Concurrent smoking and alcohol consumers had higher triglyceride glucose indices than either only smokers or alcohol consumers: a cross-sectional study in Korea

Eun Ju Chun,Hae Ok Jung,Hye Sun Lee,Hae-Won Han,Donghee Han,Su-Yeon Choi,Jidong Sung,Wonhee Baek,Sung Hak Park,Ji-Won Lee,Hyuk-Jae Chang,Hyangkyu Lee

doi:10.1186/s12944-021-01472-2

Abstract

BackgroundThe triglyceride glucose (TyG) index is a noninsulin-based marker for insulin resistance (IR) in general practice. Although smoking and heavy drinking have been regarded as major risk factors for various chronic diseases, there is limited evidence regarding the combined effects of smoking and alcohol consumption on IR. This study aimed to investigate the relationship between the TyG index and smoking and alcohol consumption using two Korean population-based datasets.MethodsThis study included 10,568 adults in the Korean National Health and Nutrition Examination Survey (KNHANES) and 9586 adults in the Korean Initiatives on Coronary Artery Calcification (KOICA) registry datasets. Multivariate logistic analysis was conducted to explore the relationship between smoking and alcohol consumption and the TyG index. To assess the predictive value of smoking and alcohol consumption on high TyG index, the area under the curve (AUC) were compared and net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses were derived.ResultsThe combined effect of smoking and alcohol consumption was an independent risk factor of a higher TyG index in the KNHANES (adjusted odds ratio: 4.33, P < .001) and KOICA (adjusted odds ratio: 1.94, P < .001) datasets. Adding smoking and alcohol consumption to the multivariate logistic models improved the model performance for the TyG index in the KNHANES (AUC: from 0.817 to 0.829, P < .001; NRI: 0.040, P < .001; IDI: 0.017, P < .001) and KOICA (AUC: from 0.822 to 0.826, P < .001; NRI: 0.025, P = .006; IDI: 0.005, P < .001) datasets.ConclusionsSmoking and alcohol consumption were independently associated with the TyG index. Concurrent smokers and alcohol consumers were more likely to have a TyG index that was ≥8.8 and higher than the TyG indices of non-users and those who exclusively consumed alcohol or smoking tobacco.

Highlights

The triglyceride glucose (TyG) index is a noninsulin-based marker for insulin resistance (IR) in general practice
Smoking and alcohol consumption were independently associated with the TyG index
KNHANES Korean National Health and Nutrition Examination Survey, KOICA Korean Initiatives on Coronary Artery Calcification, S and A Smoking and alcohol consumption, area under the curve (AUC) The area under the receiver operating characteristic (ROC) curve, net reclassification improvement (NRI) Net reclassification improvement, integrated discrimination improvement (IDI) Integrated discrimination improvement, WC Waist circumference, BMI Body mass index, total cholesterol (TC) Total cholesterol, high density lipoprotein (HDL) High density lipoprotein smoking and alcohol consumption, 0.817 [95% Confidence interval (CI), 0.805–0.829]; with smoking and alcohol consumption, 0.829 [95% CI, 0.818–0.841])

Summary

Introduction

The triglyceride glucose (TyG) index is a noninsulin-based marker for insulin resistance (IR) in general practice. The hyperinsulinemic-euglycemic clamp (HIEC) is considered the gold standard method for determining IR [5]; it is a time-consuming and invasive method with limited applicability to the general population. For this reason, several IR surrogate indices, such as homeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), the McAuley index [6], triglyceride (TG): high density lipoprotein (HDL) cholesterol ratio, lipid accumulation product (LAP), and visceral adiposity index (VAI) [7], have been used previously. The TyG index is a noninsulin-based index and is a simple, fast, and inexpensive surrogate, making it advantageous for use in general practice [8]

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