A novel criterion for identifying metabolically obese but normal weight individuals using the product of triglycerides and glucose

Triglyceride-glucose index demonstrates reasonable performance as a screening tool but exhibits limited diagnostic utility for insulin resistance: Data from the ELSA-Brasil cohort

Insulin resistance (IR) is a key risk factor for chronic metabolic diseases, but its laboratory diagnosis is still costly; thus, the triglyceride-glucose (TyG) index has been proposed as a surrogate method. Our aim was to provide a detailed analysis of cutoffs and test the hypothesis that the TyG index would present reasonable performance parameters for IR screening. This is a cross-sectional study with baseline data from 12,367 eligible participants of both sexes (aged 35-74 years) from the Brazilian Longitudinal Study of Adult Health. TyG correlation and agreement with the Homeostasis Model Assessment for Insulin Resistance were analyzed. Positive and negative predictive values (PV+, PV-) and likelihood ratio (LR+, LR-) were calculated. A moderate positive correlation between TyG and Homeostasis Model Assessment for Insulin Resistance was observed (Pearson r = 0.419). The area under the receiver operating characteristic curve of TyG for IR diagnosis was 0.742 and the optimal cutoff was 4.665, reaching a kappa agreement value of 0.354. For this cutoff, a PV+ of 59.3% and PV- of 76.0%, as well as an LR+ of 2.07 and LR- of 0.45 were obtained. Alternatively, because high sensitivity is desired for screening tests, selecting a lower cutoff, such as 4.505, increases the PV- to 82.1%, despite decreasing the PV+ to 50.8%. We conclude that TyG has important performance limitations for detecting IR, but that it may still be reasonably useful to help screening for IR in adults because it can be calculated from low-cost routine blood tests.

Phenotyping obesity: A focus on metabolically healthy obesity and metabolically unhealthy normal weight

Over the past 4 decades, research has shown that having a normal body weight does not automatically imply preserved metabolic health and a considerable number of lean individuals harbour metabolic abnormalities typically associated with obesity. Conversely, excess adiposity does not always equate with an abnormal metabolic profile. In fact, evidence exists for the presence of a metabolically unhealthy normal weight (MUHNW) and a metabolically healthy obese (MHO) phenotype. It has become increasingly recognised that different fat depots exert different effects on the metabolic profile of each individual by virtue of their location, structure and function, giving rise to these different body composition phenotypes. Furthermore, other factors have been implicated in the aetiopathogenesis of the body composition phenotypes, including genetics, ethnicity, age and lifestyle/behavioural factors. Even though to date both MHO and MUHNW have been widely investigated and documented in the literature, studies report different outcomes on long-term cardiometabolic morbidity and mortality. Future large-scale, observational and population-based studies are required for better profiling of these phenotypes as well as to further elucidate the pathophysiological role of the adipocyte in the onset of metabolic disorders to allow for better risk stratification and a personalised treatment paradigm.

Low Handgrip Strength (Possible Sarcopenia) With Insulin Resistance Is Associated With Type 2 Diabetes Mellitus

Context

Older adults with sarcopenic obesity are at high risk for type 2 diabetes mellitus (T2DM). However, few East Asians have sarcopenic obesity. Since many East Asians have insulin resistance (IR) without obesity, it is possible that older East Asians with sarcopenia and IR might be at high risk for T2DM. However, this relationship has not been studied.

Methods

This cross-sectional study included 1629 older adults aged 65 to 84 years registered in the Bunkyo Health Study. All underwent a 75-g oral glucose tolerance test and handgrip strength measurement. Participants were classified into 4 groups by possible sarcopenia (handgrip strength <28 kg in men and <18 kg in women) and IR status (triglyceride glucose [TyG] index ≥8.79 for men and ≥8.62 for women [third quartile]). Modified Poisson regression was used to estimate relative risk (RR) and 95% CIs for T2DM with adjustment for confounding factors.

Results

The mean age was 73.1 ± 5.4 years. T2DM was diagnosed in 212 (13.0%) participants. After adjusting for age, sex, body mass index, use of lipid-lowering medications, hypertension, and cardiovascular disease, possible sarcopenia and IR were associated with T2DM, with their coexistence showing a notably stronger association (control: RR, 1.00 [Reference]; possible sarcopenia: RR, 1.55 [95% CI, 1.04-2.30]; IR: RR, 2.69 [95% CI, 1.99-3.65]; and IR possible sarcopenia: RR, 4.76 [95% CI, 3.34-6.79]).

Conclusion

Possible sarcopenia based on low handgrip strength and IR based on the TyG index are independently associated with T2DM in older Japanese individuals. Their coexistence shows a particularly strong association with T2DM.

Assessment of six surrogate insulin resistance indexes for predicting cardiometabolic multimorbidity incidence in Chinese middle-aged and older populations: Insights from the China health and retirement longitudinal study

AIMS

Insulin resistance (IR) is associated with cardiometabolic multimorbidity (CMM). We aimed to explore the predictive value of six surrogate IR indexes-Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), triglyceride-glucose (TyG), atherogenic index of plasma (AIP), TyG-body mass index (TyGBMI), and TyG-waist circumference (TyGwaist)-to establish the CMM incidence in Chinese middle-aged and older populations.

MATERIAL AND METHODS

To estimate the odds ratio (OR) with a 95% confidence interval (95% CI) for incident CMM using six surrogates, we analysed data from the China Health and Retirement Longitudinal Study using multivariate logistic regression models. The nonlinear dose-response correlation was evaluated using restricted cubic spline analysis; predictive performance was assessed using receiver operator characteristic curves.

RESULTS

Among 6451 eligible participants, 268 (4.2%) developed CMM during the 4-year follow-up period. The ORs (95% CI) for incident CMM increased with increasing CVAI quartiles (Q) [Q2: 1.71, 1.03-2.90; Q3: 2.72, 1.70-4.52; Q4: 5.16, 3.29-8.45; all p < 0.05] after full adjustment, with Q1 as the reference. Other indexes yielded similar results. These associations remained significant in individuals with a normal body mass index. Notably, CVAI, AIP, and TyG exhibited a linear dose-response relationship with CMM (Pnonlinear ≥0.05), whereas LAP, TyGBMI, and TyGwaist displayed significant nonlinear correlations (Pnonlinear <0.05). The area under the curve for the CVAI (0.691) was significantly superior to that of other indexes (all p < 0.05).

CONCLUSIONS

The six IR surrogates were independently associated with CMM incidence. CVAI may be the most appropriate indicator for predicting CMM in middle-aged and older Chinese populations.

A forebrain-hypothalamic ER stress driven circuit mediates hepatic steatosis during obesity

OBJECTIVE

Non-alcoholic fatty liver disease (NAFLD) affects 1 in 3 adults and contributes to advanced liver injury and cardiometabolic disease. While recent evidence points to involvement of the brain in NAFLD, the downstream neural circuits and neuronal molecular mechanisms involved in this response, remain unclear. Here, we investigated the role of a unique forebrain-hypothalamic circuit in NAFLD.

METHODS

Chemogenetic activation and inhibition of circumventricular subfornical organ (SFO) neurons that project to the paraventricular nucleus of the hypothalamus (PVN; SFO→PVN) in mice were used to study the role of SFO→PVN signaling in NAFLD. Novel scanning electron microscopy techniques, histological approaches, molecular biology techniques, and viral methodologies were further used to delineate the role of endoplasmic reticulum (ER) stress within this circuit in driving NAFLD.

RESULTS

In lean animals, acute chemogenetic activation of SFO→PVN neurons was sufficient to cause hepatic steatosis in a liver sympathetic nerve dependent manner. Conversely, inhibition of this forebrain-hypothalamic circuit rescued obesity-associated NAFLD. Furthermore, dietary NAFLD is associated with marked ER ultrastructural alterations and ER stress in the PVN, which was blunted following reductions in excitatory signaling from the SFO. Finally, selective inhibition of PVN ER stress reduced hepatic steatosis during obesity.

CONCLUSIONS

Collectively, these findings characterize a previously unrecognized forebrain-hypothalamic-ER stress circuit that is involved in hepatic steatosis, which may point to future therapeutic strategies for NAFLD.

Clinical Classification of Obesity and Implications for Metabolic Dysfunction-Associated Fatty Liver Disease and Treatment

Obesity,and metabolic dysfunction-associated fatty liver disease (MAFLD) have reached epidemic proportions globally. Obesity and MAFLD frequently coexist and act synergistically to increase the risk of adverse clinical outcomes (both hepatic and extrahepatic). Type 2 diabetes mellitus (T2DM) is the most important risk factor for rapid progression of steatohepatitis and advanced fibrosis. Conversely, the later stages of MAFLD are associated with an increased risk of T2DM incident. According to the proposed criteria, MAFLD is diagnosed in patients with liver steatosis and in at least one in three: overweight or obese, T2DM, or signs of metabolic dysregulation if they are of normal weight. However, the clinical classification and correlation between obesity and MAFLD is more complex than expected. In addition, treatment for obesity and MAFLD are associated with a reduced risk of T2DM, suggesting that liver-based treatments could reduce the risk of developing T2DM. This review describes the clinical classification of obesity and MAFLD, discusses the clinical features of various types of obesity and MAFLD, emphasizes the role of visceral obesity and insulin resistance (IR) in the development of MAFLD,and summarizes the existing treatments for obesity and MAFLD that reduce the risk of developing T2DM.

Obesity phenotypes and cardiovascular risk: From pathophysiology to clinical management

Obesity epidemic reached the dimensions of a real global health crisis with more than one billion people worldwide living with obesity. Multiple obesity-related mechanisms cause structural, functional, humoral, and hemodynamic alterations with cardiovascular (CV) deleterious effects. A correct assessment of the cardiovascular risk in people with obesity is critical for reducing mortality and preserving quality of life. The correct identification of the obesity status remains difficult as recent evidence suggest that different phenotypes of obesity exist, each one associated with different degrees of CV risk. Diagnosis of obesity cannot depend only on anthropometric parameters but should include a precise assessment of the metabolic status. Recently, the World Heart Federation and World Obesity Federation provided an action plan for management of obesity-related CV risk and mortality, stressing for the instauration of comprehensive structured programs encompassing multidisciplinary teams. In this review we aim at providing an updated summary regarding the different obesity phenotypes, their specific effects on CV risk and differences in clinical management.

SGLT2 inhibitors improve plasma atherogenic biomarkers in patients with type 2 diabetes: a real-world retrospective observational study

BACKGROUND

There are cost-effective, non-invasive, and predictive tools used to predict the CVD risk in patients with diabetes such as the "atherogenic index of plasma (AIP)" which is defined as the logarithm to the base 10 of the ratio of fasting plasma TG (mg/dL) to HDL-C [log (TG/HDL-C)], triglyceride to high density lipoprotein (TG-to-HDL-C) ratio and the triglyceride glucose (TyG) index which is calculated as Ln (fasting TG [mg/dL] × fasting blood glucose (mg/dL)/2). These tools are indirect markers of atherosclerosis. Dapagliflozin and empagliflozin have exhibited cardiovascular beneficial effects and this study evaluated the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on AIP, TyG index and TG-to-HDL-C ratio in patients with type 2 diabetes.

METHODS

This single center, retrospective, observational study involved patients with type 2 diabetic patients who were prescribed SGLT2i in the endocrinology outpatient clinic between January 2017 and June 2019. Demographic and clinical data were collected from patient files. AIP, TyG index and TG-to-HDL-C ratio were calculated obtained at the first visit and the sixth month visit.

RESULTS

Overall, 143 patients with T2DM (75 women, 68 men) were recruited in this study. Sixty-six patients were prescribed dapagliflozin (46.2%), and 77 were prescribed empagliflozin (53.8%). SGLT2i treatment did not alter the lipid profile except the serum triglyceride (TG) levels. Serum TG levels were significantly reduced after 6 months of SGLT2i therapy (P=0.045). All patients had significant reductions in AIP at 6-month follow-up (P<0.001), accompanied by a significant reduction in TyG index (P<0.001). Both empagliflozin and dapagliflozin caused significant decrease in AIP (P=0.043 and P<0.001, respectively) and TyG index (P=0.010 and P<0.001, respectively).

CONCLUSIONS

Both dapagliflozin and empagliflozin were noted to significantly affect AIP and TyG indexes, which indicate atherosclerotic cardiovascular risk, with or without statin treatment regardless of lipid parameters.

Comparison of seven surrogate insulin resistance indexes for predicting the prevalence of carotid atherosclerosis in normal-weight individuals

Introduction

The aim of this study was to assess the correlation between surrogate insulin resistance (IR) indexes and carotid atherosclerosis (CA) in normal-weight populations, as well as compared their ability to predict CA.

Method

A total of 26,795 middle-aged and older adult individuals with normal body weights were included. Triglyceride-glucose index (TyG), TyG-body mass index, TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), visceral adiposity index, Chinese VAI (CVAI) and lipid accumulation product (LAP) were determined using established formulas. The associations between these surrogate indexes and CA were assessed using logistic regression models and restricted cubic spline (RCS) analysis. Receiver operating characteristic curves were utilized to compare the performance of these indexes for predicting CA.

Result

The levels of all seven surrogate indexes of IR were significantly higher in normal-weight individuals with CA than in those without CA (p < 0.001). In the full-adjusted model, only CVAI, TyG-WC, TyG-WHtR and LAP were significantly associated with CA, with the adjusted odds ratios (95% CI) of CA being 1.25 (1.20-1.30), 1.18 (1.14-1.23), 1.20 (1.16-1.25) and 1.25 (1.18-1.32) for each one standard deviation increase in CVAI, TyG-WC, TyG-WHtR and LAP, respectively. RCS analysis revealed a significant increase in the prevalence of CA among normal-weight individuals with CVAI >89.83, LAP >28.91, TyG-WHtR >4.42 and TyG-WC >704.93. The area under the curve for CVAI was significantly greater than for other indexes (p < 0.001).

Conclusion

CVAI, TyG-WC, TyG-WHtR and LAP were independently associated with the prevalence of CA. Specifically, CVAI may be the most appropriate predictor of CA in normal-weight individuals.

Association of triglyceride-glucose index with incident hypertension among non-overweight healthy adults: A cohort study in China

BACKGROUND AND AIMS

Overweight and obesity are well recognized as important and traditional risk factors for hypertension (HTN), but the prevalence of HTN tends to increase in non-overweight people. Triglyceride-glucose (TyG) index has been observed to be associated with HTN. However, whether such association still persists in non-overweight people remains unclear. The aim of our cohort study was to explore the link between TyG index and incident HTN in non-overweight Chinese population.

METHODS AND RESULTS

As many as 4678 individuals without HTN at baseline were involved, who underwent at least two years of health check-ups in the eight-year study period and maintained non-overweight at follow-up. According to baseline TyG index quintiles, participants were classified into five groups. Compared with the 1st quantile, those in the 5th quantile of TyG index had a 1.73-fold (HR 95% CI 1.13-2.65) risk of incident HTN. The results remained consistent when analyses were restricted to participants without abnormal TG or FPG level at baseline (HR 1.62, 95% CI 1.17-2.26). Furthermore, the subgroup analyses were conducted, the risk of incident HTN was still significantly increased with increasing TyG index for subgroups of older participants (age≥ 40 years), males, females and higher BMI group (BMI≥ 21 kg/m²).

CONCLUSIONS

The risk of incident HTN increased with increasing TyG index among Chinese non-overweight adults, so TyG index might be a reliable predictor of incident HTN among adults maintaining non-overweight.

Comparison of the prognostic value of a comprehensive set of predictors in identifying risk of metabolic-associated fatty liver disease among employed adults

Objective

Metabolic-associated fatty liver disease (MAFLD) is of concern in employed adults, while the crucial indicators in predicting MAFLD are understudied in this population. We aimed to investigate and compare the prediction performance of a set of indicators for MAFLD in employed adults.

Methods

A cross-sectional study recruiting 7968 employed adults was conducted in southwest China. MAFLD was assessed by abdominal ultrasonography and physical examination. Comprehensive indicators of demographics, anthropometric, lifestyle, psychological, and biochemical indicators were collected by questionnaire or physical examination. All indicators were evaluated for importance in predicting MAFLD by random forest. A prognostic model based on multivariate regression model was constructed to obtain a prognostic index. All indicators and prognostic index were compared to evaluate their prediction performance in predicting MAFLD by the receiver operating characteristic (ROC) curve, calibration plot, and Decision curve analysis (DCA).

Results

Triglyceride Glucose-Body Mass Index (TyG-BMI), BMI, TyG, triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C), and TG ranked the top five important indicators, and TyG-BMI performed the most accurate prediction of MAFLD according to the ROC curve, calibration plot and DCA. The area under the ROC curves (AUCs) of the five indicators were all over 0.7, with TyG-BMI (cut-off value: 218.284, sensitivity: 81.7%, specificity: 78.3%) suggesting the most sensitive and specific indicator. All five indicators showed higher prediction performance and net benefit than the prognostic model.

Conclusion

This epidemiological study firstly compared a set of indicators to evaluate their prediction performance in predicting MAFLD risk among employed adults. Intervention targeting powerful predictors can be helpful to reduce the MAFLD risk among employed adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-023-15365-9.

Accuracy of the triglyceride-glucose index as a surrogate marker for identifying metabolic syndrome in non-diabetic individuals

OBJECTIVES

This study aimed to verify the performance of the triglyceride-glucose (TyG) index in predicting metabolic syndrome (MetS) using three different criteria in healthy individuals living in rural areas. In addition, it aimed to estimate the TyG index cutoff point in the prediction of MetS.

METHODS

The study was a cross-sectional study of healthy individuals (aged ≥18 y) living in rural areas of southern Brazil. Individuals with diabetes mellitus were excluded. The variables investigated were waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol, fasting glucose, and TyG index. MetS was defined using three criteria: harmonized, International Diabetes Foundation, and National Cholesterol Education Program Adult Treatment Panel III. The Poisson regression model was used for the multivariate analysis. The performance of the TyG index in identifying MetS was determined by receiver operating characteristic curves.

RESULTS

A total of 133 individuals were included in this study, with a mean age of 49.0 ± 13.5 y; 54.1% were female. The TyG index performed better in predicting MetS through the harmonized criteria, with area under the curve (AUC) = 0.889 (95% confidence interval [CI], 0.829-0.949), followed by the International Diabetes Foundation criteria, with AUC = 0.877 (95% CI, 0.814-0.940), and the National Cholesterol Education Program criteria, with AUC = 0.867 (95% CI, 0.797-0.937). The TyG index cutoff points defined for the harmonized and International Diabetes Foundation criteria were ≥ 8.61, and ≥ 8.79 for the National Cholesterol Education Program Adult Treatment Panel III.

CONCLUSIONS

The TyG index proved to be valid for diagnosing MetS. The largest AUC of the TyG index was identified for the harmonized criteria. Thus, the TyG index can be used to diagnose MetS in individuals living in rural areas.

Association of metabolic syndrome with TyG index and TyG-related parameters in an urban Chinese population: a 15-year prospective study

BACKGROUND

The metabolic syndrome (Mets) is a multiplex risk factor for atherosclerotic cardiovascular diseases. The aims of the study were to assess the association of the Mets with TyG index and TyG-related parameters in an urban Chinese population.

METHODS

The data were collected in 1992 and then again in 2007 from the same group of 590 individuals (363 males and 227 females) without Mets in 1992. The fasting lipid profile and blood glucose were measured. TyG index and related parameters were calculated, and Mets defined according to the harmonized criteria. The area under the curve (AUC) of receiver operating characteristic curves was used to evaluate TyG index and related parameters for their diagnostic ability to identify people with Mets. Odd ratios (OR) for Mets prediction were calculated using stepwise logistic regression analyses.

RESULTS

The incidence of Mets was 18.64% over the 15-year follow-up period.During 15 years' follow-up, TyG-waist to height ratio (TyG-WHtR) shows the largest AUC for Mets detection (0.686) followed by TyG-waist circumference (TyG-WC) (0.660), TyG-waist-to-hip ratio (TyG-WHpR) (0.564), and TyG index (0.556) in all participants. Gender analysis revealed that TyG-WHtR and TyG-WC have the largest AUC in both genders. TyG-WHtR significantly predicted Mets in all participants, with an unadjusted odds ratio of 5.63 (95% CI 3.23-9.83 P < 0.001). Associations remained significant after adjustment for smoking, drinking, physical exercise and components of Mets.

CONCLUSIONS

TyG-WHtR might be a strong and independent predictor for Mets in all participants in an urban Chinese population. TyG-related markers that combine obesity markers with TyG index are superior to other parameters in identifying Mets in both genders.

Distinct triglyceride-glucose trajectories are associated with different risks of incident cardiovascular disease in normal-weight adults

BACKGROUND

Long-term patterns of the triglyceride-glucose index (TyG index) and their effects on cardiovascular disease (CVD) among normal-weight adults are poorly characterized. This study aimed to identify TyG index trajectories in normal-weight adults and to determine their association with the risk of incident CVD.

METHODS

This study included 40,473 normal-weight participants who were free of stroke and myocardial infarction prior to or in 2012. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2), and the TyG index trajectories during 2006-2012 were identified by latent mixture modeling.

RESULTS

We identified five distinct TyG index trajectories according to TyG index range and changing pattern over time: low-stable (n = 9,806; mean TyG index 7.84-7.93), moderate-stable (n = 22,066; mean TyG index 8.43-8.52), high-decreasing (n = 1,469; mean TyG index 9.83-8.75), moderate-increasing (n = 5,842; mean TyG index 8.98-9.26), and high-stable (n = 1,290; mean TyG index 9.91-10.07). During 6.74 years of follow-up, we documented 1,577 incident CVD events. Compared with the low-stable pattern, the highest risk of CVD was observed in the high-stable pattern (hazard ratio [HR], 2.24; 95% confidence interval [CI]: 1.73-2.90), followed by the moderate-increasing pattern (HR, 1.70; 95% CI, 1.43-2.04), the high-decreasing pattern (HR, 1.45; 95% CI, 1.11-1.89), and the moderate-stable pattern (HR, 1.25; 95% CI, 1.08-1.44). Similar results were also observed for stroke and myocardial infarction.

CONCLUSIONS

Distinct TyG index trajectories were significantly associated differently subsequent risk of CVD in normal-weight individuals. These observations suggested that long-term trajectories of TyG index may be useful for predicting CVD among normal-weight adults.

Association of triglyceride glucose index with all-cause and cause-specific mortality among middle age and elderly US population

Aims

To investigate the association between the triglyceride glucose (TyG) index and all-cause and cause-specific mortality in middle age and elderly population.

Methods and results

A total of 9,254 participants with age ≥ 45 years were enrolled from the National Health and Nutrition Examination Survey cycle of 1999–2014. The TyG index was determined as ln [fasting triglycerides (mg/dL) x fasting glucose (mg/dL)/2]. Primary outcomes were all-cause mortality and cause-specific mortality (cardiovascular diseases and malignant neoplasms). The association between the levels of TyG and the risk of mortality was explored with Cox regression models. After a median follow-up of 7.6 years, 1,774 all-cause death occurred. Univariate analysis showed that the TyG was associated with all-cause mortality (hazard ratio [HR] 1.18, 95% confidence interval [CI] [1.11,1.26]; p < 0.001). Furthermore, multivariate-adjusted analysis found that the third TyG quartile (8.72 ~ 9.16) was associated with the lowest risk of all-cause mortality (HR 0.84, 95%CI [0.73, 0.98]; p < 0.05). Restricted cubic splines showed that the association between levels of TyG index and the risk of all-cause mortality was non-linear (p for nonlinearity < 0.001) and the inflection point was 9.18 using threshold effect analysis. The HR was 0.82 (95%CI [0.71,0.96]) below 9.18 while the HR was 1.32 (95%CI [1.12,1.55]) above 9.18.

Conclusion

TyG index was U-shaped associated with all-cause mortality and the TyG index associated with the lowest risk of all-cause mortality was 9.18.

Comparison of obesity indices and triglyceride glucose-related parameters to predict type 2 diabetes mellitus among normal-weight elderly in China

PURPOSE

Although a significant proportion of type 2 diabetes mellitus (T2DM) cases arose from normal-weight individuals, studies on indicators of T2DM in normal-weight people are limited. Accordingly, this study aims to investigate the predictive value of obesity indices and triglyceride glucose-related parameters (TyG-related parameters) in T2DM among normal-weight Chinese elderly.

METHODS

A total of 24,215 normal-weight Chinese elderly (age ≥ 60 years) [body mass index-BMI (18.5-23.9 kg/m²)] were included. Obesity indices and triglyceride glucose-related parameters (TyG-related parameters) included waist circumference (WC), waist-to-height ratio (WHtR), visceral adiposity index (VAI), lipid accumulation product (LAP), and TyG-related parameters (TyG, TyG-BMI, TyG-WC, and TyG-WHtR). Multivariate logistic regression analysis was performed to examine the associations between obesity- and TyG-related indices and T2DM. The areas under the curve (AUC) of the receiver-operating characteristic (ROC) curve analyses were used to evaluate and compare the predictive value of the different indices.

RESULTS

The prevalence of T2DM was 14.2% in normal-weight individuals. Among the indices, TyG was significantly associated with T2DM among men and women, respectively, (adjusted odds ratio-aOR per SD 3.46; 95% CI 3.23-3.71) and (aOR per SD 3.64; 95% CI 3.43-3.86). Compared with other indices, TyG had the highest AUC value for T2DM in men (AUC: 0.818, 95% CI 0.810-0.825) and women (AUC: 0.824, 95% CI 0.814-0.833).

CONCLUSIONS

TyG is an effective marker and outperforms other indices when predicting T2DM in the normal-weight Chinese elderly population.

LEVEL OF EVIDENCE

Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Serum Fatty Acid-Binding Protein 4 Levels in Adolescents: Effect of Insulin Resistance

Background: Fatty acid-binding protein 4 (FABP4) is an adipokine that plays a causative role in obesity and diabetes. In a stratified cross-sectional study with adolescents, we explored whether changes in FABP4 are already present in lean adolescents, provided they display elements of insulin resistance (IR). Methods: Adolescents were divided in four groups according to body mass index and homeostasis model assessment-IR. Results: In metabolically unhealthy lean (MUL) adolescents (MUL, lean with IR), FABP4 was 33% higher than in healthy counterparts (metabolically healthy lean [MHL]). Obese adolescents without IR (metabolically healthy obesity [MHO]) had 50% higher levels of FABP4 than their lean counterparts (MHL), while levels of FABP4 in obese adolescents with IR (metabolically unhealthy obese [MUO]) were 220% higher than those of MUL adolescents. The differences were significant at least with P < 0.005. MUO > MHO > MUL. Our data demonstrate that the known FABP4 defect in adults with obesity also occurs in youth and even in lean adolescents, suggesting an early association between impaired glucose metabolism and FABP4 irrespective of body weight. FABP4 was more sensitive in discerning each of our 4 subgroups than either adiponectin or leptin. Moreover, evidence for a putative early adiponectin resistance in MUL suggests a combined defect in these adolescents that call for early detection and prevention of the metabolic disturbance that should stay away from concentrating only in subjects with obesity. Conclusions: Our data may serve to draw the considerable attention that is currently paid to FABP4 to the adolescent population, irrespective of the presence of obesity. Further studies with larger cohorts and analyses of visceral and liver fat are warranted.

Association of triglyceride-glucose index with clinical outcomes in patients with acute ischemic stroke receiving intravenous thrombolysis

Intravenous tissue plasminogen activator (tPA) remains the cornerstone of recanalization therapy for acute ischemic stroke (AIS), albeit with varying degrees of response. The triglyceride-glucose (TyG) index is a novel marker of insulin resistance, but association with outcomes among AIS patients who have received tPA has not been well elucidated. We studied 698 patients with AIS who received tPA from 2006 to 2018 in a comprehensive stroke centre. TyG index was calculated using the formula: ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. TyG index was significantly lower in patients that survived at 90-days than those who died (8.61 [Interquartile Range: 8.27–8.99] vs 8.76 [interquartile range: 8.39–9.40], p = 0.007). In multivariate analysis, TyG index was significantly associated with 90-day mortality (OR: 2.12, 95% CI: 1.39–3.23, p = 0.001), poor functional outcome (OR: 1.41 95% CI: 1.05–1.90, p = 0.022), and negatively associated with early neurological improvement (ENI) (OR: 0.68, 95% CI: 0.52–0.89, p = 0.004). There was no association between TyG index and symptomatic intracranial hemorrhage. ‘High TyG’ (defined by TyG index ≥ 9.15) was associated with mortality, poor functional outcomes and no ENI. In conclusion, the TyG index, a measure of insulin resistance, was significantly associated with poorer clinical outcomes in AIS patients who received tPA.

Metabolic Obesity in People with Normal Body Weight (MONW)-Review of Diagnostic Criteria

Disorders of metabolic obesity with normal body weight (MONW) are widely recognized risk factors for the development of cardiovascular diseases and type 2 diabetes. Despite this, MONW is not diagnosed in clinical practice. There is no consensus on the definition of MONW, and measuring the degree of insulin resistance or obesity among apparently healthy, non-obese patients is not widely applicable. The awareness of the relationship between metabolic disorders such as MONW and a higher risk of mortality from cardiovascular causes and other related diseases prompts the need for action to be taken aimed at creating appropriate diagnostic models that will allow for the effective detection of those with metabolic abnormalities among people with normal body weight. Such actions are decisive in the prevention and treatment of diseases. Therefore, the purpose of this article is to review the MONW diagnostic criteria used over the years.

Predictive ability of obesity- and lipid-related indicators for metabolic syndrome in relatively healthy Chinese adults

BACKGROUND AND OBJECTIVE

Metabolic syndrome (MetS) is an important risk factor for cardiovascular complications and kidney damage. Obesity- and lipid-related indices are closely related to MetS, and different indices have different predictive abilities for MetS. This study aimed to evaluate the predictive value of eight obesity- and lipid-related indicators, namely, body mass index (BMI), lipid accumulation product (LAP), body roundness index (BRI), Chinese visceral adiposity index (CVAI), body adiposity index (BAI), abdominal volume index (AVI), triglyceride glucose index (TYG), and visceral adiposity index (VAI), for MetS.

METHODS

A total of 1,452 relatively healthy people in Beijing were enrolled in 2016, and the correlation between the eight indicators and MetS was analyzed by multivariate logistic regression. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to analyze the predictive ability of the eight indicators for MetS. The Delong test was used to compare the AUC values of the eight indicators. MetS was defined according to the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 edition), the revised National Cholesterol Education Program Adult Treatment Group (NCEP-ATPIII), and the International Diabetes Federation (IDF).

RESULTS

Using these three sets of criteria, LAP, TYG, CVAI, and VAI, which are based on blood lipids, had higher AUC values for MetS prediction than BMI, BRI, AVI, and BAI, which are based on anthropometry. LAP had the highest AUC values of 0.893 (0.874-0.912), 0.886 (0.869-0.903), and 0.882 (0.864-0.899), separately, based on the three sets of criteria.

CONCLUSION

The eight obesity- and lipid-related indicators had screening value for MetS in relatively healthy people, and of the eight indicators, LAP performed the best.

Sex Differences in the TyG Index and Cardiovascular Risk Factors in Metabolically Obese Normal Weight Phenotype

BACKGROUND

The triglyceride glucose (TyG) index is a novel surrogate marker of insulin resistance and increases cardiovascular disease risk. We sought to explore sex differences in the relationship between TyG and cardiovascular (CV) risk factors in metabolically obese normal weight (MONW) phenotype.

METHOD

We analyzed data of 1208 healthy men and nonpregnant women enrolled in a population-based longitudinal study from January 2017-June 2020. MONW phenotype was defined by normal body mass index (BMI: 18-<25 kg/m²) with at least one of the following metabolic disorders (MONW phenotype): elevated blood pressure (BP), hypertriglyceridemia, hyperglycemia, and low HDL cholesterol. Multiple logistic regression analysis was performed to assess the association between elevated TyG index and the CV risk factors in women and men and was presented in odds ratio (OR) with 95% confidence interval (CI).

RESULTS

Of 1208 subjects, 350 (29%) were MONW phenotype (mean age (years): male: 43.5 ± 12.4 and female: 43.1 ± 12.7) and 858 were metabolically healthy normal weight (MHNW; n = 858 (71%)). MONW women had higher mean values of the TyG index (8.03 ± 5.07) than men (7.47 ± 4.68). Multivariate analysis revealed that the elevated TyG index is significantly associated with MONW phenotype in women (adjusted OR: 8.73, 95% CI: 5.62-13.57) and men (aOR: 5.90, 95% CI: 4.23-8.23). TyG was found to be an excellent predictor of MONW status in both women (receiver operating characteristic (ROC) area under the curve (AUC): 0.979, 95% CI: 0.969-0.988) and men (ROC-AUC: 0.968, 95% CI: 0.952-0.983).

CONCLUSION

Our study revealed that the TyG index may represent a cost-effective and informative screening tool for the high-risk MONW phenotype.

Skin microvascular reactivity and subendocardial viability ratio in relation to dyslipidemia and signs of insulin resistance in non-diabetic hypertensive patients

OBJECTIVE

The aim of this study was to evaluate the influence of dyslipidemia and insulin resistance for the development of microvascular dysfunction in non-diabetic primary hypertension.

METHODS

Seventy-one patients with untreated primary hypertension were included. Skin microvascular reactivity was evaluated by laser Doppler fluxmetry with iontophoresis (acetylcholine, ACh and sodium nitroprusside, SNP) and heat-induced hyperemia. Myocardial microvascular function was estimated by the subendocardial viability ratio (SEVR) calculated from pulse wave analysis and applanation tonometry. Triglyceride x glucose (TyG index) and triglyceride/HDL cholesterol ratio were used as measurements of insulin resistance.

RESULTS

Skin microvascular dysfunction was associated with low HDL cholesterol, where Ach-mediated peak flux (r = .27, p = .025) and heat-induced peak flux (r = .29, p = .017) related to HDL cholesterol levels. ACh peak flux was inversely related to TG/HDL ratio (r = -.29, p = .016), while responses to local heating and SNP did not. SEVR did not relate to HDL and was unrelated to markers of insulin resistance. These findings were confirmed by multivariable analyses, including potential confounders.

CONCLUSIONS

Early microvascular dysfunction can be detected in non-diabetic hypertensive patients and is related to dyslipidemia and to signs of insulin resistance, thus predicting future cardiovascular risk.

Association of Triglyceride-Glucose Index (TyG index) with HbA1c and Insulin Resistance in Type 2 Diabetes Mellitus

Background: The aim of this study was to assess the association of triglyceride-glucose (TyG) index with glycated haemoglobin (HbA1c) and insulin resistance in type 2 diabetes mellitus (T2DM). Methods:A total of 140 patients with T2DM were included in this cross-sectional study and divided into two groups according to their HbA1c levels: participants with HbA1c <7.0% (n=75) and those with HbA1c >7.0% (n=65) were defined as having a good glycemic control (group I) and a poor glycaemic control (group II) in T2DM. Anthropometric and biochemical parameters were measured, while the values of triglyceride (TG) to high density lipoprotein cholesterol (HDL-C) (TG/HDL-C) ratio and TyG index were calculated using formula. Results: Body mass index (BMI), fasting blood glucose (FBS), HbA1c and homeostatic model assessment for insulin resistance (HOMA-IR) were significantly higher in diabetic patients with poor glycemic control. TyG index was significantly correlated with HbA1c, HOMA-IR, TyG-BMI and TyG-WC. The receiver operating characteristic (ROC) analysis showed that TyG had a maximum area under the curve of 0.806, with a cut off value of 15.5 for identifying glycemic control in diabetic patients. Conclusion:TyG index is a useful tool for assessing glycemic control in T2DM patients and positively correlated with HbA1c and HOMA-IR. Hence, TyG can be used as a simple and inexpensive alternative to assess glycemic control in patients with diabetes.

Associations Between the Metabolic Score for Insulin Resistance Index and the Risk of Type 2 Diabetes Mellitus Among Non-Obese Adults: Insights from a Population-Based Cohort Study

Purpose

The metabolic score for insulin resistance (METS-IR) index is an emerging surrogate predictor of type 2 diabetes mellitus (T2DM). This study aimed to evaluate the association between the METS-IR index and the risk of T2DM in non-obese Japanese adults.

Methods

A total of 12,290 non-obese participants were selected from the NAGALA prospective cohort study conducted from 2004 to 2015. Cox proportional hazards models were used to assess the association between the baseline METS-IR index and risk of T2DM. Generalized additive models were used to identify nonlinear relationships. In addition, we performed subgroup analyses and interaction tests. Results were expressed as hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

During a median follow-up of 2050 days, 176 (1.43%) incident T2DM occurred. The fully adjusted HR (95% CI) for the incidence of T2DM in non-obese adults was 1.17 (HR=1.17, 95% CI: 1.09–1.27, P<0.001) for every 1-unit increase in the METS-IR index. The risk of developing T2DM increased with the quartile of change in the METS-IR index, after adjustment for multiple potential confounding, the HRs for the Q4 group versus the Q1 group was 4.01 (95% CI, 1.39–11.57). Generalized additive models also showed a cumulative increase in the risk of T2DM with increasing the METS-IR index. Time-dependent receiver operating curve suggested helpful discriminative power of the METS-IR index for T2DM. The C-statistics by the clinical risk factors significantly improve with the addition of the METS-IR index (from 0.862 to 0.875, P = 0.035); the discriminatory power and risk reclassification also appeared to be substantially better, with the category-free NRI of 0.216, and the IDI of 0.011.

Conclusion

The METS-IR index was a significant and independent predictor for future T2DM development in non-obese adults. The METS-IR index may have clinical significance in identifying groups at high risk of T2DM.

The Pancreatic ß-cell Response to Secretory Demands and Adaption to Stress

Pancreatic β cells dedicate much of their protein translation capacity to producing insulin to maintain glucose homeostasis. In response to increased secretory demand, β cells can compensate by increasing insulin production capability even in the face of protracted peripheral insulin resistance. The ability to amplify insulin secretion in response to hyperglycemia is a critical facet of β-cell function, and the exact mechanisms by which this occurs have been studied for decades. To adapt to the constant and fast-changing demands for insulin production, β cells use the unfolded protein response of the endoplasmic reticulum. Failure of these compensatory mechanisms contributes to both type 1 and 2 diabetes. Additionally, studies in which β cells are "rested" by reducing endogenous insulin demand have shown promise as a therapeutic strategy that could be applied more broadly. Here, we review recent findings in β cells pertaining to the metabolic amplifying pathway, the unfolded protein response, and potential advances in therapeutics based on β-cell rest.

Prognostic Value of Triglyceride and Glucose Index for Incident Type 2 Diabetes beyond Metabolic Health and Obesity

BACKGROUND

Metabolically healthy obese (MHO) phenotype is metabolically heterogeneous in terms of type 2 diabetes (T2D). Previously, the triglyceride and glucose (TyG) index has been considered for identifying metabolic health and future risk of T2D. This study aimed to evaluate the risk of incident T2D according to obesity status and metabolic health, categorized by four different criteria and the TyG index.

METHODS

The study included 39,418 Koreans without T2D at baseline. The risk of T2D was evaluated based on four different definitions of metabolic health and obesity status and according to the baseline TyG index within each metabolic health and obesity group.

RESULTS

During the median follow-up at 38.1 months, 726 individuals developed T2D. Compared with the metabolically healthy non-obese (MHNO) group with low TyG index, the MHO group with high TyG index showed increased risk of T2D in all four definitions of metabolic health with multivariate-adjusted hazard ratios of 2.57 (95% confidence interval [CI], 1.76 to 3.75), 3.72 (95% CI, 2.15 to 6.43), 4.13 (95% CI, 2.67 to 6.38), and 3.05 (95% CI, 2.24 to 4.15), when defined by Adult Treatment Panel III, Wildman, Karelis, and homeostasis model assessment (HOMA) criteria, respectively.

CONCLUSION

MHO subjects with high TyG index were at an increased risk of developing T2D compared with MHNO subjects, regardless of the definition of metabolic health. TyG index may serve as an additional factor for predicting the individual risk of incident T2D in MHO subjects.

CUN-BAE Index as a Screening Tool to Identify Increased Metabolic Risk in Apparently Healthy Normal-Weight Adults and Those with Obesity

BACKGROUND

Imbalanced dietary intake is related to increased adiposity, which is linked to increased metabolic risk even in the absence of obesity. BMI is traditionally used to classify body fatness and weight range, but it only considers body weight and height. The Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) equation has appeared as an additional tool to estimate adiposity considering also other relevant parameters, i.e., sex and age.

OBJECTIVES

We aimed to determine whether the CUN-BAE index could estimate adiposity-related metabolic risk in apparently healthy, normoglycemic adults.

METHODS

In this case-control study, men and women (18-45 y old) were classified as normal-weight (NW) [n = 20; BMI (in kg/m2) <25] or overweight-obese (OW-OB) (n = 34; BMI ≥25). The primary outcome was body fat content and clinical circulating parameters to assess by correlation analysis CUN-BAE's usefulness as a predictor of metabolic risk. In addition, transcriptomic biomarkers of lipid metabolism were analyzed in peripheral blood mononuclear cells (PBMCs) as secondary outcome indicators of metabolic impairment. Data were analyzed by correlation analysis and comparison of means.

RESULTS

CUN-BAE values correlated directly with body fatness obtained by DXA (r = 0.89, P < 0.01), with classical molecular biomarkers of metabolic risk, and with PBMC gene expression of carnitine palmitoyltransferase 1A (CPT1A), sterol regulatory element binding transcription factor 1c (SREBP-1c), and fatty acid synthase (FASN), early markers of metabolic impairment (P < 0.05). Moreover, CUN-BAE allowed identification of NW individuals with excessive body fatness, who were not yet presenting obesity-related molecular alterations. In these subjects, visceral fat correlated directly with circulating glucose, triglycerides, and total and LDL cholesterol, and with triglyceride-glucose and fatty liver indexes (P < 0.05). This is indicative of a metabolically obese NW phenotype.

CONCLUSIONS

Data obtained in our cohort of young normoglycemic volunteers support the use of the CUN-BAE index as a tool to estimate accurately body fat mass, but also as a first easy/effective screening tool to identify lean people with increased fat mass and increased metabolic risk.This trial was registered at clinicaltrials.gov as NCT04402697.

Co-administration of HAART and antikoch triggers cardiometabolic dysfunction through an oxidative stress-mediated pathway

Background

Antikoch and highly active anti-retroviral therapy are effective drugs in the management of tuberculosis and Human Immunodeficiency Virus, respectively. However, these cocktails have been independently associated with the aetiopathogenesis of metabolic syndrome. This study investigated whether or not the co-administration of antikoch and anti-retroviral, as seen in tuberculosis/Human Immunodeficiency Virus co-infection, will produce a similar effect. Also, it evaluated the role of glutathione and adenine deaminase/xanthine oxidase/uric acid signaling in antikoch/anti-retroviral-induced cardiometabolic dysfunction.

Methods

Male rats of Wistar strain were randomized into four groups: the control, which had 0.5 mL of distilled water as a vehicle, anti-Koch-treated rats that were administered a cocktail of anti-Koch, HAART-treated rats that had a combination of anti-retroviral drugs, and anti-Koch + HAART-treated rats that had treatments as anti-Koch-treated and HAART-treated rats. The treatment was once daily and lasted for eight weeks. One way-analysis of variance followed by Tukey’s posthoc test was used to test for significance and pairwise comparisons respectively.

Results

Although no changes in body weight gain and cardiac weight were noted, it was found that antikoch and/or HAART caused insulin resistance and elevated blood glucose level. In addition, antikoch and/or HAART led to dyslipidaemia, increased atherogenic indices, and elevated cardiac injury markers. These were accompanied by increased plasma and cardiac concentrations of malondialdehyde and nitric oxide, C-reactive protein, and myeloperoxidase activity, as well as suppressed activities of glutathione peroxidase and glutathione-S-transferase, and a fall in reduced glutathione level. The observed alterations were more pronounced in animals that received a combination of antikoch and HAART.

Conclusions

This study provides the first evidence that antikoch and/or HAART induce cardiometabolic dysfunction via glutathione suppression and up-regulation of adenine deaminase/xanthine oxidase/uric acid-dependent oxidative stress and inflammatory response. These events were associated with dyslipidaemia and increased atherogenic indices. This infers that regular monitoring of glucose level, insulin sensitivity, lipid profile, and oxido-inflammatory markers is important in patients on antikoch and/or HAART for prompt diagnosis and management of cardiometabolic disorder if it ensues.

The Effects of 8 Weeks of Levothyroxine Replacement Treatment on Metabolic and Anthropometric Indices of Insulin Resistance in Hypothyroid Patients

BACKGROUND

Insulin resistance (IR) is an independent cardiovascular risk factor. IR predisposes to metabolic syndrome and diabetes. Meanwhile, little evidence exists about the effect of levothyroxine replacement treatment (LRT) on IR in hypothyroid patients.

OBJECTIVE

To investigate metabolic and anthropometric indices of IR in hypothyroid patients before and after 8 weeks of LRT.

METHODS

This pre-post study evaluated the 8 weeks outcomes of LRT on 66 patients with recently diagnosed hypothyroidism. Outcome measures included body mass index (BMI), waist circumferences (WC), waist to hip ratio (WHR), waist to height ratio (WHtR), body fat percent (BF%), free thyroxin (FT4), triglyceride (TG), low density lipoprotein (LDL), fasting plasma levels of glucose (FPG) and insulin. Sex- specific cut offs of two metabolic indices i.e. the triglyceride-glucose (TyG) and the homeostasis model assessment (HOMA) were used for IR diagnosis. The changes in TyG and HOMA were also compared after LRT.

RESULTS

Participants were overt and subclinical hypothyroidism 71% and 29%, respectively. After LRT the mean values of the following anthropometric indices significantly decreased: weight (79.61 vs. 78.64), BMI (29.53 vs. 29.2), WC (98.25 vs. 97.39) and BF% (35.34 vs. 34.95). After LRT the HOMA and TyG had no significant changes relative to their initial values. Also, IR that was determined on the basis of these metabolic indices more commonly observed in participants.

CONCLUSION

Despite decreasing some anthropometric indices, the diagnosis of IR based on metabolic indices increased following 8 weeks LRT in hypothyroid cases.

Maternal Lipid Profile as a Risk Factor for Gestational Diabetes Mellitus in Obese Women

As dyslipidemia is frequently associated with gestational diabetes mellitus, the aim of this study was to establish a correlation between the evolution of the maternal lipid profile evaluated in the first and third pregnancy trimester for a series of parameters: triglycerides, cholesterol, high-density lipoprotein cholesterol (HDL-C), blood sugar fasting (BSF), triglyceride-glucose index (TyG index), TG/HDL-C ratio, leptin and the risk of gestational diabetes mellitus occurrence. The results were statistically interpreted, establishing the mean value of the obtained results and the standard deviation. From the studied parameters, only HDL-C and Tyg were statistically significant different in the  first trimester for the two study groups, while in the third trimester statistically significant differences were observed also for triglycerides, blood sugar fasting and the TG/HDL-C ratio.

Metabolically healthy obesity and metabolically obese normal weight: a review

Despite the general relationship between obesity and its co-morbidities, there are both obese individuals who scarcely present the associated pathologies (metabolically healthy obese; MHO) and individuals who present obesity alterations despite having normal weight (metabolically obese normal weight; MONW). It is still difficult to define metabolically MHO and MONW individuals because different classifications have been used in the studies reported. Indeed, different inclusion criteria have been used to discriminate between metabolically healthy and metabolically unhealthy subjects. Due to this and other reasons, such as differences in ethnicity, genetics, and lifestyle of the populations, data concerning the prevalence of MHO and MONW are very variable. The main determinants of MHO are type of growth (hypertrophy or hyperplasia), anatomical location, inflammation of adipose tissue, ectopic fat accumulation, genetic factors, and lifestyles factors. In the case of MONW, the main determinants are genetic background and lifestyle factors. With regard to treatment, it is not clear whether MHO subjects would benefit from traditional lifestyle interventions, based on diet energy restriction and increased physical activity. For MONW subjects, there is still no specialized treatment, and the therapies are the same as those used in obese subjects.

Low Dietary Magnesium and Overweight/Obesity in a Mediterranean Population: A Detrimental Synergy for the Development of Hypertension. The SUN Project

Hypertension is the strongest independent modifiable risk factor for cardiovascular disease. We aimed to investigate the association of magnesium intake with incident hypertension in a Mediterranean population, and the potential modification of this association by body mass index BMI. We assessed 14,057 participants of the SUN (Seguimiento Universidad de Navarra) prospective cohort (67.0% women) initially free of hypertension. At baseline, a validated 136-item food frequency questionnaire was administered. We used Cox models adjusted for multiple socio-demographic, anthropometric, and lifestyle factors, and prevalent conditions present at baseline. Among a mean 9.6 years of follow-up we observed 1406 incident cases of medically diagnosed hypertension. An inverse association in multivariable-adjusted models was observed for progressively higher magnesium intake up to 500 mg/d vs. intake < 200 mg/d, which was greater among those with a BMI > 27 kg/m². Lean participants with magnesium intake < 200 mg/d vs. >200 mg/d also had a higher risk of incident hypertension. Adherence to the Mediterranean diet did not modify these associations. In conclusion, dietary magnesium intake < 200 mg/d was independently associated with a higher risk of developing hypertension in a Mediterranean cohort, stronger for overweight/obese participants. Our results emphasize the importance of encouraging the consumption of magnesium-rich foods (vegetables, nuts, whole cereals, legumes) in order to prevent hypertension.

Triglyceride-Glucose Index and Related Parameters Predicted Metabolic Syndrome in Nigerians

Background: Triglyceride-glucose (TyG) index, a product of triglyceride and fasting plasma glucose, is a novel tool that can identify people with metabolic syndrome (MS). It is unknown if TyG index can identify MS among Nigerians.

Methods: Cross-sectional health screening conducted between August and December 2018, among staff and students of Ekiti State University/Ekiti State University Teaching Hospital, Nigeria, Ado-Ekiti. The analysis included 473 participants, aged ≥18 years. Anthropometric indices and blood pressure were measured by standard protocol. Fasting lipid profile and blood glucose were determined. TyG index and product of TyG and anthropometric indices were calculated, and MS defined according to the harmonized criteria. The diagnostic ability of TyG index and related parameters to identify people with MS was determined with the area under curve (AUC) of receiver operating characteristic curves. Stepwise logistic regression analyses were used to generate odd ratios (ORs) for prediction of MS.

Results: The mean age of the participants was 39.2 (11.4) years and there were 173 (36.6%) men. In all participants, TyG-waist to height ratio (TyG-WHtR) shows the largest AUC for MS detection (0.863, 95% confidence interval, CI: 0.828–0.892) followed by TyG-waist circumference (TyG-WC) (0.858, 95% CI: 0.823–0.888), TyG-body mass index (TyG-BMI) (0.838, 95% CI: 0.802–0.870), TyG index (0.796, 95% CI: 0.757–0.831), WHtR (0.791, 95% CI: 0.752–0.827), and TyG-waist-to-hip ratio (TyG-WHpR) (0.771, 95% CI: 0.730–0.808) in that order. Gender analysis revealed that TyG-WC and TyG-WHtR have largest AUC in both genders. Before and after adjustment, TyG-WHtR (OR: 6.86, 95% CI: 3.94–11.93) and TyG index (OR: 5.91, 95% CI: 3.01–11.59) presented the highest OR in all participants, respectively.

Conclusions: TyG index is effective in identifying MS in this cross-sectional study, and the product of TyG index and anthropometric indices improved identification and prediction of MS.

Codeine exerts cardiorenal injury via upregulation of adenine deaminase/xanthine oxidase and caspase 3 signaling

AIMS

Codeine treatment has been shown to be associated with glucolipid deregulation, though data reporting this are inconsistent and the mechanisms are not well understood. Perturbation of glutathione-dependent antioxidant defense and adenosine deaminase (ADA)/xanthine oxidase (XO) signaling has been implicated in the pathogenesis of cardiometabolic disorders. We thus, hypothesized that depletion of glutathione contents and upregulation of ADA/XO are involved in codeine-induced glucolipid deregulation. The present study also investigated whether or not codeine administration would induce genotoxicity and apoptosis in cardiac and renal tissues.

MATERIALS AND METHODS

Male New Zealand rabbits received per os distilled water or codeine, either in low dose (4 mg/kg) or high dose (10 mg/kg) for 6 weeks.

KEY FINDINGS

Codeine treatment led to reduced absolute and relative cardiac and renal mass independent of body weight change, increased blood glucose, total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL-C), as well as increased atherogenic indices and triglyceride-glucose index (TyG). Codeine administration significantly increased markers of cardiac and renal injury, as well as impaired cardiorenal functions. Codeine treatment also resulted in increased cardiac and renal malondialdehyde, Advanced Glycation Endproducts (AGE) and 8-hydroxydeoxyguanosine (8-OH-dG), and myeloperoxidase (MPO), ADA, XO, and caspase 3 activities. These observations were accompanied by impaired activities of cardiac and renal proton pumps.

SIGNIFICANCE

Findings of this study demonstrate that upregulation of ADA/XO and caspase 3 signaling are, at least partly, contributory to the glucolipid deregulation and cardiorenal injury induced by codeine.

Sodium acetate prevents nicotine-induced cardiorenal dysmetabolism through uric acid/creatine kinase-dependent pathway

BACKGROUND

Cigarette smoking or nicotine replacement therapy has been associated with cardiometabolic disorders (CMD). Hyperuricemia has been implicated in the pathogenesis of CMD and cardiorenal dysfunction. Gut microbiota-derived short chain fatty acids (SCFAs) have been reported to have beneficial glucoregulatory and cardiorenal protective effects. This study aimed at investigating the effect of acetate, a gut-derived SCFA, on nicotine-induced CMD and associated cardiorenal dysmetabolism.

MATERIALS AND METHOD

Twenty-four male Wistar rats (n = 6/group) were grouped as: vehicle (p.o.), nicotine-exposed (1.0 mg/kg; p.o.), and sodium acetate-treated (200 mg/kg; p.o.) with or without nicotine exposure daily for 6 weeks. Glucose regulation was evaluated by oral glucose tolerance test and homeostatic model assessment of insulin resistance. Cardiac and renal triacylglycerol (TG), lactate, nitric oxide (NO), uric acid (UA) levels, lactate dehydrogenase (LDH), creatine kinase (CK), adenosine deaminase (ADA), and xanthine oxidase (XO) activities were measured.

RESULTS

The CMD were confirmed in the nicotine-exposed rats that exhibited lower body weight, insulin resistance, endothelial dysfunction, glucose intolerance, increased cardiac and renal TG, TG/HDL-cholesterol, UA, lactate, lipid peroxidation, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, LDH, CK, ADA and XO activities. Concurrent treatment with acetate prevented nicotine-induced glucometabolic and cardiorenal alterations.

CONCLUSION

In summary, these results implied that nicotine exposure caused glucometabolic dysregulation and surplus lipid deposit in the heart and kidney through increased UA production and CK activity. Therefore, oral acetate administration prevents cardiorenal lipotoxicity and glucometabolic dysregulation via suppression of UA production and CK activity in nicotine-exposed rats.

From obesity through gut microbiota to cardiovascular diseases: a dangerous journey

The co-existence of humans and gut microbiota started millions of years ago. Until now, a balance gradually developed between gut bacteria and their hosts. It is now recognized that gut microbiota are key to form adequate immune and metabolic functions and, more in general, for the maintenance of good health. Gut microbiota are established before birth under the influence of maternal nutrition and metabolic status, which can impact the future metabolic risk of the offspring in terms of obesity, diabetes, and cardiometabolic disorders during the lifespan. Obesity and diabetes are prone to disrupt the gut microbiota and alter the gut barrier permeability, leading to metabolic endotoxaemia with its detrimental consequences on health. Specific bacterial sequences are now viewed as peculiar signatures of the metabolic syndrome across life stages in each individual, and are linked to pathogenesis of cardiovascular diseases (CVDs) via metabolic products (metabolites) and immune modulation. These mechanisms have been linked, in association with abnormalities in microbial richness and diversity, to an increased risk of developing arterial hypertension, systemic inflammation, nonalcoholic fatty liver disease, coronary artery disease, chronic kidney disease, and heart failure. Emerging strategies for the manipulation of intestinal microbiota represent a promising therapeutic option for the prevention and treatment of CVD especially in individuals prone to CV events.

The triglycerides and glucose index is associated with cardiovascular risk factors in metabolically obese normal-weight subjects

PURPOSE

The aim of this study was to determine whether the triglycerides and glucose (TyG) index is associated with the presence of metabolically obese normal-weight (MONW) phenotype and related cardiovascular risk factors.

METHODS

Apparently healthy men and non-pregnant women aged 20-65 years were enrolled in a population-based cross-sectional study. Overweight, obesity, smoking, alcohol consumption, pregnancy, diagnosis of hypertension, diabetes, cardiovascular disease, liver disease, renal disease, malignancy, and medical treatment were exclusion criteria. Subjects were allocated into the MONW or normal-weight groups. MONW phenotype was defined by normal weight and the presence of at least one of the following cardiovascular risk factors: elevated blood pressure, hyperglycemia, hypertriglyceridemia, and low HDL cholesterol.

RESULTS

A total of 542 subjects were enrolled and allocated into the MONW (n = 354) and normal-weight (n = 188) groups. The adjusted logistic regression analysis showed that the elevated TyG index is significantly associated with the presence of MONW phenotype (OR = 11.14; 95% CI 6.04-20.57), hyperglycemia (OR = 3.18; 95% CI 1.95-5.21), hypertriglyceridemia (OR = 399.19; 95% CI 94.01-1694.98), and low HDL-C (OR = 2.60; 95% CI 1.74-3.87), but not with elevated blood pressure (OR = 1.55; 95% CI 0.93-2.60).

CONCLUSION

Results of this study support that the TyG index may be a useful indicator to detect MONW phenotype and associated cardiovascular risk factors.

TAG-glucose (TyG) index in childhood: an estimate of cut-off points and the relation to cardiometabolic risk in 4- to 9-year-old children

OBJECTIVE

To propose cut-off points for the TAG-glucose (TyG) index in Brazilian children and evaluate the link to cardiometabolic risk.

DESIGN

A cross-sectional study with children from a municipality in Minas Gerais, Brazil. Anthropometric (weight, height, waist circumference and waist:height ratio), biochemical (lipid and glucose profile) and blood pressure (BP) tests were performed. Using the receiver operating characteristic curve, cut-off points for the TyG index were proposed according to sex using homoeostasis model of assessment - insulin resistance (IR) as the reference method.

SETTING

Viçosa, MG, Brazil.

PARTICIPANTS

Children aged 4-9 years (n 515).

RESULTS

The TyG index cut-off points to identify the risk of IR were 7·9 and 8·1 for boys and girls, respectively. We observed that 48·7 % of the children had an increased TyG index. The increased TyG index was associated with overweight, total body and central fat, increased BP and altered lipid profile. Children with an increased TyG index had a higher accumulation of cardiometabolic risk factors.

CONCLUSIONS

According to the cut-off points proposed by the current study, children at risk of IR estimated by the TyG index presented a higher cardiometabolic risk, including isolated risk factors, as to the higher accumulation of these.

Estrogen-progestin oral contraceptive and nicotine exposure synergistically confers cardio-renoprotection in female Wistar rats

Approximately fifty percent of premenopausal women who smoke cigarettes or on nicotine replacement therapy are also on hormonal contraceptives, especially oral estrogen-progestin. Oral estrogen-progestin therapy has been reported to promote insulin resistance (IR) which causes lipid influx into non-adipose tissue and impairs Na⁺/K⁺ -ATPase activity, especially in the heart and kidney. However, the effects of nicotine on excess lipid and altered Na⁺/K⁺ -ATPase activity associated with the use of estrogen-progestin therapy have not been fully elucidated. This study therefore aimed at investigating the effect of nicotine on cardiac and renal lipid influx and Na⁺/K⁺ -ATPase activity during estrogen-progestin therapy. Twenty-four female Wistar rats grouped into 4 (n = 6/group) received (p.o.) vehicle, nicotine (1.0 mg/kg) with or without estrogen-progestin steroids (1.0 μg ethinyl estradiol and 5.0 μg levonorgestrel) and estrogen-progestin only daily for 6 weeks. Data showed that estrogen-progestin treatment or nicotine exposure caused IR, hyperinsulinemia, increased cardiac and renal uric acid, malondialdehyde, triglyceride, glycogen synthase kinase-3, plasminogen activator inhibitor-1, reduced bilirubin and circulating estradiol. Estrogen-progestin treatment led to decreased cardiac Na⁺/K⁺-ATPase activity while nicotine did not alter Na⁺/K⁺-ATPase activity but increased plasma and tissue cotinine. Renal Na⁺/K⁺-ATPase activity was not altered by the treatments. However, all these alterations were reversed following combined administration of oral estrogen-progestin therapy and nicotine. The present study therefore demonstrates that oral estrogen-progestin therapy and nicotine exposure synergistically prevents IR-linked cardio-renotoxicity with corresponding improvement in cardiac and renal lipid accumulation, oxidative stress, inflammation and Na⁺/K⁺-ATPase activity.

Metabolic Health, Obesity, and the Risk of Developing Open-Angle Glaucoma: Metabolically Healthy Obese Patients versus Metabolically Unhealthy but Normal Weight Patients

BACKGROUND

This study sought to investigate the associations between metabolic health status, obesity, and incidence of primary open-angle glaucoma (POAG).

METHODS

In this nationwide, population-based, longitudinal prospective cohort study conducted using the Korean National Health Insurance System, we categorized all subjects based on presence and severity of metabolic syndrome and obesity. Insurance claims data were used to identify POAG development. Then, Cox regression was applied to calculate the hazard of developing POAG in people with various components of metabolic syndrome, obesity, or their combination.

RESULTS

Of the total 287,553 subjects, 4,970 (1.3%) developed POAG. High fasting glucose, blood pressure, and total cholesterol levels were all associated with increased risk of developing POAG. Regarding obesity level, people with body mass index (BMI) greater than 30 kg/m² were more likely to develop POAG than those with normal BMI. Also, people with greater number of metabolic syndrome components showed a greater POAG incidence. People who are metabolically unhealthy and obese (adjusted hazard ratio [HR], 1.574; 95% confidence interval [CI], 1.449 to 1.711) and those who are metabolically unhealthy nonobese (MUNO: adjusted HR, 1.521; 95% CI, 1.405 to 1.645) but not those who are metabolically healthy obese (MHO: adjusted HR, 1.019; 95% CI, 0.907 to 1.144) had an increased hazard of developing POAG compared with metabolically healthy nonobese (MHNO) subjects.

CONCLUSION

Metabolic health status and obesity were significantly associated with increased risk of POAG incidence. MUNO subjects but not MHO subjects showed a higher risk of POAG development than did MHNO subjects, suggesting that metabolic status is more important than obesity in POAG.

l-glutamine supplementation exerts cardio-renal protection in estrogen-progestin oral contraceptive-treated female rats

Glycogen and lipid disruptions represent a spectrum of metabolic disorders that are crucial risk factors for cardiovascular disease in estrogen-progestin oral contraceptive (COC) users. l-glutamine (GLN) has been shown to exert a modulatory effect in metabolic disorders-related syndromes. We therefore hypothesized that GLN supplementation would protect against myocardial and renal glycogen-lipid mishandling in COC-treated animals by modulation of Glucose-6-phosphate dehydrogenase (G6PD) and xanthine oxidase (XO) activities. Adult female Wistar rats were randomly allotted into control, GLN, COC and COC + GLN groups (six rats per group). The groups received vehicle (distilled water, p.o.), GLN (1 g/kg), COC containing 1.0 μg ethinylestradiol plus 5.0 μg levonorgestrel and COC plus GLN respectively, daily for 8 weeks. Data showed that treatment with COC led to metabolically-induced obesity with correspondent increased visceral and epicardial fat mass. It also led to increased plasma, myocardial and renal triglyceride, free fatty acid, malondialdehyde (MDA), XO activity, uric acid content and decreased glutathione content and G6PD activity. In addition, COC increased myocardial but not renal glycogen content, and increased myocardial and renal glycogen synthase activity, increased plasma and renal lactate production and plasma aspartate transaminase/alanine aminotransferase (AST/ALT) ratio. However, these alterations were attenuated when supplemented with GLN except plasma AST/ALT ratio. Collectively, the present results indicate that estrogen-progestin oral contraceptive causes metabolically-induced obesity that is accompanied by differential myocardial and renal metabolic disturbances. The findings also suggest that irrespective of varying metabolic phenotypes, GLN exerts protection against cardio-renal dysmetabolism by modulation of XO and G6PD activities.

Metabolically Healthy Obesity-Heterogeneity in Definitions and Unconventional Factors

The concept of heterogeneity among obese individuals in their risk for developing metabolic dysfunction and associated complications has been recognized for decades. At the origin of the heterogeneity idea is the acknowledgement that individuals with central obesity are more prone to developing type 2 diabetes and cardiovascular disease than those with peripheral obesity. There have been attempts to categorize subjects according to their metabolic health and degree of obesity giving rise to different obese and non-obese phenotypes that include metabolically unhealthy normal-weight (MUHNW), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Individuals belonging to the MHO phenotype are obese according to their body mass index although exhibiting fewer or none metabolic anomalies such as type 2 diabetes, dyslipidemia, hypertension, and/or unfavorable inflammatory and fribinolytic profiles. However, some authors claim that MHO is only transient in nature. Additionally, the phenotype categorization is controversial as it lacks standardized definitions possibly blurring the distinction between obesity phenotypes and confounding the associations with health outcomes. To add to the discussion, the factors underlying the origin or protection from metabolic deterioration and cardiometabolic risk for these subclasses are being intensely investigated and several hypotheses have been put forward. In the present review, we compare the different definitions of obesity phenotypes and present several possible factors underlying them (adipose tissue distribution and cellularity, contaminant accumulation on the adipose tissue, dysbiosis and metabolic endotoxemia imposing on to the endocannabinoid tone and inflammasome, and nutrient intake and dietary patterns) having inflammatory activation at the center.

Association of Alanine Aminotransferase With Different Metabolic Phenotypes of Obesity in Children and Adolescents: The CASPIAN-V Study

Aim: To determine the association of alanine aminotransferase with different metabolic phenotypes of obesity in a nationally- representative sample of Iranian children and adolescents. Methods: This national study was conducted in the framework of the fifth survey of a national surveillance program entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease study. Participants consisted of 4,200 subjects aged 7-18 years, who were recruited by multistage random cluster sampling from 30 provinces in Iran. They were categorized to normal weight and obese groups and in each group those with and without MetS components. Results: Overall, 3,843 of participants completed the survey (response rate: 91.5%). Their mean (SD) age was 12.58 (3.15) years; 52.6% were boys, and 72.7% lived in urban areas. Mean of alanine aminotransferase (ALT) in subjects with abdominal obesity and general obesity was 8.81 (95% CI: 7.99-9.62) (IU/L) and 8.87 (95% CI: 7.28-10.46) (IU/L), respectively. According to the adjusted model, one unit increment in ALT increased odds of being metabolically non-healthy obese (MNHO) by 2% compared to metabolically healthy non-obese (MHNO) [adj.OR (95% CI): 1.02 (1.01-1.04)]. Also, subjects in the third and fourth quartiles of serum ALT had significantly greater odds of being MNHO than those in its first quartile [Q3/Q1: adj. OR (95% CI): 3.85 (1.70-8.71); Q4/Q1: Adj. OR (95% CI): 3.63 (1.51-8.73)]. Conclusion: This large population-based study revealed significant associations between metabolic phenotypes of obesity and ALT level.

Impact of body mass index and metabolically unhealthy status on mortality in the Japanese general population: The JMS cohort study

This study aimed to investigate the associations of body mass index (BMI) and metabolically unhealthy weight with all-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality as well as the effect of age on the associations. This prospective study enrolled Japanese individuals in the general population. Participants were divided into eight phenotypes according to the BMI classification and metabolic status. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a Cox regression hazard model. In total, 10,824 individuals with a mean age of 55.3 years were evaluated. During a mean follow-up of 18.4 years (198,776 person-years), 2,274 participants died. Among the metabolically unhealthy, the association between BMI and mortality was J-shaped after adjustment for various confounders (multivariable HR [95% CI] for all-cause mortality: underweight, 2.0 [1.5-2.7]; obesity 2.8 [2.1-3.6]). The association remained the same in metabolically unhealthy participants aged <65 years and ≥65 years. The results were compatible in the analyses restricted to subjects who never smoked. Regardless of age, metabolically unhealthy underweight (MUHU) have approximately a 3-fold higher risk of CVD mortality, compared with metabolically healthy normal weight. Not only metabolically unhealthy obesity, but also MUHU was strongly associated with an increased risk of mortality. More attention should be given to the health issues of metabolically unhealthy participants without obesity, particularly those with MUHU.

Metabolic Unhealthiness Increases the Likelihood of Having Metabolic Syndrome Components in Normoweight Young Adults

Findings on risk detection for having metabolic syndrome (MetS) components, each of which may individually increase the risk of disease and mortality, are limited in young adults. In this study, we aimed to calculate the likelihood of having ≥1 MetS component in normoweight young adults using two different metabolic health criteria. We recruited 1182 normoweight young adults from the Taiwan Survey on the Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia and the National Health Interview Survey (aged 16–45 years, 39% male, body mass index = 18.5–22.99, all without MetS) and followed them for 5 years. Metabolic health criteria were derived from the Harmonized criteria (unhealthy if showing abnormality in one or two MetS components) and the triglyceride-glucose index (TyG-i; unhealthy if TyG-i was in the >75th percentile). Odds ratio (OR) and 95% confidence interval (CI) estimations for having ≥1 MetS component and for having each MetS component in 5 years were assessed using multivariable-adjusted logistic regression. We observed a significantly increased likelihood of the presence of ≥1 MetS component in the unhealthy group by using the Harmonized criteria and TyG-i (adjusted OR (aOR); 95%CI: 2.64; 2.02–3.45 and 2.1; 1.57–2.82, respectively). The areas under the receiver-operating characteristics curves were 0.679 and 0.652 for the final models using Harmonized and TyG-i criteria, respectively. These findings support the recommendation of treating any metabolic component abnormality, even in young adults without a MetS diagnosis.

Metabolic phenotypes of obese, overweight, and normal weight individuals and risk of chronic kidney disease: a systematic review and meta-analysis

OBJECTIVE

Chronic kidney disease (CKD) risk is inconsistent in the normal-weight, overweight, and obese individuals due to the heterogeneity of metabolic status. This meta-analysis aimed to examine the combined effects of body mass index (BMI) and metabolic status on CKD risk.

MATERIALS AND METHODS

The MEDLINE, EMBASE, and Web of Knowledge databases were systematically searched up to March 2019 to identify all eligible studies investigating the CKD risk (defined as GFR < 60 mL/min per 1.73 m2 and/or microalbuminuria or proteinuria) associated with the body size phenotypes which are known as metabolically unhealthy normal-weight (MUNW), metabolically healthy overweight (MHOW), metabolically unhealthy overweight, metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO). The classification of subjects in included studies as metabolically unhealthy was based on the presence of three components of metabolic syndrome. BMI categorization was based on the criteria of included studies. The risk estimates and 95% confidence intervals (CIs) were extracted and pooled using random effects analysis.

RESULTS

A total of 9 prospective cohort studies with 128773 participants and 4797 incident cases were included in the meta-analysis. Compared with healthy normal-weight individuals as reference, MUNW and MHO subjects showed an increased risk for CKD events with a pooled RR of 1.58 (95% CI = 1.28-1.96) in MUNW and 1.55 (95% CI = 1.34-1.79) in MHO persons. Also, MHOW was at increased risk for CKD (RR = 1.34, 95% CI = 1.20-1.51). MUHO individuals were at the highest risk for the development of CKD (RR = 2.13, 95% CI = 1.66-2.72).

CONCLUSIONS

Individuals with metabolic abnormality, although at normal-weight, have an increased risk for CKD. Healthy overweight and obese individuals had higher risk; refuting the notion that metabolically healthy overweight and obese phenotypes are benign conditions.

Fasting triglycerides and glucose index is more suitable for the identification of metabolically unhealthy individuals in the Chinese adult population: A nationwide study

AIMS/INTRODUCTION

Metabolic unhealth can be defined by the components of metabolic syndrome, which is closely connected to insulin resistance. We aimed to determine a simple index to identify metabolic unhealth in the Chinese adult population.

MATERIALS AND METHODS

A total of 30,291 individuals were screened from the China National Diabetes and Metabolic Disorders Study carried out from June 2007 to May 2008. Metabolic unhealth was defined using components of metabolic syndrome, except waist circumference. We compared the three surrogate indices of insulin resistance: the product of fasting triglycerides and glucose (TyG), triglycerides divided by high-density lipoprotein cholesterol and the metabolic score for insulin resistance for the evaluation of metabolic status.

RESULTS

All indices had high sensitivity and specificity for the identification of metabolic unhealth, especially the TyG index with an area under the curve of 0.863 for men and 0.867 for women. Participants were divided into subgroups for further analysis. The TyG index also showed high diagnostic values, especially for younger individuals and men with normal waist circumference. Sex-specific cut-offs for three indices were also used to define metabolic unhealth. The TyG index showed the highest agreement with κ values of 0.603 and 0.605 for men and women between the components of metabolic syndrome and three indices.

CONCLUSIONS

We propose that the TyG index, just read in one blood laboratory test report, is simpler and more suitable for the identification of metabolically unhealthy individuals as well as who have high risk of cardiometabolic diseases of the Chinese adult population.

Why primary obesity is a disease?

Obesity must be considered a real pathology. In the world wide, obesity represent one of the major public health issue associated with increased morbidity and mortality. Overweight or obesity, in fact, significantly increases the risk of contracting diseases, such as: arterial hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, cerebral vasculopathy, gallbladder lithiasis, arthropathy, ovarian polycytosis, sleep apnea syndrome, and some neoplasms. Despite numerous informative campaigns, unfortunately, the fight against obesity does not seem to work: in the last years, the prevalence continued to increase. The progressive and rapid increase in the incidence of obesity, which has characterized most of the economically advanced countries in the last decade, has been the main stimulus for the research of the mechanisms underlying this pathology and the related disorders. The aims of this review is to provide a revision of the literature in order to define obesity as diseases, secondly to highlight the limits and the inaccuracy of common tools used for the diagnosis of obesity, and as a third thing to strengthen the concept of the complexity of obesity as a disease among political health care providers. Obesity may be viewed as a multifactorial pathology and chronic low-grade inflammatory disease. In fact, people affected by obesity have greater risk of developing comorbility and morbility, respect to healthy. Hence, the absolute therapeutic benefit is directly proportional to the basic risk. So, internationally interest on early diagnosis of obesity is growing to avoid under- and overdiagnosis consequences. Therefore, the consequences are an aggravation of the disease and an increase in obesity related pathology like diabetes, cardiovascular disease, and cancer. The most widely used parameter for diagnosis, body mass index (BMI) is not suitable for assessing the body fat. In fact, several studies demonstrate that BMI alone cannot define obesity, which consists not so much in weight gain as in excess fat mass. The use of suitable tools for the assessment of fat mass percentage combined with clinical and genetic analysis allowed to identify different phenotypes of obesity, which explain the various paradoxes of obesity. It is essential to adopt all possible strategies to be able to combat obesity, ameliorate the suffering of patients, and reduce the social and treatment costs of obesity.

Adipose Tissue Dysfunction as Determinant of Obesity-Associated Metabolic Complications

Obesity is a critical risk factor for the development of type 2 diabetes (T2D), and its prevalence is rising worldwide. White adipose tissue (WAT) has a crucial role in regulating systemic energy homeostasis. Adipose tissue expands by a combination of an increase in adipocyte size (hypertrophy) and number (hyperplasia). The recruitment and differentiation of adipose precursor cells in the subcutaneous adipose tissue (SAT), rather than merely inflating the cells, would be protective from the obesity-associated metabolic complications. In metabolically unhealthy obesity, the storage capacity of SAT, the largest WAT depot, is limited, and further caloric overload leads to the fat accumulation in ectopic tissues (e.g., liver, skeletal muscle, and heart) and in the visceral adipose depots, an event commonly defined as “lipotoxicity.” Excessive ectopic lipid accumulation leads to local inflammation and insulin resistance (IR). Indeed, overnutrition triggers uncontrolled inflammatory responses in WAT, leading to chronic low-grade inflammation, therefore fostering the progression of IR. This review summarizes the current knowledge on WAT dysfunction in obesity and its associated metabolic abnormalities, such as IR. A better understanding of the mechanisms regulating adipose tissue expansion in obesity is required for the development of future therapeutic approaches in obesity-associated metabolic complications.

Impaired Glucose Metabolism in Bipolar Patients: The Role of Psychiatrists in Its Detection and Management

Bipolar patients have a higher risk of type 2 diabetes and obesity, which are associated with cardiovascular diseases as the leading cause of death in this group. Additionally, there is growing evidence that impaired glucose metabolism in bipolar patients is associated with rapid cycling, poor response to mood stabilizers and chronic course of illness. The aim of the study was to assess the prevalence of type 2 diabetes and other types of impaired glucose metabolism in bipolar patients along with an evaluation of the Fasting Triglycerides and Glucose Index (TyG) as a method of the insulin sensitivity assessment. The analysis of fasting glycemia, insulinemia and lipid profile in euthymic bipolar patients was performed, and the Homeostasis model assessment for insulin resistance (HOMA-IR) and TyG were computed. Type 2 diabetes was observed in 9% and insulin resistance with HOMA-IR in 48% of patients. The TyG and HOMA-IR indices were correlated (p < 0.0001), the TyG index value of 4.7 had the highest sensitivity and specificity for insulin resistance detection. The usefulness of TyG in the recognition of insulin resistance in bipolar patients was suggested. The significant role of psychiatrists in the detection and management of impaired glucose metabolism in bipolar patients was presented.