Abstract
The triglyceride glucose (TyG) index, a product of triglyceride and fasting glucose, is a reliable marker for insulin resistance (IR). Obesity is also known to be closely related with IR. Recently, the efficiency of TyG-related markers that combine obesity markers with TyG index has been studied; however, earlier studies were limited in number and the results were inconsistent. Therefore, in this study, we investigated the efficiency of several combinations of TyG index and obesity indices, namely, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), in reflecting IR. Data were obtained from the Korean National Health and Nutrition Examination Survey from 2007–2010. A total of 11,149 subjects (4,777 men and 6,372 women) were included. IR was defined as the homeostasis model assessment for IR (HOMA-IR) of above the 75th percentile for each gender. Logistic regression analysis was performed after adjusting for confounding factors, to compare and identify the associations of the 4 parameters (TyG index, TyG-BMI, TyG-WC, and TyG-WHtR) with IR. For each parameter, odds ratios (OR) and 95% confidence intervals (CIs) of quartiles 2–4 were calculated and compared with quartile 1 as a reference. A receiver operating characteristic (ROC) curve analysis was conducted to evaluate the ability of each parameter to predict IR. The adjusted ORs of quartile 4 in comparison with quartile 1 (95% CIs) for IR were 7.60 (6.52–8.87) for TyG index, 12.82 (10.89–15.10) for TyG-BMI, 16.29 (13.70–19.38) for TyG-WC, and 14.86 (12.53–17.62) for TyG-WHtR. The areas under the ROC curve for each parameter were 0.690 for TyG index, 0.748 for TyG-BMI, 0.731 for TyG-WC, and 0.733 for TyG-WHtR. In conclusion, TyG-BMI was found to be superior to other parameters for IR prediction. We propose TyG-BMI as an alternative marker for assessing IR in clinical settings.
Highlights
Insulin resistance (IR) is characterized by an inappropriate physiologic response in which insensitivity to insulin results in compensatory hyperinsulinemia [1]
Mean body weight, waist circumference, body mass index (BMI), waist-to-height ratio (WHtR), systolic and diastolic Blood pressure (BP), glucose, total cholesterol, TG, LDL, insulin, homeostasis model for IR (HOMA-IR), triglyceride glucose (TyG) index, TyG-BMI, TyG-WC, and TyG-WHtR, were significantly higher while the mean HDL level was significantly lower in the IR group than in the non-IR group
TyG-WC presented the highest odds ratios (OR) and 95% confidence interval (CI) for IR, reaching 16.29 for the top quartile compared with the bottom quartile (P < 0.001), followed by TyG-WHtR (Q4 14.86, 95% CI 12.53–17.62) and TyG-BMI (Q4 12.82, 95% CI 10.89–15.10)
Summary
Insulin resistance (IR) is characterized by an inappropriate physiologic response in which insensitivity to insulin results in compensatory hyperinsulinemia [1]. IR is known to be a major risk factor for metabolic syndrome, type 2 diabetes and cardiovascular diseases [2,3,4]. Growing population with chronic diseases associated with IR are reported worldwide, including among the Korean population [5,6]. Early detection of IR is crucial to prevent the manifestation of clinical diseases. It is difficult to perform in routine laboratory because of its complexity and invasiveness [8]. To overcome these problems, the homeostasis model for IR (HOMA-IR) was developed in 1985 [9] and has been widely used for IR quantification. The triglyceride glucose (TyG) index, a product of fasting triglycerides and glucose, has recently been suggested for IR estimation, and this measurement demonstrates improved efficiency compared to previous markers [8,17,18]
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