Association between the triglyceride to high-density lipoprotein cholesterol ratio and the risk of gestational diabetes mellitus: a second analysis based on data from a prospective cohort study

Association of cardiometabolic index and new-onset stroke in middle-aged and elderly Chinese: a national prospective cohort study

BACKGROUND AND AIMS

The Cardiometabolic Index (CMI), a novel metabolic marker, has been associated with various metabolic diseases in previous studies. However, its relationship with stroke risk remains underexplored. This study investigates the potential correlation between CMI and stroke risk among Chinese adults aged 45 and older.

METHODS

In the China Health and Retirement Longitudinal Study (CHARLS), participants were categorized into four groups based on CMI quartiles. The primary outcome was the incidence of new strokes during the follow-up period. A Cox proportional hazards model was used to analyze the relationship between CMI and stroke risk among the elderly. Kaplan-Meier survival analysis compared incidence rates across CMI levels, and restricted cubic splines (RCS) assessed potential non-linear relationships between CMI and stroke. Subgroup analyses verified the robustness of these findings.

RESULTS

The study included 6620 patients (45% male), with 417 new stroke cases reported over an average follow-up of seven years. Multivariate analysis indicated a significant association between increased CMI and higher stroke risk [HR, 1.132 (1.021-1.273), P = 0.003]. The RCS model revealed a nonlinear increase in stroke risk with rising CMI levels (P for nonlinearity = 0.006). No significant interactions were detected between CMI and the selected subgroups (all P values for interaction > 0.05).

CONCLUSION

CMI significantly correlates with stroke risk in the elderly Chinese population, suggesting its potential utility in early risk stratification.

The first-trimester triglyceride glucose-body mass index is a valuable predictor for adverse pregnancy outcomes

BACKGROUND

Although insulin resistance has been associated with unfavorable pregnancy outcomes, the ability of non-insulin-based insulin resistance indicators to predict adverse pregnancy outcomes has yet to be thoroughly understood. The study aims to investigate the association and predictability of triglyceride glucose-body mass index (TyG-BMI), a biomarker of non-insulin-based insulin resistance, with the risks of adverse pregnancy outcomes.

METHOD

The retrospective study included 1,136 subjects. Group-based trajectory modeling (GBTM) was employed to identify the TyG-BMI index trajectory. Logistic regression, restricted cubic spline (RCS) regression, and subgroup analysis were used to assess the association between the TyG-BMI index trajectory and the first-trimester TyG-BMI index with the risks of adverse pregnancy outcomes. Receiver-operating characteristic (ROC) curve analysis and the DeLong test were utilized to evaluate the prediction ability of the first-trimester TyG-BMI index for adverse pregnancy outcomes.

RESULTS

GBTM revealed three distinct trajectories of the TyG-BMI index. Using the "low-stable" trajectory as a reference, the "high-stable" trajectory was independently associated with an increased risk of gestational diabetes mellitus (GDM) (aOR = 2.01, 95% CI 1.20-3.37), hypertensive disorders of pregnancy (HDP) (aOR = 6.05, 95% CI 3.00-12.18), and large for gestational age (LGA) (aOR = 2.83, 95% CI 1.28-6.25). The highest quartile of the first-trimester TyG-BMI index was independently linked to elevated GDM (aOR = 3.27, 95% CI 1.92-5.59), HDP (aOR = 9.26, 95% CI 3.19-26.88), and LGA (aOR = 2.26, 95% CI 1.00-5.09)risks. Additionally, the third quartile of the first-trimester TyG-BMI index had 2.21-fold increased odds of GDM (aOR = 2.21, 95% CI 1.27-3.82). The first-trimester TyG-BMI index demonstrated a significant linear association with GDM, HDP, SGA, and LGA risks. Compared to the TyG-BMI index trajectory, the highest quartile of the first-trimester TyG-BMI index exhibited a stronger association with the risks of GDM and HDP (aOR = 3.09 and 7.39, respectively). Furthermore, according to the ROC curve, the first-trimester TyG-BMI index outperformed the TyG index and triglyceride/high-density lipoprotein cholesterol (TG/HDL-c) ratio at predicting HDP (0.726 [0.650-0.801] vs. 0.603 [0.527-0.679] vs. 0.615 [0.537-0.693]), LGA (0.619 [0.540-0.699] vs. 0.534 [0.454-0.613] vs. 0.540 [0.458-0.622]), and GDM (0.664 [0.622-0.705] vs. 0.632 [0.588-0.676] vs. 0.604 [0.560-0.649]). According to the DeLong test, the first-trimester TyG-BMI index was a more valuable predictor for LGA and HDP compared to TyG index and TG/HDL-c ratio.

CONCLUSION

Higher levels of first-trimester TyG-BMI and a "high-stable" trajectory were linked to a greater risk of adverse pregnancy outcomes. Furthermore, as compared to TyG and TG/HDL-c, the first-trimester TyG-BMI index is a valuable predictor for HDP, GDM, and LGA.

Ratio of remnant cholesterol to high-density lipoprotein cholesterol in relation to gestational diabetes mellitus risk in early pregnancy among Korean women

OBJECTIVE

There is no evidence to suggest that an association exists between the remnant cholesterol (RC) to high-density lipoprotein cholesterol (HDL-C) ratio and gestational diabetes mellitus (GDM). In this study, the RC/HDL-C ratio during the first trimester was examined as a potential indicator of the onset of GDM during the second trimester.

METHODS

This was a secondary analysis of data from a Korea-based prospective cohort study. The study involved 582 women within 14 weeks of pregnancy who were examined between November 2014 and July 2016 at two Korean hospitals. RC was calculated as total cholesterol (TC) minus the sum of low-density lipoprotein cholesterol (LDL-C) and HDL-C. The RC/HDL-C ratio was determined by dividing the RC content by the HDL-C content. The RC/HDL-C ratio and GDM occurrence were investigated utilizing a binary logistic regression model, various sensitivity analyses, and subgroup analyses. Additionally, the RC/HDL-C ratio was evaluated using receiver operating characteristic (ROC) analysis.

RESULTS

The average age of the pregnant women was 32.07 ± 3.78 years, and the RC/HDL-C ratio had a median value of 0.39. The prevalence of GDM was 6.01%. There was a positive association between the RC/HDL-C ratio and the incidence of GDM after adjusting for potential confounding variables (odds ratio: 21.78, 95% confidence interval [CI]: 3.55-133.73, P < 0.001). Furthermore, this association was validated by subgroup and sensitivity analyses. The results indicated that the RC/HDL-C ratio was a robust predictor of GDM, with an area under the ROC curve of 0.795 (95% CI: 0.723-0.868). The optimal threshold value was 0.45, with a sensitivity of 71.4% and a specificity of 75.3%. Compared with traditional lipid markers, including LDL-C, HDL-C, triglycerides, TC, and the emerging marker RC, the RC/HDL-C exhibited higher diagnostic efficacy.

CONCLUSION

There is an increased risk of GDM associated with higher levels of the RC/HDL-C ratio between 12 and 14 weeks of gestation, independent of traditional risk factors. The RC/HDL-C ratio is more effective in diagnosing GDM than traditional lipid markers.

Serum triglyceride to high density lipoprotein cholesterol ratio in late pregnancy as a potential predictor of adverse birth outcomes: an analysis of real-world data

BACKGROUND

The association between serum triglyceride to high density lipoprotein cholesterol ratio (THR) in late pregnancy and adverse birth outcomes (ABO) remains controversial because of inconsistent results. The present study assessed the association between maternal serum THR and incidence of ABO [preterm birth (PTB), small and large for gestational age (SGA/LGA), low birth weight (LBW) and macrosomia] in a Chinese population.

METHODS

A total of 11,553 consecutive participants from a real-world database with data on lipid profiles and birth outcomes were included. Logistic regression models were applied to assess the association between THR and incident ABO. Mediation analysis was performed to investigate the contribution of pregnancy complications [gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP) and pre-eclampsia (PE)] to this association.

RESULTS

Approximately 6.6% (762/11,553), 8.9% (1023/11,553), 15.5% (1792/11,553), 4.3% (494/11,553), and 7.4% (851/11,553) of individuals developed PTB, SGA, LGA, LBW and macrosomia, respectively. Significant trends across the quintiles of THR toward decreasing incidence of SGA and LBW and increasing incidence of LGA and macrosomia were observed. The multivariate-adjusted odds ratios (OR) in the top quintile of serum THR (> 3.16) versus the bottom quintile (< 1.44) were 0.52 for PTB, 0.48 for SGA, 0.64 for LBW, 2.80 for LGA and 3.80 for macrosomia, respectively. A 1-standard deviation (SD) increase in serum THR was associated with decreased risk of PTB [OR = 0.84, 95% confidence interval (CI): 0.76-0.93), SGA (OR = 0.71, 95% CI:0.65-0.78) and LBW (OR = 0.76, 95% CI:0.65-0.90) and increased risk of LGA (OR = 1.40, 95% CI:1.32-1.49) and macrosomia (OR = 1.49, 95% CI:1.38-1.62). In mediation analyses, PE mediated - 19.8%, -10.6% and - 24.6% of THR-associated PTB, SGA and LBW, respectively, GDM accounted for - 3.7%, 6.8% and 4.3% of THR-associated PTB, LGA and macrosomia, respectively, and ICP explained - 1.9% and - 2.1% of THR-associated PTB and LBW, respectively. In addition, incorporating THR to ABO predictive models significantly improved the area under the curve for SGA (0.743 vs. 0.753, P < 0.001), LGA (0.734 vs. 0.745, P < 0.001) and macrosomia (0.786 vs. 0.800, P < 0.001).

CONCLUSION

Real-world data showed an association between serum THR in late pregnancy and ABO risk, and this association may be partially mediated by prevalent pregnancy complications (PE/GDM/ICP), suggesting a potential role of THR in predicting ABO (SGA/LGA/macrosomia).

Predictive Utility of Biochemical Markers for the Diagnosis and Prognosis of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a common complication during pregnancy with an increasing prevalence worldwide. Early prediction of GDM and its associated adverse outcomes is crucial for timely intervention and improved maternal and fetal health. The objective of this review is to provide a comprehensive summary of contemporary evidence on biomarkers, focusing on their potential to predict the development of GDM and serve as predictors of maternal, fetal, and neonatal outcomes in women with GDM. A literature search was conducted in the PubMed database using relevant terms. Original research articles published in English between 1 January 2015, and 30 June 2024, were included. A two-stage screening process was employed to identify studies on biomarkers for GDM diagnosis and prognosis and to evaluate the evidence for each biomarker's diagnostic performance and its potential prognostic correlation with GDM. Various biochemical markers, including adipokines, inflammatory markers, insulin resistance markers, glycemic markers, lipid profile markers, placenta-derived markers, and other related markers, have shown promise in identifying women at risk of developing GDM and predicting adverse pregnancy outcomes. Several promising markers with high predictive performance were identified. However, no single biomarker has demonstrated sufficient accuracy to replace the current diagnostic criteria for GDM. The complexity of multiple pathways in GDM pathogenesis highlights the need for a multi-marker approach to improve risk stratification and guide personalized management strategies. While significant progress has been made in GDM biomarker research, further studies are required to refine and validate these markers for clinical use and to develop a comprehensive, evidence-based approach to GDM prediction and management that can improve maternal and child health outcomes.

Association between maternal lipid profiles and lipid ratios in early to middle pregnancy as well as their dynamic changes and gestational diabetes mellitus

BACKGROUND

Unfavourable lipid and glucose levels may play a crucial role in the pathogenesis of gestational diabetes mellitus (GDM). However, there is a lack of prospective studies on the relationship between lipid profiles, lipid ratios and GDM during pregnancy.

AIMS

To prospectively investigate the relationship between lipid profile and lipid ratios in early and mid-pregnancy and their pattern of change from early to mid-pregnancy and the risk of GDM.

METHODS

This nested case-control study was based on maternal and child healthcare hospitals from Fujian Province, China. We included pregnant women who delivered in the hospital from January 2021 to June 2023. Lipid profiles (TC, TG, ApoA1, ApoB, HDL-c, LDL-c) and fasting glucose were measured before 14 weeks of gestation and between 20 and 28 weeks of gestation, and lipid ratios (triglyceride glucose index, TG/HDL-c and TC/HDL-c) was constructed. Logistic regression was used to assess the relationship between lipid profile, lipid ratios and GDM.

RESULTS

Of 1586 pregnant women, 741 were diagnosed with GDM. After adjusting for potential confounders, TG, ApoA1, ApoB, LDL-c, triglyceride glucose index, TG/HDL-c, and TC/HDL-c in early pregnancy were positively associated with the risk of GDM (odds ratios [95% CI] for extreme interquartile comparisons were 2.040 (1.468-2.843), 1.506 (1.091-2.082), 1.529 (1.110-2.107), 1.504 (1.086-2.086), 1.952 (1.398-2.731), 2.127 (1.526-2.971), and 2.370 (1.700-3.312), all trend P < 0.05). HDL-c was negatively associated with the risk of GDM (0.639: 0.459-0.889, trend P all less than 0.05). Similarly, in mid-pregnancy, lower levels of HDL-c, higher levels of triglyceride glucose index, TG/HDL-c ratio, and TC/HDL-c ratio were associated with increased risk of GDM (all trends P < 0.05). Stably high levels (both ≥ median for early and mid-pregnancy) of triglyceride glucose index, TG/HDL-c and TC/HDL-c were associated with increased risk of GDM (OR [95% CI]: 2.369 (1.438-3.940), 1.588 (1.077-2.341), 1.921 (1.309-2.829), respectively). The opposite was true for HDL-c, where stable high levels were negatively associated with GDM risk (OR [95% CI]: 0.599 (0.405-0.883)).

CONCLUSION

Increases in triglyceride glucose index, TG/HDL-c ratio, and TC/HDL-c ratio in early and mid-pregnancy, as well as their stable high levels from early to mid-pregnancy, are associated with a higher risk of GDM. In contrast, increased levels of HDL-c, both in early and mid-pregnancy, and their stable high levels from early to mid-pregnancy were associated with a lower risk of GDM. That highlighted their possible clinical relevance in identifying those at high risk of GDM.

A nonlinear relationship between the triglycerides to high-density lipoprotein cholesterol ratio and stroke risk: an analysis based on data from the China Health and Retirement Longitudinal Study

OBJECTIVE

The connection between triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio and stroke risk is controversial. Our goal was to explore this relationship in individuals aged 45 and older enrolled in the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

Our analysis encompassed 10,164 participants from the CHARLS cohorts. We applied the Cox proportional-hazards regression model to evaluate the potential correlation between the TG/HDL-C ratio and stroke incidence. Using a cubic spline function and smooth curve fitting within the Cox model allowed us to unearth a possible non-linear pattern in this relationship. We also conducted thorough sensitivity and subgroup analyses to deepen our understanding of the TG/HDL-C ratio's impact on stroke risk.

RESULTS

Adjusting for various risk factors, we observed a significant link between the TG/HDL-C ratio and increased stroke risk in individuals aged 45 and above (HR: 1.03, 95% CI 1.00-1.05, P = 0.0426). The relationship appeared non-linear, with an inflection at a TG/HDL-C ratio of 1.85. Ratios below this threshold indicated a heightened stroke risk (HR: 1.28, 95% CI 1.06-1.54, P = 0.0089), while ratios above it did not show a significant risk increase (HR: 1.01, 95% CI 0.98-1.04, P = 0.6738). Sensitivity analysis confirmed the robustness of these findings. Notably, non-smokers exhibited a stronger correlation between the TG/HDL-C ratio and stroke risk compared to past and current smokers.

CONCLUSION

Our investigation revealed a significant, yet non-linear, association between the TG/HDL-C ratio and the incidence of stroke among individuals aged 45 and above. Specifically, we found that stroke risk increased in correlation with TG/HDL-C ratio below the threshold of 1.85. These insights may guide healthcare providers in advising and developing more effective strategies for stroke prevention in this demographic.

First-Trimester Triglyceride-Glucose Index and Triglyceride/High-Density Lipoprotein Cholesterol are Predictors of Gestational Diabetes Mellitus Among the Four Surrogate Biomarkers of Insulin Resistance

Purpose

This study seeks to assess the potential of early pregnancy Triglyceride Glucose Index (TyG), triglyceride to High-Density Lipoprotein Cholesterol ratio (TG/HDL-c), Low-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol ratio (LDL-C/HDL-C), and Total Cholesterol to High-Density Lipoprotein Cholesterol ratio (TC/HDL-C) in predicting Gestational Diabetes Mellitus (GDM).

Patients and Methods

A total of 1073 adults singleton pregnant women were enrolled from June 2017 to September 2019. Complete anthropometric data and lipid profiles were measured in the first trimester (before 12 weeks gestation) and a 75g oral glucose tolerance test (OGTT) at 24-28 weeks was performed. Based on OGTT results, participants were categorised into Normal Glucose Tolerance (NGT) group (n=872) and GDM group (n=201). General data, laboratory test results, and surrogate insulin resistance indicators such as TyG index, TG/HDL-C, LDL-C/HDL-C, and TC/HDL-C were documented and compared. To compare differences between the two groups, t-test was used, Spearman correlation analysis and linear regression analysis were performed to establish associations between these indicators and insulin resistance in GDM. Receiver Operating Characteristic (ROC) curves were generated to compare the thresholds of these indicators for predicting GDM during pregnancy and to quantify overall diagnostic accuracy.

Results

Individuals with GDM had higher TyG, TG/HDL-C, and LDL-C/HDL-C levels (P < 0.001), but with no significant difference observed in TC/HDL-C. All four ratios were positively correlated with Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), yet only TyG emerged as an independent risk factor for HOMA-IR. The Area under the Curve (AUC) of TyG index (0.692) was comparable to that of HOMA-IR (0.703). The cut-off points for TyG index, TG/HDL-C, and HOMA-IR in predicting GDM were 7.088, 0.831, and 1.8, respectively. HOMA-IR exhibited the highest sensitivity (79.1%), while TyG index (64.3%) and TG/HDL-C ratio (64.3%) demonstrated better specificity compared to HOMA-IR (56.3%). LDL-C/HDL-C and TC/HDL-C offered no discernible predictive advantage.

Conclusion

Early pregnancy TyG index and TG/HDL-C can aid in identifying pregnant women at risk for GDM, potentially facilitating early and effective intervention to improve prognosis. TyG index exhibited superior predictive capability compared to TG/HDL-C.