Use of Blood Lipid Indicators as a Screening Tool of Insulin Resistance among Individuals in Low-Income Country Sides of China: A Multiethnic Region Study.

Yi-Zhong Yan,Shu-Gang Li,Xiang-Hui Zhang,Jia-Ming Liu,Xin-Ping Wang,Yun-Hua Hu,Jia He,Shu-Xia Guo,Heng Guo,Jia-Ning Fan,Jiao-Long Ma

doi:10.1155/2019/3592620

Abstract

Objective This study is aimed at evaluating the diagnostic value of blood lipid indicators (BLIs) for insulin resistance (IR) among major ethnic groups in Xinjiang, China, to identify the most valuable indicators and appropriate cut-off points for each ethnic group and to lay the foundation for the early detection, diagnosis, and treatment of metabolic diseases in remote rural areas. Methods Overall, 418 Uygurs, 331 Kazakhs, and 220 Hans were randomly included in our study. The homeostasis model assessment was the gold standard for identifying IR. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value, and the nomogram was utilized to analyze the predictive value. The size of the area under the curve (AUC) reflected the accuracy of screening and prediction. Results Differences in races were observed in terms of IR and BLIs, and the Kazakhs had the highest IR level at 5.27 mmol/L. The correlation between IR and BLIs differed among the three races. For the Kazakhs and Hans, all BLIs, except total cholesterol (TC), were correlated to IR. However, for the Uygurs, only the triglyceride (TG) level, TG/high-density lipoprotein cholesterol (HDL-C) ratio, and TC/HDL-C ratio were associated with IR. After further adjustment of confounding factors, these indicators were still correlated to IR. BLIs that independently correlated to IR in the three nationalities had a certain diagnostic value for IR. In terms of the AUC size, the TG level was the highest in Uygurs, the TG/HDL-C ratio was the highest for Kazakhs and Hans, and the corresponding best cut-off points for IR were 1.515, 1.230, and 1.495 mmol/L, respectively. In addition, for each race, when the indicators with a certain diagnostic value were combined, the diagnostic value for IR was higher. Conclusion BLIs had a certain diagnostic value for IR and could be used as a screening tool for IR among Uygurs, Kazakhs, and Hans in Xinjiang. These findings are extremely important for the prevention and treatment of IR and metabolic diseases in remote rural areas.

Highlights

insulin resistance (IR) is the collective physiological and pathological bases of metabolic diseases, such as abdominal obesity, hypertension, diabetes, and dyslipidemia, and it is considered the central link of the development of such diseases [1, 2]
BMI, TG level, TG/HDLC ratio, and total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio significantly differed between the two groups for Uygurs and Kazakhs, and the TG level, HDL-C level, TG/HDL-C ratio, TC/HDL-C ratio, LDLC/HDL-C ratio, and 1 mmol/HDL-C level were obviously different for Hans (P < 0:05 for each comparison) (Table 2)
The pathogenesis of these diseases has been linked to IR, which was found to be associated with dyslipidemia, including low HDL-C level, high TG level, and postprandial lipid level [17,18,19], and all these atherosclerotic lipid abnormalities preceded other symptoms of diabetes, such as elevated blood sugar level, and another obvious advantage was that they were easy to detect

Summary

Introduction

IR is the collective physiological and pathological bases of metabolic diseases, such as abdominal obesity, hypertension, diabetes, and dyslipidemia, and it is considered the central link of the development of such diseases [1, 2]. IR and insufficient insulin secretion are the main factors associated with the development of type 2 diabetes mellitus (T2DM) and are regarded as the important clinical markers for the early diagnosis and late follow-up of such condition [3]. Its role in predicting the risk of a disease and establishing effective treatment strategies has been limited due to the lack of practical quantitative and universal diagnostic methods. The homeostasis model assessment as an index of insulin resistance (HOMA-IR) is the recognized diagnostic criterion [11]; this tool requires the identification of fasting insulin in the serum (FINS), and standardized methods for it in laboratories are limited. All the disadvantages will make the implementation of clinical and epidemiological research challenging, and IR will be more difficult to be identified in natural population. The TG/HDL-C ratio has emerged as a marker of IR [12] in nondiabetic individuals as well as a good predictor of metabolic syndrome (MS) and cardiovascular disease (CVD) [13]

Methods

Results

Conclusion