Surrogate markers of insulin resistance: A review

Association between triglyceride/high density lipoprotein ratio and incidence risk of Parkinson's disease: a population-based cohort study

The association between insulin resistance and increased risk of Parkinson's disease (PD) has rarely been investigated. Our study aimed to investigate the association between the triglyceride/high-density lipoprotein (TG/HDL) ratio (which represents insulin resistance), and the incidence risk of PD in the general population. This study was conducted using data from the National Health Insurance Service-Health Screening Cohort Database of South Korea (2002-2019). We enrolled 310,023 participants who had no previous PD history and who had undergone more than three repeated measurements for the TG/HDL cholesterol ratio. The diagnosis of PD was determined using the International Classification of Diseases, 10th Revision code G20, specific reimbursement codes for Rare Intractable Diseases of V124, and a history of anti-PD drug prescription. During a median of 9.64 years (interquartile range 8.72-10.53), 4,587 individuals (1.47%) had an incidence of PD. Considering the multivariable time-dependent Cox proportional hazard model with repeated measures of average TG/HDL cholesterol ratio, a per unit increase in TG/HDL cholesterol ratio significantly increased the risk of PD in the entire cohort (hazard ratio (HR), 1.010; 95% confidence interval (CI), 1.001-1.020). These repeated measures of the average TG/HDL cholesterol ratio were associated with the incidence risk of PD in a J-shaped pattern for the entire diabetes mellitus (DM) and non-DM cohorts in restricted cubic spline analysis. Compared to the lowest tertiles (T1), the highest tertiles (T3) were positively associated with the incidence risk of PD (HR: 1.149, 95% CI 1.065-1.239 in the entire cohort, p for trend < 0.001; HR: 1.175, 95% CI 1.075-1.285 in the non-DM cohort, p for trend < 0.001). In contrast, the lowest (T1) and highest tertiles (T3) were not associated with the incidence risk of PD in the DM cohort (HR: 1.128, 95% CI 0.909-1.348) in fully adjusted multivariable analysis. Our study provides information that TG/HDL ratio may be positively associated with PD incidence risk in a non-DM population in longitudinal setting of the general population.

Early Life Nutrition and its Effects on the Developing Heifer: Growth, nutritive intakes, and metabolism

We aimed to assess the effects of preweaning nutrition and postweaning growth rates on the metabolic characteristics of replacement dairy heifers until 20 mo of age. At birth heifers, were allocated to one of 4 treatment groups which were a combination of preweaning (high or low preweaning nutritional treatment), and postweaning treatments (high or low postweaning growth rate). In the preweaning phase (birth until weaning at 10 weeks of age) heifers were subject to either a High (8 L/day) or Low (4 L/day) milk feeding strategy, then at weaning either a high or low postweaning growth rate. Heifers in the high preweaning treatment groups recorded greater growth rates until weaning compared with heifers in the low preweaning treatment groups. Heifers in the high preweaning groups consumed approximately twice the amount of milk and half the amount of concentrate. Blood samples taken at 6 weeks of age had lower BHB and higher glucose and IGF-1 concentrations in the high preweaning treatment in the preweaning phase; these differences disappeared postweaning. Additionally, insulin levels were also higher, and QUICKI index results were lower for heifers on the high preweaning treatment and for those on the high postweaning treatment, at 6 weeks and 13 mo of age. No differences between treatments were detected at 8 mo of age. Results indicate a positive effect of accelerated preweaning nutrition and post weaning growth rate (at 13 mo of age) on these metabolic biomarkers, however these treatment effects were independent of one another and reflected the nutritional input at the time.

The association between thyroid function and insulin resistance as measured by the metabolic score for insulin resistance (METS-IR): insights from NHANES 2007-2012

BACKGROUND

Altered thyroid function has been linked to insulin resistance (IR), but its relationship with the Metabolic Score for Insulin Resistance (METS-IR), a novel non-insulin-based index of IR, remains unclear. This study aimed to investigate the association between thyroid function status and METS-IR in a U.S.

POPULATION

METHODS

This cross-sectional study utilized data from 6,507 adults (aged ≥ 20 years) participating in the National Health and Nutrition Examination Survey from 2007 to 2012. Thyroid function status was categorized into five groups based on thyroid-stimulating hormone and free thyroxine levels. METS-IR was calculated from measures of fasting glucose, triglycerides, high-density lipoprotein cholesterol (HDL-C), and body mass index (BMI). Multivariate regression analyzed the relationship between thyroid status and METS-IR after adjusting for potential confounders.

RESULTS

Higher thyroid-stimulating hormone levels were positively associated with METS-IR (β = 0.003, 95% CI 0.001-0.004, p = 0.021). Subclinical hypothyroidism in males and subclinical hyperthyroidism in females showed significant correlations with higher METS-IR. Thyroid peroxidase antibodies (TPO Ab) positivity strengthened the association between overt hypothyroidism and METS-IR.

CONCLUSIONS

This study demonstrates significant associations between thyroid function status, particularly subclinical thyroid dysfunction, and insulin resistance as measured by METS-IR in a U.S.

POPULATION

Thyroid status may serve as an early marker of insulin resistance risk.

Association of TyG Index and TG/HDL-C Ratio with Trajectories of Depressive Symptoms: Evidence from China Health and Retirement Longitudinal Study

OBJECTIVES

To explore whether the triglyceride-glucose (TyG) index and the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio are associated with the trajectories of depressive symptoms.

METHODS

In this longitudinal study, 4215 participants aged 45 years and older were recruited from the China Health and Retirement Longitudinal Study from 2011 to 2018. The trajectories of depressive symptoms, measured by the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), were identified using group-based trajectory modeling. Multinomial logistic models and restricted cubic spline analysis were used to investigate the relationships between the TyG index and the TG/HDL-C ratio and the trajectories of depressive symptoms. Stratified analyses were conducted based on sex, age, place of residence, and body mass index (BMI).

RESULTS

Five distinct trajectories of depressive symptoms characterized by stable low, stable moderate, decreasing, increasing, and stable high were identified during a follow-up of 7 years. The associations of the TyG index and the TG/HDL-C ratio with trajectories of depressive symptoms are not entirely consistent. After adjusting for covariates, a higher TyG index at baseline was associated with lower odds of being on the decreasing trajectory of depressive symptoms (ORad = 0.61, 95% CI: 0.40-0.92) compared to the stable low trajectory, and restricted cubic spline analysis revealed a negative linear relationship between the TyG index and the likelihood of a decreasing trajectory of depressive symptoms. However, the relationship between the TG/HDL-C ratio and the decreasing trajectory of depressive symptoms was no longer statistically significant when all confounders were controlled (ORad = 0.72, 95% CI: 0.50-1.04). Additionally, this negative association between the TyG index and decreasing trajectory of depressive symptoms was observed among 45-64-year-old individuals, female participants, those living in rural areas, and those with a normal BMI.

LIMITATIONS

This study was conducted in a middle-aged and elderly population in China, and extrapolation to other regions and populations requires further confirmation.

CONCLUSIONS

Compared to the TG/HDL-C ratio, the TyG index may be a better predictor for trajectories of depressive symptoms in middle-aged and older adults. Considering that the pathology of depression progresses long term, our findings may have utility for identifying available and reliable markers for the development of depression.

Correlation of the FIB-4 Liver Biomarker Score with the Severity of Heart Failure

Background and Objectives: Heart failure is associated with high morbidity and mortality and linked with several pre-existing health conditions and risk factors. Early detection and prompt management in heart failure improves patient outcomes. Liver involvement is associated with heart failure disease progression, and hence liver biomarkers and liver fibrosis may have a prognostic impact. Several blood test based markers and scoring systems estimate liver fibrosis and hence can be useful prognostic tools. Materials and Methods: We retrospectively analyzed a series of 303 patients with decompensated heart failure in a city in western Romania over a period of 6 months. Several biochemical parameters were measured, the FIB-4 score was estimated and echocardiography was performed. Results for targeted variables are presented using descriptive statistics. Patients were analyzed based on their LVEF categories. Statistical analysis was based on ANOVA one-way tests for continuous variables and Chi-square tests for categorical variables. Pairwise comparisons were performed based on Bonferroni adjusted significance tests. The correlations between FIB-4 score, LVEF and NT-pro BNP in patients with and without diabetes and hypertension were explored using Spearman's correlation coefficient. Result: Age, gender, NYHA class, death, history of (h/o) type 2 diabetes mellitus (T2DM), h/o coronary artery disease (CAD), h/o arrhythmias, sodium, potassium, creatinine, eGFR, uric acid, NT-pro BNP, left atrial volume, LDL, HDL, and TG were analyzed by LVEF categories using ANOVA one-way tests, Chi-square tests, and Bonferroni correction comparisons. We found a strong statistically significant correlation between each of NT-pro BNP, left atrial volume, LDL, and HDL with the LVEF categories. Discussion: Early detection of cardiac dysfunction leads to better management in patients with cardiovascular risk factors including diabetes and hypertension. High LDL and low HDL levels contribute to a reduction in left ventricular (LV) function. Available literature suggests the FIB-4 score as superior to other non-invasive markers of fibrosis. It utilizes the patient's age, platelet count, AST, and ALT, which can be available retrospectively, making it an easy and inexpensive tool. FIB-4 score has a few limitations. Conclusions: Our study has shown a statistically significant positive correlation between severity categories of LVEF and FIB-4 score for heart failure patients with and without diabetes, and for heart failure patients with or without hypertension. We propose the implementation of FIB-4 score as a prognostic tool for heart failure.

SPISE INDEX (Single point insulin sensitivity estimator): indicator of insulin resistance in children and adolescents with overweight and obesity

Background

Insulin resistance in children and adolescents with obesity is linked to increased risk of type 2 diabetes mellitus and cardiovascular disease. The SPISE index, based on values of fasting triglycerides (mg/dL), HDL cholesterol (mg/dL), and BMI (kg/m2), shows promise in predicting insulin resistance in children.

Methods

This study aimed to identify a SPISE cut-off for detecting insulin resistance and evaluate its relationship with pubertal development, anthropometrics, and glycometabolic profile in 232 children and adolescents, 105 males and 127 females (median age 13.2 years) with overweight (n=48) and obesity (n=184). SPISE index was calculated with the formula: 600 x HDL Cholesterol0,185/Triglycerides0,2x BMI1,338, and patients were categorized based on Tanner stages [(Group 1 (18.8%) Tanner 1, Group 2 (44.6%) Tanner 2-3-4, Group 3 (36.6%) Tanner 5)].

Results

A SPISE cut-off ≤ 6.92 or ≤ 6.13 (based on the method used for insulin resistance detection), in subjects with Tanner stages I and II, showed good sensitivity and specificity as a marker of insulin resistance. SPISE index decreased significantly with the advancement of pubertal status (P < 0.0001) and with worsening severity of obesity (P < 0.0001). While no significant differences in SPISE marker were observed between patients with normal and abnormal glucose tolerance during OGTT within any pubertal stage, SPISE values were significantly lower in patients with confirmed insulin resistance (total sum of insulin OGTT ≥ 535 µu/mL) in all three pubertal groups (Group 1: P=0.008; Group 2: P=0.0008 and Group 3: P=0.002, respectively).

Conclusions

In children and adolescents with obesity the SPISE index can be proposed as an alternative to OGTT and other insulin-based methods for evaluating insulin resistance. Its advantage lies in using readily available and inexpensive laboratory tests, making it suitable for large-scale studies and follow-up monitoring across diverse populations.

Increases in Psychological Stress Are Associated With Higher Fasting Glucose in US Chinese Immigrants

BACKGROUND

The majority of Chinese Americans is foreign-born, and it is well-documented that immigration to the United States (US) leads to increased risk for chronic diseases including type 2 diabetes. Increased disease risk has been attributed to changes in lifestyle behaviors following immigration, but few studies have considered the psychosocial impact of immigration upon biomarkers of disease risk.

PURPOSE

To examine associations of psychological stress and social isolation with markers of type 2 diabetes risk over time among US Chinese immigrants.

METHODS

In this longitudinal study of 614 Chinese immigrants, participants completed assessments of perceived stress, acculturative stress, negative life events, and social isolation annually at three time points. Fasting blood samples were obtained at each time point to measure blood glucose, glycated hemoglobin, and insulin resistance. Mean duration between baseline and follow-up assessments was approximately 2 years.

RESULTS

Increases in migration-related stress, perceived stress and social isolation were associated with significant increases in fasting glucose at follow-up independent of age, body mass index, length of US residence, and other potential covariates. Moreover, increases in glucose varied depending on perceived stress levels at baseline, such that those with higher baseline stress had a steeper increase in glucose over time.

CONCLUSIONS

Psychological stress and social isolation are associated with increases in fasting glucose in a sample of US Chinese immigrants. Findings suggest that the unique experiences of immigration may be involved in the risk of developing type 2 diabetes, a condition that is prevalent among US Chinese despite relatively low rates of obesity.

Neem seed oil ameliorates diabetic phenotype by suppressing redox imbalance, dyslipidaemia and pro-inflammatory mediators in a rodent model of type 2 diabetes

The neem plant (Azadirachta indica) has popular ethnomedicinal applications. The anti-diabetic potential and mechanism of neem seed oil (NSO) in a rodent model of type 2 diabetes mellitus was evaluated in the present study. Experimentally-induced diabetic animals were administered NSO (200 and 400 mg/kg) or metformin (150 mg/kg) orally for 30 days, with some animals serving as positive and negative controls. NSO significantly (p < .05) reversed diabetes-induced impaired glucose metabolism, dyslipidaemia, and oxido-inflammatory imbalances typified by changes in the NADH/NAD+ ratio (p < .001) and increases in the mRNA or protein levels of C-reactive protein, 4-hydroxynonenal, and pro-inflammatory cytokines (TNF-α and Il-1β) among others in the hepatic or pancreatic tissues of diabetic animals. The histological evaluation of the pancreatic tissue corroborated the protective effect of NSO. The findings showed that the antidiabetic effect of NSO proceeded through its hypolipidemic effect and modulation of redox and inflammatory signalling events in the tissues of animals.

Development and validation of a risk score for detecting non-alcoholic fatty liver disease

The development of an easy-to-use noninvasive model to screen nonalcoholic fatty liver disease (NAFLD) is warranted. This study aimed to develop and validate a simple noninvasive NAFLD risk score (NARS). We used the National Health and Nutrition Examination Survey 2017 to March 2020 cycle data. The sample size of derivation and validation cohort were 4056 and 2502, separately. The NAFLD was determined by FibroScan® measured controlled attenuation parameter scores of >285 dB/m in the absence of excessive alcohol use, steatogenic medications use, and viral hepatitis. The NARS was derived from a multivariable logistic regression model and variables were selected based on Boruta analysis. The performance of NARS was internally validated and compared with previous models using receiver-operating characteristics curve and C-statistics. The NARS was established using waist circumference, triglycerides, alanine aminotransferase, and fasting glucose, and the total score ranges from 0 to 8, with an increasing risk of NAFLD. NARS demonstrated ideal discrimination in the validation cohort, with C-statistics of 0.832 (95% confidence interval, 0.801-0.824), and was not inferior to any existing models. The optimal cutoff point for predicting NAFLD was obtained at 4 scores with a sensitivity of 82% and specificity of 69%. We reported the derivation and internal validation of a novel and easy-to-use risk score for detecting the presence of NAFLD. NARS demonstrated ideal discrimination performance and was practical in clinical practice for selecting individuals at higher risk of NAFLD for further examination or intervention.

Evaluation of Maternal Factors Affecting Postpartum Insulin Resistance Markers in Mothers with Gestational Diabetes-A Case-Control Study

BACKGROUND

Gestational diabetes mellitus (GDM) is defined by an insufficient insulin response to counteract the insulin resistance (IR) that arises from the physiological adaptations associated with pregnancy. However, the pathophysiology of IR is complex and unclear, as it encompasses elements such as epigenetics, environmental factors, modifiable lifestyle factors, and psychosocial factors.

AIM

The objective of this study was to evaluate the influence of GDM and other maternal factors on IR markers in comparison to mothers with normal glucose tolerance during pregnancy in the first week postpartum.

MATERIAL AND METHODS

The study population comprised 70 participants, including mothers with gestational diabetes who were treated with a diet and physical activity (GDM G1), with insulin (GDM G2), and a control group of healthy mothers without gestational diabetes (non-GDM). A series of statistical techniques were employed to facilitate the comparison of data between the study groups, with the objective of identifying potential associations with maternal factors. A taxonomic analysis was conducted using the following factors: classification by study group, a history of hypothyroidism in the maternal medical interview, and maternal gestational weight gain, which were identified as the best-fitting predictors.

RESULTS

The analysis resulted in the identification of four clusters of patients. Comparison of the insulin resistance markers between mothers assigned to the abovementioned clusters showed differences in the incidence of excessive weight loss and in the results of glucose screening tests during pregnancy. Also, differences concerning fasting glucose levels in the first and second/third trimesters of pregnancy and glucose levels at 1 h post-OGTT were found. For the clusters, the results of the HOMA-IR and the QUICKI did not show any differences in the first week after delivery (p > 0.05). HbA1c results varied significantly.

CONCLUSIONS

Degree of glucose metabolism disorders, hypothyroidism, and weight gain in pregnancy influence maternal insulin resistance markers in the first week postpartum. Additionally, gestational weight fluctuation has a significant influence on the outcome of pregnancy, particularly with regard to fetal growth and, consequently, the infant's birth weight and adipose tissue accumulation.

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.