessed via multivariable logistic regression analysis. Restricted cubic spline (RCS) analysis was performed to quantify nonlinearity. The consistency of these associations was confirmed through subgroup and interaction analyses. Additionally, the additional predictive value of NI-IRIs beyond established risk factors for restenosis was evaluated via receiver operating characteristic (ROC) curves, the net reclassification improvement (NRI), and integrated discrimination improvement (IDI) indices.

RESULTS

Except for the TyG index, the other three NI-IRIs demonstrated nonlinear relationships with the probability of postoperative restenosis. Specifically, TG/HDL-C (inflection point: 1.48, P for nonlinearity: 0.003) exhibited a saturating effect, whereas METS-IR (inflection point: 49.30, P for nonlinearity: 0.017) and TyG-BMI (inflection point: 221.53, P for nonlinearity: 0.039) showed threshold effects. Subgroup analysis revealed that the interactions among the subgroups were not statistically significant. Furthermore, among the four NI-IRIs, the addition of the TG/HDL-C index significantly enhanced the predictive power of the base model for restenosis in ASO patients following DCB angioplasty (AUC values: 0.726 vs. 0.760, P = 0.042). The P values for the NRI and IDI were 0.001 and 0.002, respectively.

CONCLUSION

TG/HDL-C showed a saturating effect on restenosis within one year after DCB treatment in ASO patients, and METS-IR and TyG-BMI showed threshold effects. The addition of the TG/HDL-C index significantly improved the predictive ability of the base model for restenosis in ASO patients who underwent DCB angioplasty.

Relationship between four insulin resistance surrogates and regression to normoglycemia from prediabetes among Chinese adults: A longitudinal Cohort Study

PURPOSE

We aimed to investigate the association of the triglyceride glucose-body mass index(TyG-BMI), metabolic score for insulin resistance (METS-IR) with regression to normoglycaemia, and further to compare the value of the four insulin resistance(IR) related indices(TyG-BMI, METS-IR, TyG and triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio) in identifying regressions to normoglycaemia from prediabetes.

METHODS

A total of 15,025 patients with prediabetes from the DATA-DRYAD database were included. Cox proportional hazards regression models and restricted cubic spline functions were performed to explore the association and nonlinearity between the indices with the incidence rate of normoglycaemia. Sensitivity and subgroup analyses evaluated the robustness of our findings.

RESULTS

Compared with the first quintile, TyG-BMI and METS-IR was negatively linked with the probability of regression to normoglycaemia from prediabetes, the adjusted effect size of the highest quintiles of METS-IR were the most obvious (HR:0.456,95% CI:0.4-0.519), followed by TG/HDL (HR:0.792, 95% CI:0.733-0.856), TyG-BMI (HR:0.816, 95% CI:0.73-0.911) and TyG (HR:0.841, 95% CI: 0.754-0.937) (all p for trend <0.001). A 1.0 SD increase in METS-IR induced a 43% decrease in the probability of regression to normoglycaemia, with 9.8% for TyG-BMI. There were nonlinear associations between TyG-BMI and METS-IR and outcomes, with the inflection point of the TyG-BMI being 218.2 and that of the METS-IR being 37.

CONCLUSIONS

The METS-IR might be the most superior indicator among the four non-insulin indices in identifying regressions to normoglycaemia from prediabetes in clinical application. The inflection points of the METS-IR and TyG-BMI may be instructive therapeutic points for assessing the status of prediabetes in advance and making more appropriate management and health care decisions.

Association between different insulin resistance surrogates and osteoarthritis: a cross-sectional study from NHANES 1999-2018

BACKGROUND

Previous studies have demonstrated a relationship between prevalence of Osteoarthritis (OA) and insulin resistance (IR). The correlation between IR surrogates indices and gold standard tool for IR evaluation (Hyperinsulinemic-euglycemic clamp (HIEC)) have been well demonstrated. However, few studies evaluated the relationship between IR surrogates and OA. The aim of this study is to investigate the potential associations between different IR surrogates (the homeostatic model assessment of insulin resistance (HOMA-IR) index, the triglyceride glucose (TyG) index, the triglyceride glucose with body mass (TyG-BMI) index, the triglyceride glucose with waist circumference (TyG-WC) index, and the triglyceride glucose with the ratio of waist circumference divided by height (TyG-WtHR) index) and OA.

METHODS

This study used data from the National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression analysis was used to assess the associations of different IR surrogates with OA.

RESULTS

After adjusting for covariates, TyG-BMI index (OR = 1.006, 95% CI [1.004, 1.007], P < 0.0001), TyG-WC index (OR = 1.002, 95% CI [1.002, 1.003], P < 0.0001) and TyG-WtHR index (OR = 1.425, 95%CI [1.292,1.572], P < 0.0001) still showed robust positive correlation with IR. The risk of OA in the fourth quartile of the TyG-BMI index, TyG-WC index, and TyG-WtHR index are 2.634-fold, 2.651-fold, and 2.433-fold higher than that in the first quartile, respectively.

CONCLUSIONS

Compared to the HOMA-IR index and the TyG index, the association between the TyG-BMI, TyG-WC, and TyG-WtHR indices and OA is closer and more stable. The TyG-WtHR index has the highest accuracy in predicting OA, followed by the TyG-WC and TyG-BMI index.

Association Between Weight-Adjusted Waist Index and Periodontitis: A Cross-Sectional Study and Mediation Analysis

Aim

The research examined the correlation between the weight-adjusted waist index (WWI) and periodontal disease, as well as the intermediary influence of triglyceride glucose (TyG) index-related indicators, utilizing a health examination dataset.

Methods

This cross-sectional study included 39,522 subjects from health check-up database of Shanghai Health and Medical Center. The WWI was determined by applying a formula that includes dividing the waist circumference (WC) by the body weight's square root. Periodontitis diagnosis followed the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC/AAP) classification. The correlation between the WWI and periodontitis was investigated through multivariate logistic regression and smoothing curve fitting. Subgroup analysis and interaction tests were also performed to verify the stability of the results. A mediation analysis was conducted to quantify the direct and indirect influences mediated by the TyG-related indicators [TyG, TyG -body mass index (TyG-BMI), TyG -waist-to-height ratio (TyG-WHtR), and TyG-waist circumference (TyG-WC)].

Results

Multivariable logistic regression analysis revealed the positive association of WWI and periodontitis (OR=1.37, 95% CI: 1.30-1.43). Compared to those in the lowest quartile of WWI, participants in the highest quartile exhibited a 82% higher likelihood of periodontitis (OR=1.82, 95% CI: 1.69-1.96). Subgroup analysis and interaction tests revealed that this positive correlation was consistent in gender, BMI, WC, smoking, drinking, hypertension, and dyslipidemia (P for interaction > 0.05), with some variations noted by age and diabetes status (P for interaction<0.05). Mediation analysis showed that the proportions mediated by TyG, TyG-BMI, TyG-WC, and TyG-WHtR on the association of WWI and periodontitis risk were 13.13%, 6.30%, 16.46% and 19.79%, respectively.

Conclusion

A higher WWI in Chinese adults was linked to an increased likelihood of periodontitis, and this correlation could be partially explained by elevated levels of TyG index-related indicators.

Association Between Triglyceride-Glucose Index and Development of Asthma in US Adolescents: A Cross-Sectional Study

PURPOSE

Metabolic abnormalities, such as insulin resistance (IR) and dyslipidemia, have been linked to an increased risk of asthma. The triglyceride-glucose index (TyG), a metric indicating metabolic dysfunction, exhibits correlations with metabolic syndrome and IR. However, little research has been conducted on the relationship between TyG and asthma in the pediatric population. Therefore, we aimed to investigate the relationship between TyG and asthma among adolescents.

METHODS

Data from the National Health and Nutrition Examination Survey between 2007 and 2012 was analyzed in this cross-sectional study. The association between TyG and asthma was evaluated using various statistical methods, including multivariate logistic regression analysis, restricted cubic spline (RCS) analysis, threshold effects analysis, and subgroup analysis.

RESULTS

A total of 1,629 adolescent participants were enrolled in the study, consisting of 878 (53.9%) males and 751 females (46.1%), with a mean age of 15.5 years. After adjusting for all covariates in the multivariate logistic regression, the adjusted odds ratio (OR) for TyG and asthma in the highest quintile (Q5, > 8.65) was 4.26 (95% confidence interval [CI], 1.54, 11.81; P = 0.005) compared to the TyG in the second quintile (Q2, 7.68-7.96). Additionally, the multivariate RCS analysis revealed a non-linear relationship between TyG and asthma (P = 0.003). In the threshold analysis, the adjusted OR of asthma was 0.001 (95% CI, 0, 0.145; P = 0.007) in participants with a TyG < 7.78, and the adjusted OR of asthma was 3.685 (95% CI, 1.499, 9.058; P = 0.004) in participants with a TyG ≥ 7.78. Subgroup analysis did not show any interactive role for TyG and asthma.

CONCLUSIONS

In US adolescents, a U-shaped association was observed between asthma and the TyG, with a critical turning point identified at around 7.78.

The joint effect of cumulative metabolic parameters on the risk of type 2 diabetes: a population-based cohort study

BACKGROUND AND AIMS

This study aimed to examine the cumulative effects of body mass index (BMI), body roundness index (BRI), pulse pressure (PP), triglycerides (TG), high-density lipoprotein cholesterol (HDL) and fasting plasma glucose (FPG) on Type 2 diabetes (T2D) morbidity.

METHODS

A total of 78,456 participants aged older than 45 years were extracted from basic public health services in China. During the 2-year follow-up, 6,942 individuals had developed T2D. The binary logistic regression models and multinomial logistic regression models were conducted to investigate the effects of cumulative metabolic parameters on incident T2D, prediabetes regression and progression.

RESULTS

We found statistically deleterious impacts of exposure to high cumulative BMI, BRI, PP, TG and low cumulative HDL on T2D morbidity and prediabetes progression. Compared to the group with low cumulative of all five parameters, the adjusted ORs for new-onset T2D for participants presenting with 1-2, 3, and 4-5 elevated metabolic parameters were 1.41(1.31,1.52), 1.93(1.74,2.13) and 2.21(1.94,2.51), respectively. There was additive interaction between FPG level and cumulative metabolic parameters with T2D. Compared with participants with the lowest quartile of FPG and low cumulative of all 5 parameters, those with the highest quartile of FPG and high cumulative of 4-5 parameters had a 14.63 [95% CI (12.27, 17.42)] higher risk of incident T2D.

CONCLUSIONS

Participants with more numbers of high-cumulative metabolic parameters were associated with a higher risk of incident T2D and prediabetes progression. A high level of normal FPG could enhance these risks.

Assessing and predicting type 2 diabetes risk with triglyceride glucose-body mass index in the Chinese nondiabetic population-Data from long-term follow-up of Da Qing IGT and Diabetes Study

AIMS

We intended to characterize the superiority of triglyceride glucose-body mass index (TyG-BMI) in predicting type 2 diabetes mellitus (T2DM) compared with triglyceride glucose (TyG) and homeostatic model assessment for insulin resistance (HOMA-IR).

METHODS

A total of 699 nondiabetic participants in the Da Qing IGT and Diabetes Study were involved in the present analysis and classified according to the median of baseline TyG-BMI, namely the G1 (low TyG-BMI) and G2 (high TyG-BMI) groups. Information on developing diabetes was assessed from 1986 to 2020.

RESULTS

During the 34-year follow-up, after adjustment for confounders, the G2 group had a higher risk of developing type 2 diabetes than the G1 group (hazard ratio [HR]: 1.92, 95% confidence interval [CI]: 1.51-2.45, p < 0.0001). Restricted cubic spline analyses showed that increased TyG-BMI was linearly related to higher risks of type 2 diabetes (p for non-linearity>0.05). Time-dependent receiver operator characteristics curves suggested that TyG-BMI exhibited higher predictive ability than TyG (6-year: area under the curve [AUC]TyG-BMI vs. AUCTyG, 0.78 vs. 0.70, p = 0.03; 34-year: AUCTyG-BMI vs. AUCTyG, 0.79 vs. 0.73, p = 0.04) and HOMA-IR (6-year: AUCTyG-BMI vs. AUCHOMA-IR, 0.78 vs. 0.70, p = 0.07; 34-year: AUCTyG-BMI vs. AUCHOMA-IR, 0.79 vs. 0.71, p = 0.04) in both short and long terms, and the thresholds of TyG-BMI to predict type 2 diabetes were relatively stable (195.24-208.41) over the 34-year follow-up.

CONCLUSIONS

In this post hoc study, higher TyG-BMI was associated with an increased risk of type 2 diabetes and demonstrated better predictability than TyG and HOMA-IR, favoring the application of TyG-BMI as a potential tool for evaluating the risk of type 2 diabetes in clinical practice.

[Association Between Triglyceride Glucose Index and Triglyceride Glucose-Obesity Composite Indices and the Risk of Ischemic Heart Disease]

Objective

To explore the association between the triglyceride-glucose index (TyG) and TyG-obesity composite indices, including TyG-waist circumference (TyG-WC), TyG-body mass index (TyG-BMI), and TyG-waist-to-height ratio (TyG-WHtR), and the risk of ischemic heart disease (IHD), and to provide reference for the prevention of IHD.

Methods

The sample of this study was derived from the West China Elderly Preventive and Treatment Merging Cohort, from which 9628 elderly individuals from the retrospective cohort were selected. Cox regression models were used to analyze the association between TyG-related indices and the risk of IHD. Receiver operating characteristic (ROC) curves were plotted to assess and compare the performance of TyG-related indices in predicting the occurrence of IHD.

Results

The participants were followed up for a median of 2.82 years, with 7.2% (694/9628) of the participants experiencing IHD events. Multivariate Cox regression showed that after controlling for the covariates, including sex, age, educational attainment, smoking, drinking, exercise, dietary habits, medication history, and whether the participant had hypertension, every time TyG, TyG-WC, TyG-BMI and TyG-WHtR increased by one standard deviation (SD), the risk of IHD increased by 12% (hazard ratio [HR]=1.12, 95% confidence interval [CI]: 1.04-1.20), 21% (HR=1.21, 95% CI: 1.12-1.31), 20% (HR=1.20, 95% CI: 1.12-1.29), and 19% (HR=1.19, 95% CI: 1.10-1.28), respectively. Both the TyG index and TyG-obesity composite indices were positively correlated with IHD risk, showing a linear relationship (P<0.05). TyG-WC (area under the curve[AUC]=0.680, 95% CI: 0.660-0.700, P<0.001), TyG-BMI (AUC=0.674, 95% CI: 0.654-0.695, P<0.001), and TyG-WHtR (AUC=0.678, 95% CI: 0.658-0.698, P<0.001) demonstrated better predictive performance than TyG did (AUC=0.669, 95% CI: 0.648-0.689, P<0.001).

Conclusion

Elevated levels of TyG and TyG-obesity composite indices were associated with a higher risk for IHD, and combining TyG with BMI, WC, and WHtR may lead to better performance in risk assessment for IHD than using TyG alone.

Relationship between four visceral obesity indices and prediabetes and diabetes: a cross-sectional study in Dalian, China

BACKGROUND

In recent times, a number of new indices for measuring visceral obesity have been developed. This research sought to investigate the relationship between four visceral obesity indices and prediabetes and diabetes.

METHODS

Conducted in 2011 as a cross-sectional analysis in Dalian, China, this study utilized logistic regression models to explore the relationships between four visceral obesity indices and prediabetes and diabetes. It also assessed the dose-response relationships using restricted cubic splines (RCS), performed subgroup analyses, and conducted interaction tests. The predictive values of four visceral obesity indices were evaluated using receiver operating characteristic (ROC) curves.

RESULTS

The study enrolled 10,090 participants, with prediabetes and diabetes prevalence at 80.53%. Multifactorial logistic regression revealed positive relationships between the four visceral obesity indices and prediabetes and diabetes. The results of the RCS analysis revealed a linear relationship between the body roundness index (BRI), cardiometabolic index (CMI) and prediabetes and diabetes. Conversely, a non-linear relationship was observed between Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP) and prediabetes and diabetes. Subgroup analyses demonstrated stronger relationships of CMI, CVAI, and LAP with prediabetes and diabetes among females. ROC curves suggested that LAP could be an effective predictor of these conditions.

CONCLUSION

This research confirmed that four visceral obesity indices are linked with a higher risk of prediabetes and diabetes in middle-aged and elderly individuals in Dalian. Importantly, LAP could be an effective predictor of prediabetes and diabetes. Effective weight management significantly reduces the risk of both prediabetes and diabetes.

Association Between Visceral Obesity Index and Diabetes: A Systematic Review and Meta-analysis

CONTENT

The correlation between visceral obesity index (VAI) and diabetes and accuracy of early prediction of diabetes are still controversial.

OBJECTIVE

This study aims to review the relationship between high level of VAI and diabetes and early predictive value of diabetes.

DATA SOURCES

The databases of PubMed, Cochrane, Embase, and Web of Science were searched until October 17, 2023.

STUDY SELECTION

After adjusting for confounding factors, the original study on the association between VAI and diabetes was analyzed.

DATA EXTRACTION

We extracted odds ratio (OR) between VAI and diabetes management after controlling for mixed factors, and the sensitivity, specificity, and diagnostic 4-grid table for early prediction of diabetes.

DATA SYNTHESIS

Fifty-three studies comprising 595 946 participants were included. The findings of the meta-analysis elucidated that in cohort studies, a high VAI significantly increased the risk of diabetes mellitus in males (OR = 2.83 [95% CI, 2.30-3.49]) and females (OR = 3.32 [95% CI, 2.48-4.45]). The receiver operating characteristic, sensitivity, and specificity of VAI for early prediction of diabetes in males were 0.64 (95% CI, .62-.66), 0.57 (95% CI, .53-.61), and 0.65 (95% CI, .61-.69), respectively, and 0.67 (95% CI, .65-.69), 0.66 (95% CI, .60-.71), and 0.61 (95% CI, .57-.66) in females, respectively.

CONCLUSION

VAI is an independent predictor of the risk of diabetes, yet its predictive accuracy remains limited. In future studies, determine whether VAI can be used in conjunction with other related indicators to early predict the risk of diabetes, to enhance the accuracy of prediction of the risk of diabetes.

Relationship between indices of insulin resistance and incident type 2 diabetes mellitus in Chinese adults

BACKGROUND

Insulin resistance (IR) is a pivotal pathogenesis characteristic of type 2 diabetes mellitus (T2DM). The current study aimed to explore the association between triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c), triglyceride-glucose (TyG), and triglyceride glucose-body mass index (TyG-BMI), and T2DM incidence.

METHODS

A total of 116,855 Chinese adults aged over 20 without diabetes were included. Multivariate Cox regression analysis and restricted cubic spine were utilized to investigate the association between IR indicators and T2DM. The T2DM risk across different quartiles of IR parameters was compared using Kaplan-Meier curves. The receiver operating characteristic analysis was used to investigate the predictive potential of each IR indicator for future T2DM.

RESULTS

A total of 2685 participants developed T2DM during a median follow-up of 2.98 years. The adjusted hazard ratios (HR) of incident T2DM were 1.177, 2.766, and 1.1018 for TG/HDL-c, TyG, and TyG-BMI, respectively. There were significant increasing trends of T2DM across the quartiles of TG/HDL-c, TyG, and TyG-BMI. The HRs of new-onset T2DM in the highest quartiles versus the lowest quartile of TG/HDL-c, TyG, and TyG-BMI were 3.298, 8.402, and 8.468. RCS revealed the nonlinear relationship between IR and T2DM risk. The correlations between IR and T2DM were more pronounced in subjects aged <40. TyG-BMI had the highest predictive value for incident T2DM (AUC = 0.774), with a cut-off value of 213.289.

CONCLUSION

TG/HDL-c, TyG, and TyG-BMI index were all significantly positively associated with higher risk for future T2DM. Baseline TyG-BMI level had high predictive value for the identification of T2DM.

Oxidative stress mediates the association between triglyceride-glucose index and risk of cardiovascular and all-cause mortality in metabolic syndrome: evidence from a prospective cohort study

Background

The aim of this study was to investigate the relationship between triglyceride-glucose (TyG) index and cardiovascular disease (CVD) and all-cause mortality in adults with metabolic syndrome (MeS) and explore the mediating role of oxidative stress.

Methods

This study included 6131 adults with MeS from the National Health and Nutrition Examination Survey (NHANES). The relationships between TyG index and mortality were elucidated using multivariate Cox proportional hazards models, restricted cubic splines (RCS) Fine-Gray competing risk model. In addition, mediation analysis was used to test the indirect effect of oxidative stress indicators.

Results

Over a median 106-month follow-up, a total of 357 CVD and 1292 all-cause deaths were recorded. After multivariate adjustment, there was a J-type relationship between TyG index and CVD and all-cause mortality, with optimal inflection point of 9.13 and 8.92. After the threshold point, TyG index was positively associated with CVD (HR: 4.21, 95%CI: 1.82, 9.78) and all-cause mortality(HR: 2.93, 95%CI: 2.05, 4.18). Even using non-cardiovascular mortality as a competitive risk, the Fine-Gray model also illustrated that the cumulative CVD mortality incidence was higher in MeS with TyG index >9.13 (Fine-Gray P< 0.01). Mediation analysis revealed that biomarkers of oxidative stress, including gamma-glutamyl transferase and uric acid, collectively mediated 10.53% of the association between the TyG index and CVD mortality, and 8.44% of the association with all-cause mortality (P < 0.05).

Conclusion

In the cohort study, TyG index was found to have a J-shaped association with CVD mortality and all-cause mortality in MeS population and oxidative stress may play a key mediating role in this relationship.

Comparison of TyG and Newly TyG Related Indicators for Chronic Kidney Diseases Estimation in a Chinese Population

Background

Obesity and insulin resistance (IR) are positively associated with chronic kidney disease (CKD). Previous studies have identified triglyceride-glucose index (TyG) as a valuable surrogate of insulin resistance. Recently, new indicators combining TyG and simple anthropometric indices have emerged, The objective of this study was to assess the diagnostic accuracy of TyG and newly TyG related indicators in detecting CKD and explore which indices were superior in associating with CKD in Chinese population.

Methods

Correlation test, logistic regression analysis, and receiver operating characteristic (ROC) analyses were used to evaluate the optimal cut-off and value of TyG, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist to height ratio (TyG-WHtR) for predicting CKD.

Results

TyG-WHtR, TyG-WC, and TyG-BMI correlated with several risk factors for CKD. After adjusting for confounders, TyG-WHtR and TyG-WC remained significantly associated with CKD, while TyG-BMI did not. The highest quartiles of TyG-WHtR and TyG-WC had 1.95- and 1.91-fold increased risk of CKD than the lowest quartiles (P<0.05). TyG-WHtR had the largest AUC (0.687) for CKD detection, followed by TyG-WC (0.669), TyG (0.652), and TyG-BMI (0.648). A united model that involved TyG-WHtR and other risk variables had higher predictive performance (AUC=0.791) than a single TyG related indicator. However, TyG had the highest OR (2.713, 95% CI, 1.446-5.090) for reduced eGFR in the fully adjusted model. A united model that involved TyG and WHtR separately had stronger predictive ability (AUC: 0.794) than the model that involved TyG-WHtR individually (AUC:0.791).

Conclusion

This study found that TyG-WHtR had a better diagnostic value in the diagnosis of CKD, compared to other TyG related indicators, but none of the TyG related indicators showed a stronger association with CKD than TyG. Further research and more refined algorithms are needed to verify these new indicators.

Relationship between changes in the triglyceride glucose-body mass index and frail development trajectory and incidence in middle-aged and elderly individuals: a national cohort study

BACKGROUND

Insulin resistance is linked to an increased risk of frailty, yet the comprehensive relationship between the triglyceride glucose-body mass index (TyG-BMI), which reflects weight, and frailty, remains unclear. This relationship is investigated in this study.

METHODS

Data from 9135 participants in the China Health and Retirement Longitudinal Study (2011-2020) were analysed. Baseline TyG-BMI, changes in the TyG-BMI and cumulative TyG-BMI between baseline and 2015, along with the frailty index (FI) over nine years, were calculated. Participants were grouped into different categories based on TyG-BMI changes using K-means clustering. FI trajectories were assessed using a group-based trajectory model. Logistic and Cox regression models were used to analyse the associations between the TyG-BMI and FI trajectory and frail incidence. Nonlinear relationships were explored using restricted cubic splines, and a linear mixed-effects model was used to evaluate FI development speed. Weighted quantile regression was used to identify the primary contributing factors.

RESULTS

Four classes of changes in the TyG-BMI and two FI trajectories were identified. Individuals in the third (OR = 1.25, 95% CI: 1.10-1.42) and fourth (OR = 1.83, 95% CI: 1.61-2.09) quartiles of baseline TyG-BMI, those with consistently second to highest (OR = 1.49, 95% CI: 1.32-1.70) and the highest (OR = 2.17, 95% CI: 1.84-2.56) TyG-BMI changes, and those in the third (OR = 1.20, 95% CI: 1.05-1.36) and fourth (OR = 1.94, 95% CI: 1.70-2.22) quartiles of the cumulative TyG-BMI had greater odds of experiencing a rapid FI trajectory. Higher frail risk was noted in those in the fourth quartile of baseline TyG-BMI (HR = 1.42, 95% CI: 1.28-1.58), with consistently second to highest (HR = 1.23, 95% CI: 1.12-1.34) and the highest TyG-BMI changes (HR = 1.58, 95% CI: 1.42-1.77), and those in the third (HR = 1.10, 95% CI: 1.00-1.21) and fourth quartile of cumulative TyG-BMI (HR = 1.46, 95% CI: 1.33-1.60). Participants with persistently second-lowest to the highest TyG-BMI changes (β = 0.15, 0.38 and 0.76 respectively) and those experiencing the third to fourth cumulative TyG-BMI (β = 0.25 and 0.56, respectively) demonstrated accelerated FI progression. A U-shaped association was observed between TyG-BMI levels and both rapid FI trajectory and higher frail risk, with BMI being the primary factor.

CONCLUSION

A higher TyG-BMI is associated with the rapid development of FI trajectory and a greater frail risk. However, excessively low TyG-BMI levels also appear to contribute to frail development. Maintaining a healthy TyG-BMI, especially a healthy BMI, may help prevent or delay the frail onset.

Elevated triglyceride-glucose index associated with increased risk of diabetes in non-obese young adults: a longitudinal retrospective cohort study from multiple Asian countries

Objective

Previous studies have confirmed a positive correlation between the Triglyceride-Glucose (TyG) index and future risk of diabetes. However, evidence of this association in non-obese young populations remains limited. This study aims to investigate the relationship between the TyG index and the future risk of diabetes among non-obese young adults.

Methods

This retrospective cohort study included 113,509 non-obese young adults from China and 9,549 from Japan. The mean age was 35.73 ± 6.38 years, and 56,469 participants (45.89%) were male. The median follow-up duration was 3.38 years. The association between baseline TyG index and risk of diabetes was examined using Cox proportional hazards regression models. Non-linear relationships between the TyG index and risk of diabetes were identified using cubic splines and smoothed curve fitting in the Cox models. Sensitivity and subgroup analyses were also conducted.

Results

After adjusting for covariates, the results indicated a positive correlation between the TyG index and risk of diabetes in non-obese young adults (HR=3.57, 95% CI: 2.92-4.36, P<0.0001). A non-linear relationship was observed with an inflection point at 7.3. The HR to the right of this inflection point was 3.70 (95% CI: 3.02-4.52, P<0.0001), while to the left, it was 0.34 (95% CI: 0.06-1.88, P=0.2161). The robustness of our findings was confirmed through a series of sensitivity analyses and subgroup analyses.

Conclusion

This study reveals a positive and non-linear association between the TyG index and risk of diabetes among non-obese young adults. Interventions aimed at reducing the TyG index by lowering triglycerides or fasting glucose levels could substantially decrease the future likelihood of developing diabetes in this population.

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.

Association between triglyceride-glucose related indices and all-cause and cause-specific mortality in the general population: a cohort study

BACKGROUND

Although triglyceride-glucose (TyG) index is a reliable indicator of insulin resistance and cardiometabolic disease, its effectiveness in predicting mortality risk has not been adequately validated. We aimed to investigate the association between the TyG-related indices and all-cause and cause-specific mortality in the general population.

METHODS

A total of 27,642 individuals were included from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. Three indicators were constructed, including the TyG index, TyG combined with waist-to-height ratio (TyG-WHtR), and TyG combined with waist circumference (TyG-WC). Mortality data was acquired through the linkage of NHANES data with National Death Index records. Weighted Cox proportional hazards models were used to estimate the independent association between the TyG-related indices and mortality. Nonlinear associations were explored using restricted cubic splines.

RESULTS

Multivariable adjusted models showed a progressive increase in all-cause and cause-specific mortality across quartiles of the TyG-related indices. Compared with the lowest quartile of the TyG index, the highest quartile had adjusted hazard ratios of 1.26 (95% CI 1.04-1.52) for all-cause mortality, 1.38 (1.04-1.74) for cardiovascular mortality, and 1.23 (1.01-1.50) for non-cardiovascular mortality, respectively. For the TyG-WHtR index, the corresponding hazard ratios were 1.60 (1.25-2.05), 1.86 (1.26-2.50), and 1.48 (1.10-1.99), respectively. For the TyG-WC index, the corresponding hazard ratios were 1.42 (1.11-1.75), 1.48 (1.04-1.96), and 1.38 (1.05-1.72), respectively. The associations between the three TyG-related indices and all-cause, cardiovascular and non-cardiovascular mortality were J-shaped. Interaction tests revealed significant effect modification by age, low-density lipoprotein cholesterol (LDL-C) level, and statin use (all P values < 0.05).

CONCLUSIONS

The TyG-related indices were independent predictors of all-cause and cause-specific mortality in the general population. Young individuals should be particularly vigilant, whereas low LDL-C levels and statin use are potentially protective.

Association between different triglyceride-glucose index combinations with obesity indicators and arthritis: results from two nationally representative population-based study

BACKGROUND

Insulin resistance (IR) and arthritis are strongly associated, and the triglyceride-glucose (TyG) index combinations with obesity indicators [including TyG-BMI (glucose triglyceride-body mass index), TyG-WC (glucose triglyceride-waist circumference), and TyG-WHtR (glucose triglyceride-waist height ratio)] has recently been recognized as a more effective indicator for assessing IR. However, there is a lack of research on its association with arthritis, and it is also important to assess in different populations.

METHODS

The analysis utilized data from the China Health and Retirement Longitudinal Study (CHARLS) and the National Health and Nutrition Examination Survey (NHANES). Arthritis diagnosis relied on self-reporting confirmed by physicians. The association of TyG-BMI, TyG-WC, and TyG-WHtR with arthritis was analyzed through weighted logistic regression models, and exploring nonlinear effects with restricted cubic spline (RCS) models. Secondary and sensitivity analyses included receiver operating characteristic curve (ROC) analysis, comparisons of z score-related odds ratios, subgroup analyses, and multiple imputation.

RESULTS

The study involved 6141 CHARLS participants and 17,091 NHANES participants. Adjusting for confounding variables, TyG-BMI and TyG-WHtR demonstrate a positive correlation with arthritis prevalence in both CHARLS (TyG-BMI: OR = 1.02, 95% CI 1.00-1.04; TyG-WHtR: OR = 1.13, 95% CI 1.03-1.24) and NHANES (TyG-BMI: OR = 1.07, 95% CI 1.06-1.08; TyG-WHtR: OR = 1.50, 95% CI 1.40-1.60). RCS regression analysis demonstrated a significant nonlinear association. ROC analysis indicated that TyG-BMI and TyG-WHtR were superior to TyG for the diagnosis of arthritis in both CHARLS and NHANES.

CONCLUSIONS

TyG-BMI and TyG-WHtR demonstrate a positive correlation with arthritis prevalence in both Chinese and the U.S. populations, displaying superior diagnostic relevance compared to TyG.

Association Between Serum Magnesium Levels and Glycemic Control in Type 2 Diabetes

Introduction

Serum magnesium is a crucial mineral within the human body. It is imperative for diabetic patients to maintain optimal serum magnesium levels. We focus on the relationship between glycemic control and serum magnesium in type 2 diabetes mellitus (T2DM).

Methods

The retrospective, observational, cross-sectional study comprised 1694 patients recruited from the People's Hospital of Yuxi. Fasting blood samples were collected for analysis, accompanied by the recording of participants' demographic characteristics. Patients were categorized into two groups based on whether their glycosylated hemoglobin (HbA1c) levels < 7%. A t-test was employed to identify significant differences between the two groups. Correlation coefficients were calculated using Pearson's method. A Logistic regression analysis was conducted to assess the association between variables and glycemic control. A linear regression analysis was performed to assess the relationship between serum magnesium levels and HbA1c.

Results

Patients with poor glycemic control exhibited elevated age, low-density lipoprotein (LDL-C), fasting plasma glucose (FPG), and homeostasis model assessment (HOMA-IR) compared to those with good glycemic control (P < 0.001). Additionally, total cholesterol (TC) levels were significantly higher in patients with poor glycemic control. Conversely, high-density lipoprotein (HDL-C) and serum magnesium levels were lower in patients with poor glycemic control. Serum magnesium levels exhibited negative correlations with HOMA-IR (r = -0.05, P < 0.05), HbA1c (r = -0.29, P < 0.05), and FPG (r = -0.20, P < 0.05). Moreover, serum magnesium was significantly associated with reduced odds of glycemic control (OR = 0.0005, 95% CI 0.0001-0.0027, P < 0.001).

Conclusion

The serum magnesium level in patients with T2DM is closely associated with glycemic control.

Association of triglyceride glucose-related parameters with all-cause mortality and cardiovascular disease in NAFLD patients: NHANES 1999-2018

BACKGROUND

The relationship between the triglyceride-glucose (TyG) index and its derived index, the triglyceride glucose-waist height ratio (TyG-WHtR), with mortality and cardiovascular diseases (CVDs) in patients with non-alcoholic fatty liver disease (NAFLD) remains unclear.

METHODS

This study enrolled 6627 adults aged 18 and above diagnosed NAFLD from the National Health and Nutrition Examination Survey (NHANES, 1999-2018). Binary weighted logistic regression analyses, cox proportional hazards model and restricted cubic spline (RCS) were used to analyze the relationship between TyG and TyG-WHtR with all-cause mortality, CVD mortality and CVDs. Mediation analysis explored the mediating role of glycohemoglobin, insulin and hypertension in the above relationships. Meanwhile, the incremental predictive value of the TyG index and TyG-WHtR was further assessed.

RESULTS

Except for no significant association between the TyG index and both all-cause mortality and chronic heart failure (CHF), both TyG and TyG-WHtR exhibited significant positive correlations or trends of positive correlation with all-cause mortality, CVD mortality, total-CVD, CHF, coronary heart disease (CHD) and angina pectoris. For all-cause mortality, CVD mortality and CHF, TyG-WHtR was a better predictor than TyG (TyG-WHtR: HR 1.31, 95%CI 1.03-1.66; HR 2.22, 95%CI 1.42-3.47; OR 3.99, 95%CI 1.79-8.93). In contrast, TyG index demonstrated a stronger association with total-CVD, CHD and angina pectoris (TyG index: OR 2.00, 95%CI 1.26-3.18; OR 1.85, 95%CI 1.19-2.91; OR 2.93, 95%CI 1.23-7.00). RCS analysis showed that after adjusting for covariates, most of the aforementioned relationships were linear(P overall < 0.0001, P-nonlinear > 0.05), while the associations of the TyG index and TyG-WHtR with all-cause mortality and CHF were non-linear(P overall < 0.0001, P nonlinear < 0.05). The addition of the TyG index and TyG-WHtR to the basic model for outcomes improved the C-statistics, net reclassification improvement value, and integrated discrimination improvement value.

CONCLUSIONS

The predictive value of TyG or TyG-WHtR for all-cause mortality and cardiovascular risk in NAFLD patients was significant. The TyG index and TyG-WHtR might be valid predictors of cardiovascular outcomes of patients with NAFLD.

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.

Follow-up study to explore the relationship between Neutrophil to lymphocyte ratio and impaired fasting glucose-using the group-based trajectory modeling

Previous studies have indicated a link between neutrophil to lymphocyte ratio (NLR) and impaired fasting glucose (IFG), but the findings have been disputed. By conducting a real-world follow-up study, we can monitor the development of diseases and confirm the connection between NLR and IFG. A total of 1168 patients without IFG or T2DM were followed up for six years. At baseline, participants' NLR levels, fasting plasma glucose and other clinical characteristics were recorded. During the follow-up period, NLR levels and the prevalence of IFG were recorded. Ultimately, 45 individuals were lost to follow-up, leaving 1,123 participants for analysis. Using Group-Based Trajectory Modeling (GBTM), the sample was divided into three groups. The prevalence of IFG in the three groups was 12.1%, 19.4%, and 20.85%, respectively. Compared with the low-level NLR group, the hazard ratio of IFG in the moderate-level NLR group and high-level NLR group were 1.628 (1.109-2.390) and 1.575 (1.001-2.497), respectively. There was a significant interaction effect of BMI and NLR on the risk of IFG (P < 0.001). In this real-world follow-up study, we observed a positive association between NLR and the risk of IFG, with this relationship being exacerbated by obesity status.

J-shaped association of the triglyceride glucose-body mass index with new-onset diabetes

The triglyceride glucose-body mass index (TyG-BMI) is a convenient and clinically significant indicator of insulin resistance. This study aims to investigate the correlation between TyG-BMI and the onset of new-onset diabetes and determine an optimal reflection point for TyG-BMI. An analysis was conducted on 1917 participants from the risk evaluation of cancers in Chinese diabetic individuals: a lONgitudinal (REACTION) study. Participants were categorized based on their TyG-BMI, and the relationship between TyG-BMI and the incidence of new-onset diabetes was explored through logistic regression models, smoothed curve fitting with restricted cubic spline, and a two-piecewise logistic regression model. The mean age of the participants was 57.60 ± 8.89 years, with 66.5% being females. The mean TyG-BMI was 223.3 ± 32.8. Ultimately, 137 individuals (7.1%) progressed to diabetes after three years. After adjusting for covariates, TyG-BMI exhibited a positive correlation with new-onset diabetes (odd ratios (OR) for each standard deviation increase = 1.330, 95% CI 1.110-1.595). The relationship between TyG-BMI and new-onset diabetes was non-linear, with a inflcetion point at 202.9. This study reveals a positive non-linear relationship between TyG-BMI and the risk of new-onset diabetes in Chinese middle-aged and elderly individuals. When TyG-BMI exceeds 202.9, there is a significantly heightened risk of new-onset diabetes. These findings offer valuable insights for preventing new-onset diabetes.

Comparison of triglyceride glucose index and modified triglyceride glucose indices in prediction of cardiovascular diseases in middle aged and older Chinese adults

BACKGROUND

Triglyceride and glucose (TyG) index, a surrogate marker of insulin resistance, has been validated as a predictor of cardiovascular disease. However, effects of TyG-related indices combined with obesity markers on cardiovascular diseases remained unknown. We aimed to investigate the associations between TyG index and modified TyG indices with new-onset cardiovascular disease and the time-dependent predictive capacity using a national representative cohort.

METHODS

This study is a retrospective observational cohort study using data from China Health and Retirement Longitudinal Study (CHARLS) of 7 115 participants. The TyG index was calculated as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The modified TyG indices were developed combining TyG with body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). We used adjusted Cox proportional hazards regression to analyze the association and predictive capacity based on hazard ratio (HR) and Harrell's C-index.

RESULTS

Over a 7-year follow-up period, 2136 participants developed cardiovascular disease, including 1633 cases of coronary heart disease and 719 cases of stroke. Compared with the lowest tertile group, the adjusted HR (95% CI) for new-onset cardiovascular disease in the highest tertile for TyG, TyG-BMI, TyG-WC, and TyG-WHtR were 1.215 (1.088-1.356), 1.073 (0.967-1.191), 1.078 (0.970-1.198), and 1.112 (1.002-1.235), respectively. The C-indices of TyG index for cardiovascular disease onset were higher than other modified TyG indices. Similar results were observed for coronary heart disease and stroke.

CONCLUSION

TyG and TyG-WhtR were significantly associated with new-onset cardiovascular diseases, and TyG outperformed the modified TyG indices to identify individuals at risk of incident cardiovascular event.

Association between triglyceride glucose-body mass index and long-term adverse outcomes of heart failure patients with coronary heart disease

BACKGROUND

The triglyceride glucose-body mass index (TyG-BMI) is recognized as a reliable surrogate for evaluating insulin resistance and an effective predictor of cardiovascular disease. However, the link between TyG-BMI index and adverse outcomes in heart failure (HF) patients remains unclear. This study examines the correlation of the TyG-BMI index with long-term adverse outcomes in HF patients with coronary heart disease (CHD).

METHODS

This single-center, prospective cohort study included 823 HF patients with CHD. The TyG-BMI index was calculated as follows: ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2] × BMI. To explore the association between the TyG-BMI index and the occurrences of all-cause mortality and HF rehospitalization, we utilized multivariate Cox regression models and restricted cubic splines with threshold analysis.

RESULTS

Over a follow-up period of 9.4 years, 425 patients died, and 484 were rehospitalized due to HF. Threshold analysis revealed a significant reverse "J"-shaped relationship between the TyG-BMI index and all-cause mortality, indicating a decreased risk of all-cause mortality with higher TyG-BMI index values below 240.0 (adjusted model: HR 0.90, 95% CI 0.86-0.93; Log-likelihood ratio p = 0.003). A distinct "U"-shaped nonlinear relationship was observed with HF rehospitalization, with the inflection point at 228.56 (adjusted model: below: HR 0.95, 95% CI 0.91-0.98; above: HR 1.08, 95% CI 1.03-1.13; Log-likelihood ratio p < 0.001).

CONCLUSIONS

This study reveals a nonlinear association between the TyG-BMI index and both all-cause mortality and HF rehospitalization in HF patients with CHD, positioning the TyG-BMI index as a significant prognostic marker in this population.

Correlation between alternative insulin resistance indexes and diabetic kidney disease: a retrospective study

PURPOSE

This retrospective study aimed to investigate the relationship between alternative insulin resistance (IR) indexes not reliant on insulin and diabetic kidney disease (DKD) incidence in a newly diagnosed cohort of individuals with type 2 diabetes mellitus (T2DM).

METHODS

We conducted a retrospective analysis of baseline characteristics in a cohort of 521 individuals with T2DM, then followed up on the outcome of DKD. To assess the predictive ability of IR indexes, we compared the performance of four non-insulin-based IR indexes and the homeostasis model for insulin resistance (HOMA-IR) using logistic regression and consistency-statistics (C-statistics). Furthermore, we computed the net reclassification index (NRI) and integrated discrimination improvement (IDI) to evaluate the additional effects of the indexes.

RESULTS

The four alternative IR indexes of DKD patients were significantly higher than those of non-DKD. After adjustment for other variables, the highest tertile of all indexes was significantly related to DKD incidence, compared with the lowest tertile. Furthermore, the C-statistics for the triglyceride-glucose index (TyG index) and triglyceride to high-density lipoprotein ratio (TG/HDL) were all 0.652, while triglyceride glucose-body mass index (TyG-BMI) and metabolic score for insulin resistance (METS-IR) were 0.639 and 0.651, respectively. The incorporation of the alternative IR indexes into the baseline model revealed positive additional effects, leading to an improved prediction of the risk for DKD.

CONCLUSIONS

It was discovered that the alternative IR indexes served as independent risk factors of DKD. Among the four alternative indexes, TyG index and TG/HDL had the best prediction performance for DKD, followed by METS-IR.

Triglyceride-Glucose Index and Its Correlates: Associations with Serum Creatinine and Estimated Glomerular Filtration Rate in a Cross-Sectional Study from CHARLS 2011-2015

Background: Chronic kidney disease (CKD) has emerged as a significant global public health challenge, and the estimated glomerular filtration rate (eGFR) is widely used due to its convenience, low cost, and broad clinical applicability. Concurrently, insulin resistance (IR) serves as a crucial marker of metabolic disturbance, and alternative indicators have garnered increasing attention in CKD research in recent years. Objective: This study aims to investigate the relationship between IR-related indices (TyG index, TyG-BMI index, and TyG-WC index) and serum creatinine levels, as well as the eGFR, with the intention of uncovering their potential roles in the assessment of renal function. Methods: We analyzed nationally representative cross-sectional data from a cohort of individuals aged 45 and above in China, comprising 11,608 participants. Participants were categorized into different groups based on quartiles of the TyG index, and multiple factors, including gender, age, lifestyle, and co-morbidities, were adjusted for using linear regression models. Results: By linear regression, TyG, TyG-BMI, and TyG-WC indices were significantly positively correlated with serum creatinine and significantly negatively correlated with eGFR. Results showed similar trends when TyG, TyG-BMI, and TyG-WC indices were used as categorical variables. In the fully adjusted model, the highest quartile of serum creatinine was higher than the first quartile for TyG, TyG-BMI, and TyG-WC indices, with β values of 2.673, 3.67, and 1.937 mg/dL, respectively; the highest quartile of eGFR was lower than the first quartile, with β values of -2.4, -2.955, and -1.823 mL/min/1.73 m2. P values were statistically significant. Conclusions: This study indicates a consistent correlation between the TyG index and its related indices with serum creatinine levels and eGFR among the middle aged and elderly population in China. These findings suggest the potential utility of these indices in early screening and management of the risk of chronic kidney disease.

Predictive value of insulin resistance surrogates for the development of diabetes in individuals with baseline normoglycemia: findings from two independent cohort studies in China and Japan

BACKGROUND

Insulin resistance (IR) plays a crucial role in the occurrence and progression of diabetes. This study aimed to evaluate and compare the predictive value of four IR surrogates, including the triglycerides glucose (TyG) index, TyG and body mass index (TyG-BMI), triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio, and the metabolic score for IR (MetS-IR) for diabetes in two large cohorts.

METHODS

A total of 116,661 adult participants from the China Rich Healthcare Group and 15,464 adult participants from the Japanese NAGALA cohort were included in the study. Multivariable Cox proportional hazards models were used to assess the standardized hazard ratio (HR) of the TyG index, TyG-BMI, TG/HDL-C ratio, and MetS-IR directly associated with diabetes. Receiver operating characteristic (ROC) curve and time-dependent ROC curve analysis were performed to evaluate and compare the predictive value of the four IR surrogates for diabetes.

RESULTS

In the two independent cohorts, the average follow-up time was 3.1 years in the China cohort, with 2681(2.30%) incident cases of diabetes recorded, and 6.13 years in the Japan cohort, with 373 incident cases (2.41%) of diabetes recorded. After adjusting for potential confounding factors, we found that among the four IR surrogates, TyG-BMI and MetS-IR showed stronger associations with diabetes. The stronger associations persisted even after further stratification by age, sex, hypertension, and obese subgroups. In terms of diabetes prediction, based on ROC analysis, TyG-BMI demonstrated the highest predictive accuracy for diabetes in the Chinese population, while both TyG-BMI and MetS-IR showed the highest predictive accuracy in the Japanese population. The results of further subgroup ROC analysis confirmed the robustness of these findings. Furthermore, the time-dependent ROC results indicated that among the four IR surrogates, MetS-IR exhibited the highest accuracy in predicting future diabetes at various time intervals in the Japanese population.

CONCLUSION

Our findings suggest that evaluating TyG-BMI and MetS-IR as IR surrogates may be the most useful for predicting diabetes events and assessing the risk of developing diabetes in East Asian populations.

Prognostic significance of glucose-lipid metabolic index in pancreatic cancer patients with diabetes mellitus

BACKGROUND

The incidence of pancreatic cancer (PC) is higher in diabetic patients due to disturbances in glucose and lipid metabolism caused by insulin resistance (IR). However, the effect of diabetes as well as IR on the prognosis of PC patients remains inconclusive. Our study aims to assess the impact of IR on the prognosis of PC patients with diabetes.

METHODS

We conducted a retrospective analysis of 172 PC patients with diabetes in our institute from 2015 to 2021. Prognostic assessment was performed using univariate/multifactorial analysis and survival analysis. The predictive efficacy of metabolic indices was compared using receiver operator characteristic (ROC) curve analysis.

RESULTS

One hundred twenty-one of 172 patients died during follow-up, with a median follow-up of 477 days and a median overall survival (OS) of 270 days. Survival analysis showed a significant difference in OS by IR related parameters, which were triglyceride-glucose index (TyG), triglyceride-glucose index-body mass index (TyG-BMI), and triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c). The ROC curve indicated that TyG, TyG-BMI, and TG/HDL-c had prognostic efficacy for PC with diabetes. We next optimized TyG-BMI and obtained a new parameter, namely glucose-lipid metabolism index (GLMI), and the patients were classified into GLMI low group and high group based on the calculated cutoff value. The GLMI high group had higher TyG, TyG-BMI, TyG/HDL-c, BMI, TG, total cholesterol (TC), TC/HDL-c, fasting plasma glucose, CA199, and more advanced tumor stage compared to low group. Univariate and multivariate analyses showed that GLMI was an independent prognostic factor. Furthermore, the patients of GLMI high group had worse OS compared to low group and the ROC curves showed GLMI had better predictive ability than TyG and TyG-BMI.

CONCLUSIONS

IR is associated with the outcome of PC patients with diabetes and higher level of IR indicates worse prognosis. GLMI has a good predictive value for PC with diabetes.

Association between the triglyceride glucose index and heart failure: NHANES 2007-2018

Background

Patients with heart failure (HF) were compared with non-HF people to explore the relationship between the triglyceride glucose (TyG) index and HF in participants with cardiovascular and cerebrovascular diseases.

Methods

TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Multivariate logistic regression models were used to investigate the association between the TyG index and the risk of HF. Restricted cubic spline (RCS) analysis was applied to evaluate the dose-response relationship between the TyG index and the risk of HF.

Results

National Health and Nutrition Examination Survey (NHANES) (2007-2018) was used to analyze the association between TyG and HF in patients. A total of 13,825 participants who had their TyG index measured were included, involving 435 individuals with HF and 13,390 individuals without HF. Those with HF had higher levels of the TyG index compared with those without HF (8.91 ± 0.74 vs. 8.57 ± 0.66, p < 0.001). The odds ratio (OR) of HF for the TyG index from logistic regression was 1.644 and 1.057 in Model 1 (without adjusting for any variables) and Model 4 (adjusted for all covariates), respectively. Compared with individuals with Q1, a higher TyG index was related to the increased risk of HF. Model 1 showed that there was a linear dose-response relationship between the TyG index and HF (p = 0.686). The TyG index predicted the area of the receiver operating characteristic (ROC) curve of 0.602 (95% CI: 0.575-0.629, p < 0.001) and the optimal cutoff value was 8.91.

Conclusion

The TyG index was positively associated with the risk of HF. The TyG index may be a therapeutic target and an important predictor of HF.

[Relationship of triglyceride-glucose index and its derivatives with blood pressure abnormalities in adolescents: an analysis based on a restricted cubic spline model]

OBJECTIVES

To explore the relationship of triglyceride-glucose index (TyG), triglyceride-glucose-body mass index (TyG-BMI), and triglyceride-glucose-waist circumference index (TyG-WC) with blood pressure abnormalities in adolescents, providing theoretical basis for the prevention and control of hypertension in adolescents.

METHODS

A stratified cluster sampling method was used to select 1 572 adolescents aged 12 to 18 years in Yinchuan City for questionnaire surveys, physical measurements, and laboratory tests. Logistic regression analysis and restricted cubic spline analysis were employed to examine the relationship of TyG, TyG-BMI, and TyG-WC with blood pressure abnormalities in adolescents.

RESULTS

Multivariable logistic regression analysis revealed that after adjusting for confounding factors, the groups with the highest quartile of TyG, TyG-BMI, and TyG-WC had 1.48 times (95%CI: 1.07-2.04), 3.71 times (95%CI: 2.67-5.15), and 4.07 times (95%CI: 2.89-5.73) higher risks of blood pressure abnormalities compared to the groups with the lowest quartile, respectively. Moreover, as the levels of TyG, TyG-BMI, and TyG-WC increased, the risk of blood pressure abnormalities gradually increased (P<0.05). A non-linear dose-response relationship was observed between TyG-BMI and the risk of blood pressure abnormalities (P overall trend<0.001, P non-linearity=0.002). Linear dose-response relationships were found between TyG and the risk of blood pressure abnormalities (P overall trend<0.001, P non-linearit =0.232), and between TyG-WC and the risk of blood pressure abnormalities (P overall trend<0.001, P non-linearity=0.224).

CONCLUSIONS

Higher levels of TyG and its derivatives are associated with an increased risk of blood pressure abnormalities in adolescents, with linear or non-linear dose-response relationships.

Association of hypertension with the triglyceride-glucose index and its associated indices in the Chinese population: A 6-year prospective cohort study

The authors aim to assess the correlation between hypertension and the triglyceride-glucose (TyG) index and its associated indices, and to compare their abilities to identify hypertension. Four thousand eight hundred and sixty-six non-hypertensive participants were enrolled from the China National Health Survey in 2009. The data on new-onset hypertension were gathered in both 2011 and 2015. The TyG index and its associated indices were derived from the fasting triglyceride, blood glucose levels, and anthropometric parameters. Multivariate logistic regression analyses and receiver operating characteristic curve analysis were used. The adjusted odds ratio (OR) and 95% confidence interval (CI) for the new-onset hypertension for the TyG-waist-to-height ratio (TyG-WHtR), TyG-waist circumference (TyG-WC), TyG-waist-to-hip ratio (TyG-WHR), TyG-body mass index (TyG-BMI), and TyG index were 1.379 (1.230-1.546), 1.002 (1.001-1.003), 1.156 (1.069-1.251), 1.007 (1.005-1.009), and 1.187 (1.051-1.341), respectively. In addition, comparing the lowest quartile (Q1) group with the highest quartile (Q4), the adjusted OR and 95% CI for the new-onset hypertension were found to be 1.86 (1.48-2.35), 1.93 (1.53-2.43), 1.71 (1.36-2.16), 2.00 (1.60-2.50), and 1.49 (1.19-1.88) for TyG-WHtR, TyG-WC, TyG-WHR, TyG-BMI, and TyG index, respectively, among all participants. The TyG-WHtR had the largest area under the curve (AUC) for hypertension (AUC, 0.628; 95% CI, 0.614-0.641) in all participants. Stratified analysis also indicated that the TyG-WHtR exhibited the greatest AUC in both males (AUC, 0.608; 95% CI, 0.587-0.629) and females (AUC, 0.648; 95% CI, 0.629-0.666). In conclusions, the TyG index and its associated indices were positively associated with hypertension. Among these indices, TyG-WHtR was the most valuable indicator for predicting hypertension.

Association between different insulin resistance surrogates and infertility in reproductive-aged females

BACKGROUND

Obesity and metabolic syndrome are observed more frequently in infertile women, and insulin resistance (IR) is closely related to them. However, there are no studies that have examined the association between different IR surrogates and female infertility, hence we investigated the potential association between them in the general population.

METHODS

This was a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES, 2013-2018). The association of different IR surrogates (HOMA-IR index, TyG index and TyG-BMI index) with female infertility was estimated by multivariable regression analysis.

RESULTS

After adjusting for confounders, the HOMA-IR index and TyG index did not show an association with female infertility, while the TyG-BMI index was found to have a positive association with female infertility (OR = 1.01, 95% CI: 1.00, 1.01; P < 0.0001), and the OR of the TyG-BMI group T3 (≥ 255.55) was significantly different compared to the group T1 (< 185.31) (OR = 3.02, 95% CI: 1.62, 5.60). Similar results were seen in most of the subgroup participants by stratified analysis (P-interaction > 0.05). However, different IR surrogates did not show variability in their ability to predict infertility [TyG-BMI: 0.68 (95% CI: 0.62, 0.74) vs. TyG: 0.62 (95% CI: 0.57, 0.68) vs. HOMA-IR: 0.65 (95% CI: 0.60, 0.71)].

CONCLUSIONS

Our result suggests that high levels of TyG-BMI index were positively associated with female infertility in US reproductive-aged females.

Triglyceride-glucose index in the prediction of adverse cardiovascular events in patients without diabetes mellitus after coronary artery bypass grafting: a multicenter retrospective cohort study

BACKGROUND

The triglyceride-glucose (TyG) index has been evaluated as a reliable surrogate for insulin resistance (IR) and has been proven to be a predictor of poor outcomes in patients with cardiovascular diseases. However, data are lacking on the relationship of the TyG index with prognosis in nondiabetic patients who underwent coronary artery bypass grafting (CABG). Thus, the purpose of our current study was to investigate the potential value of the TyG index as a prognostic indicator in patients without diabetes mellitus (DM) after CABG.

METHODS

This multicenter, retrospective cohort study involving 830 nondiabetic patients after CABG from 3 tertiary public hospitals from 2014 to 2018. Kaplan-Meier survival curve analysis was conducted followed by the log-rank test. Cox proportional hazards regression models were used to explore the association between the TyG index and major adverse cardiovascular events (MACEs). The incremental predictive power of the TyG index was evaluated with C-statistics, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

RESULTS

An incrementally higher TyG index was associated with an increasingly higher cumulative incidence of MACEs (log-rank test, p < 0.001). The hazard ratio (95% CI) of MACEs was 2.22 (1.46-3.38) in tertile 3 of the TyG index and 1.38 (1.18-1.62) per SD increase in the TyG index. The addition of the TyG index yielded a significant improvement in the global performance of the baseline model [C-statistic increased from 0.656 to 0.680, p < 0.001; continuous NRI (95% CI) 0.269 (0.100-0.438), p = 0.002; IDI (95% CI) 0.014 (0.003-0.025), p = 0.014].

CONCLUSIONS

The TyG index may be an independent factor for predicting adverse cardiovascular events in nondiabetic patients after CABG.

Assessing temporal differences in the predictive power of baseline TyG-related parameters for future diabetes: an analysis using time-dependent receiver operating characteristics

BACKGROUND

It is known that measuring the triglyceride glucose (TyG) index and TyG-related parameters [triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC), and triglyceride glucose-waist to height ratio (TyG-WHtR)] can predict diabetes; this study aimed to compare the predictive value of the baseline TyG index and TyG-related parameters for the onset of diabetes at different future periods.

METHODS

We conducted a longitudinal cohort study involving 15,464 Japanese people who had undergone health physical examinations. The subject's TyG index and TyG-related parameters were measured at the first physical examination, and diabetes was defined according to the American Diabetes Association criteria. Multivariate Cox regression models and time-dependent receiver operating characteristic (ROC) curves were constructed to examine and compare the risk assessment/predictive value of the TyG index and TyG-related parameters for the onset of diabetes in different future periods.

RESULTS

The mean follow-up period of the current study cohort was 6.13 years, with a maximum of 13 years, and the incidence density of diabetes was 39.88/10,000 person-years. In multivariate Cox regression models with standardized hazard ratios (HRs), we found that both the TyG index and TyG-related parameters were significantly and positively associated with diabetes risk and that the TyG-related parameters were stronger in assessing diabetes risk than the TyG index, with TyG-WC being the best parameter (HR per SD increase: 1.70, 95% CI 1.46, 1.97). In addition, TyG-WC also showed the highest predictive accuracy in time-dependent ROC analysis for diabetes occurring in the short-term (2-6 years), while TyG-WHtR had the highest predictive accuracy and the most stable predictive threshold for predicting the onset of diabetes in the medium- to long-term (6-12 years).

CONCLUSIONS

These results suggest that the TyG index combined with BMI, WC, and WHtR can further improve its ability to assess/predict the risk of diabetes in different future periods, where TyG-WC was not only the best parameter for assessing diabetes risk but also the best risk marker for predicting future diabetes in the short-term, while TyG-WHtR may be more suitable for predicting future diabetes in the medium- to long-term.

High triglyceride glucose-body mass index correlates with prehypertension and hypertension in east Asian populations: A population-based retrospective study

Background

There is compelling evidence for an association between triglyceride glucose-body mass index (TyG-BMI) and cardiovascular disease (CVD). However, data on the relationship between TyG-BMI and prehypertension (pre-HTN) or hypertension (HTN) remains scant. The aim of this study was to characterize the association between TyG-BMI and pre-HTN or HTN risk, and to assess the ability of TyG-BMI in predicting pre-HTN and HTN in Chinese and Japanese populations.

Methods

A total of 214,493 participants were included in this study. The participants were divided into 5 groups based on quintiles of TyG-BMI index at baseline (Q1, Q2, Q3 Q4 and Q5). Logistic regression analysis was then employed to assess the relationship between TyG-BMI quintiles and pre-HTN or HTN. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs).

Results

Our restricted cubic spline analysis showed that TyG-BMI was linearly correlated with both pre-HTN and HTN. Multivariate logistic regression analysis indicated that TyG-BMI was independently correlated with pre-HTN [ORs and 95% CIs were 1.011 (1.011-1.012), 1.021 (1.02-1.023), 1.012 (1.012-1.012), respectively] and HTN [ORs and 95% CIs were 1.021 (1.02-1.021), 1.031 (1.028-1.033), 1.021 (1.02-1.021), respectively] in Chinese or Japanese individuals or both groups after adjusting for all variates. In addition, subgroup analyses showed that the relationship between TyG-BMI and pre-HTN or HTN was independent of age, sex, BMI, country, smoking and drinking status. Across all study populations, the areas under the TyG-BMI curve predicting pre-HTN and HTN were 0.667 and 0.762, respectively, resulting in cut-off values of 189.7 and 193.7, respectively.

Conclusion

Our analyses showed that TyG-BMI was independently correlated with both pre-HTN and HTN. Besides, TyG-BMI showed superior predictive power in predicting pre-HTN and HTN compared to TyG or BMI alone.

The preoperative triglyceride-glucose index has a positive effect on predicting the risk of short-term restenosis after carotid artery stenting: a retrospective cohort study

Background

Increasing evidence suggests that insulin resistance is linked to cardiovascular disease and atherosclerosis. The triglyceride-glucose (TyG) index has proven to be a convincing marker to quantitatively evaluate insulin resistance. However, there is no relevant information about the relationship between the TyG index and restenosis after carotid artery stenting.

Methods

A total of 218 patients were enrolled. Carotid ultrasound and computed tomography angiography were used to evaluate in-stent restenosis. A Kaplan-Meier analysis and Cox regression method were performed to analyze the correlation between TyG index and restenosis. Schoenfeld residuals were used to determine the proportional-hazards assumption. A restricted cubic spline method was used to model and visualize the dose-response relationship between the TyG index and the risk of in-stent restenosis. Subgroup analysis was also performed.

Results

Thirty-one participants (14.2%) developed restenosis. The preoperative TyG index had a time-varying effect on restenosis. Within 29 months post-surgery, an increasing preoperative TyG index was linked to a significant increased risk of restenosis (hazard ratio: 4.347; 95% confidence interval 1.886-10.023). However, after 29 months, the effect was decreased, although not statistically significant. The subgroup analysis showed that the hazard ratios tended to be higher in the age ≤ 71 years subgroup (p < 0.001) and participants with hypertension (p < 0.001).

Conclusion

The preoperative TyG index was significantly associated with the risk of short-term restenosis after CAS within 29 months post-surgery. The TyG index may be employed to stratify patients based on their risk of restenosis after carotid artery stenting.

Association between surrogate indicators of insulin resistance and risk of type 2 diabetes combined with hypertension among Chinese adults: two independent cohort studies

BACKGROUND

Type 2 diabetes (T2D) combined with hypertension has a higher risk of developing cardiovascular diseases. This study aimed to investigate the relationships between the surrogate indicators of insulin resistance (TyG, TG/HDL, and Mets-IR) with the risk of T2D combined with hypertension.

METHODS

This study is based on a functional community cohort from Beijing and the China Health and Retirement Longitudinal Study, comprising 4234 and 4658 participants respectively. Cox proportional hazards models and restricted cubic spline regression were performed to assess the link between TyG, TG/HDL, and Mets-IR with T2D combined with hypertension. The cross-lagged panel analysis and the mediation analysis were used to examine the temporal relationship between insulin resistance and obesity and their temporal relationship with follow-up T2D combined with hypertension.

RESULTS

In multivariable-adjusted models, higher TyG was associated with a higher risk of developing T2D combined with hypertension, the hazard ratios (95% confidence interval) were 3.46 (2.43-4.93) and 2.02 (1.67-2.44), in two cohorts respectively. A similar positive association was shown for Mets-IR, the hazard ratios (95% confidence interval) were 1.04 (1.03-1.06) and 1.05 (1.03-1.07), in two cohorts respectively. However, the association between TG/HDL with T2D combined with hypertension was different in two cohorts. The restricted cubic spline regression showed a linear association between TyG and T2D combined with hypertension (P-nonlinear > 0.05). The cross-lagged path coefficient from baseline BMI to follow-up TyG index was significantly greater than the path coefficient from baseline TyG to follow-up BMI. TyG partially mediated the effect of BMI on the risk of T2D combined with hypertension and the percentage of mediated association was estimated at 41.58% and 48.41% in two cohorts, respectively.

CONCLUSION

These findings indicated positive associations between TyG and Mets-IR with the risk of T2D combined with hypertension in two cohorts. In addition, BMI change may precede TyG index change, and the TyG index plays a mediating role in BMI induced T2D combined with hypertension.