Novel metabolic indices and incident type 2 diabetes among women and men: the Rotterdam Study

Lycopene: A Potent Antioxidant with Multiple Health Benefits

Lycopene is a naturally occurring carotenoid predominantly found in tomatoes and tomato-based products. Like other phytochemicals, it exhibits health beneficial biological activities that can be exploited when it is used as a dietary supplement. In vitro and in vivo, lycopene has been demonstrated to mitigate oxidative stress-induced metabolic dysfunctions and diseases including inflammation, obesity, and diabetes mellitus. Lycopene has been shown to alleviate metabolic diseases that affect the bone, eye, kidney, liver, lungs, heart, and nervous system. This review presents the state of the art regarding lycopene's health benefits and its potential applications in health system delivery. Furthermore, lycopene's protective effects against toxins, safety in its use, and possible toxicity are explored.

Comparison of triglyceride glucose index and modified triglyceride glucose indices in prediction of cardiovascular diseases in middle aged and older Chinese adults

BACKGROUND

Triglyceride and glucose (TyG) index, a surrogate marker of insulin resistance, has been validated as a predictor of cardiovascular disease. However, effects of TyG-related indices combined with obesity markers on cardiovascular diseases remained unknown. We aimed to investigate the associations between TyG index and modified TyG indices with new-onset cardiovascular disease and the time-dependent predictive capacity using a national representative cohort.

METHODS

This study is a retrospective observational cohort study using data from China Health and Retirement Longitudinal Study (CHARLS) of 7 115 participants. The TyG index was calculated as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The modified TyG indices were developed combining TyG with body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). We used adjusted Cox proportional hazards regression to analyze the association and predictive capacity based on hazard ratio (HR) and Harrell's C-index.

RESULTS

Over a 7-year follow-up period, 2136 participants developed cardiovascular disease, including 1633 cases of coronary heart disease and 719 cases of stroke. Compared with the lowest tertile group, the adjusted HR (95% CI) for new-onset cardiovascular disease in the highest tertile for TyG, TyG-BMI, TyG-WC, and TyG-WHtR were 1.215 (1.088-1.356), 1.073 (0.967-1.191), 1.078 (0.970-1.198), and 1.112 (1.002-1.235), respectively. The C-indices of TyG index for cardiovascular disease onset were higher than other modified TyG indices. Similar results were observed for coronary heart disease and stroke.

CONCLUSION

TyG and TyG-WhtR were significantly associated with new-onset cardiovascular diseases, and TyG outperformed the modified TyG indices to identify individuals at risk of incident cardiovascular event.

Visceral adiposity associated with incidence and development trajectory of cardiometabolic diseases: A prospective cohort study

BACKGROUND AND AIMS

There is a lack of literature concerning the effects of visceral adipose on the development of first cardiometabolic disease (FCMD) and its subsequent progression to cardiometabolic multimorbidity (CMM) and mortality.

METHODS AND RESULTS

423,934 participants from the UK Biobank with different baseline disease conditions were included in the analysis. CMM was defined as the simultaneous presence of coronary heart disease, T2D, and stroke. Visceral adiposity was estimated by calculating the visceral adiposity index (VAI). Multistate models were used to assess the effect of visceral adiposity on the development of CMM. During a median follow-up of 13.5 years, 50,589 patients had at least one CMD, 6131 were diagnosed with CMM, whereas 24,634 patients died. We observed distinct roles of VAI with respect to different disease transitions of CMM. HRs (95 % CIs) of high VAI were 2.35 (2.29-2.42) and 1.64 (1.50-1.79) for transitions from healthy to FCMD and from FCMD to CMM, and 0.97 (0.93-1.02) for all-cause mortality risk from healthy, FCMD and CMM, respectively.

CONCLUSIONS

Our study provides the first evidence that visceral adipose may contribute to the development of FCMD and CMM in healthy participants. However, visceral adipose may confer resistance to all-cause mortality in participants with existing CMD or CMM. A better understanding of the relationship between visceral adipose and CMM can focalize further investigations on patients with CMD with high levels of visceral fat and help take targeted preventive measures to reduce the medical burden on individual patients and society.

Relationship between indices of insulin resistance and incident type 2 diabetes mellitus in Chinese adults

BACKGROUND

Insulin resistance (IR) is a pivotal pathogenesis characteristic of type 2 diabetes mellitus (T2DM). The current study aimed to explore the association between triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c), triglyceride-glucose (TyG), and triglyceride glucose-body mass index (TyG-BMI), and T2DM incidence.

METHODS

A total of 116,855 Chinese adults aged over 20 without diabetes were included. Multivariate Cox regression analysis and restricted cubic spine were utilized to investigate the association between IR indicators and T2DM. The T2DM risk across different quartiles of IR parameters was compared using Kaplan-Meier curves. The receiver operating characteristic analysis was used to investigate the predictive potential of each IR indicator for future T2DM.

RESULTS

A total of 2685 participants developed T2DM during a median follow-up of 2.98 years. The adjusted hazard ratios (HR) of incident T2DM were 1.177, 2.766, and 1.1018 for TG/HDL-c, TyG, and TyG-BMI, respectively. There were significant increasing trends of T2DM across the quartiles of TG/HDL-c, TyG, and TyG-BMI. The HRs of new-onset T2DM in the highest quartiles versus the lowest quartile of TG/HDL-c, TyG, and TyG-BMI were 3.298, 8.402, and 8.468. RCS revealed the nonlinear relationship between IR and T2DM risk. The correlations between IR and T2DM were more pronounced in subjects aged <40. TyG-BMI had the highest predictive value for incident T2DM (AUC = 0.774), with a cut-off value of 213.289.

CONCLUSION

TG/HDL-c, TyG, and TyG-BMI index were all significantly positively associated with higher risk for future T2DM. Baseline TyG-BMI level had high predictive value for the identification of T2DM.

A Combined Measure of the Triglyceride Glucose Index and Trimethylamine N-Oxide in Risk Stratification of ST-Segment Elevation Myocardial Infarction Patients with High-Risk Plaque Features Defined by Optical Coherence Tomography: A Substudy of the OCTAMI Registry Study

Background and Aim

An elevated triglyceride-glucose (TyG) level is associated with increased risk of mortality in patients with CAD. Trimethylamine N-oxide (TMAO) has mechanistic links to atherosclerotic coronary artery disease (CAD) pathogenesis and is correlated with adverse outcomes. However, the incremental prognostic value of TMAO and TyG in the cohort of optical coherence tomography (OCT)-defined high-risk ST-segment elevation myocardial infarction (STEMI) patients is unknown.

Methods

We studied 274 consecutive aged ≥18 years patients with evidence of STEMI and detected on pre-intervention OCT imaging of culprit lesions between March 2017 and March 2019.

Outcomes

There were 22 (22.68%), 27 (27.84%), 26 (26.80%), and 22 (22.68%) patients in groups A-D, respectively. The baseline characteristics according to the level of TMAO and TyG showed that patients with higher level in both indicators were more likely to have higher triglycerides (p < 0.001), fasting glucose (p < 0.001) and higher incidence of diabetes (p = 0.008). The group with TMAO > median and TyG ≤ median was associated with higher rates of MACEs significantly (p = 0.009) in fully adjusted analyses. During a median follow-up of 2.027 years, 20 (20.6%) patients experienced MACEs. To evaluate the diagnostic value of the TyG index combined with TMAO, the area under the receiver operating characteristic curve for predicting MACEs after full adjustment was 0.815 (95% confidence interval, 0.723-0.887; sensitivity, 85.00%; specificity, 72.73%; cut-off level, 0.577). Among the group of patients with TMAO > median and TyG ≤ median, there was a significantly higher incidence of MACEs (p=0.033). A similar tendency was found in the cohort with hyperlipidemia (p=0.016) and diabetes mellitus (p=0.036).

Conclusion

This study demonstrated the usefulness of combined measures of the TyG index and TMAO in enhancing risk stratification in STEMI patients with OCT-defined high-risk plaque characteristics.

Trial Registration

This study was registered at ClinicalTrials.gov as NCT03593928.

Triglyceride-glucose Index as a Valuable Marker to Predict Severity of Coronary Artery Disease: A Retrospective Cohort Study

BACKGROUND AND AIMS

The diagnostic standard of coronary artery disease (CAD) is coronary angiography (CAG). Since CAG is an invasive procedure underscores the need for identifying non-invasive, effective, and innovative biomarkers. Our study aimed to retrospectively analyze hematological markers for predicting the severity of CAD.

METHODS AND RESULTS

Case data were collected from 195 CAD patients admitted to the hospital for CAG. According to Gensini score, patients were divided into mild, moderate, and severe CAD groups. Blood indexes and predictive efficacy of the triglyceride-glucose (TyG) index were retrospectively analyzed. Among 195 CAD patients, 81 had mild CAD, 60 had moderate CAD, and 54 had severe CAD. Sex, fast blood glucose (FBG), TyG index, and high-sensitivity C-reactive protein (hs-CRP) significantly differed among the three groups. The TyG index demonstrated higher values in patients with moderate (9.07[8.62-9.44]) and severe (8.98[8.46-9.45]) CAD compared to those with mild CAD (8.75[8.49-9.14]). The AUC of the TyG index was 0.615 (95% confidence interval (CI): 0.536-0.694, P =.004), with a cut-off value of 8.997, specificity of 0.704, and sensitivity of 0.535. Logistics analysis showed the risk of moderate and severe CAD with an odds ratio (OR) value of 2.595 (95% CI: 1.199-5.619, adjusted P = .016) following regrouping by the TyG index optimal cut-off value of 8.997. The TyG index combined with FBG and hs-CRP had an elevated AUC value, significantly higher than other combinations (P  =  .011 and 0.02, respectively).

CONCLUSIONS

The severity of CAD is positively correlated with an increased TyG index value. A combination of TyG, FBG, and hs-CRP has demonstrated improved diagnostic efficiency, suggesting its potential as a novel indicator for predicting and diagnosing CAD progression.

The predictive significance of lipid accumulation products for future diabetes in a non-diabetic population from a gender perspective: an analysis using time-dependent receiver operating characteristics

Objective

The increasing prevalence of diabetes is strongly associated with visceral adipose tissue (VAT), and gender differences in VAT remarkably affect the risk of developing diabetes. This study aimed to assess the predictive significance of lipid accumulation products (LAP) for the future onset of diabetes from a gender perspective.

Methods

A total of 8,430 male and 7,034 female non-diabetic participants in the NAGALA (NAfld in the Gifu Area, Longitudinal Analysis) program were included. The ability of LAP to assess the risk of future new-onset diabetes in both genders was analyzed using multivariate Cox regression. Subgroup analysis was conducted to explore the impact of potential modifiers on the association between LAP and diabetes. Additionally, time-dependent receiver operator characteristics (ROC) curves were used to assess the predictive power of LAP in both genders for new-onset diabetes over the next 2-12 years.

Results

Over an average follow-up of 6.13 years (maximum 13.14 years), 373 participants developed diabetes. Multivariate Cox regression analysis showed a significant gender difference in the association between LAP and future diabetes risk (P-interaction<0.05): the risk of diabetes associated with LAP was greater in females than males [hazard ratios (HRs) per standard deviation (SD) increase: male 1.20 (1.10, 1.30) vs female 1.35 (1.11, 1.64)]. Subgroup analysis revealed no significant modifying effect of factors such as age, body mass index (BMI), smoking history, drinking history, exercise habits, and fatty liver on the risk of diabetes associated with LAP (All P-interaction <0.05). Time-dependent ROC analysis showed that LAP had greater accuracy in predicting diabetes events occurring within the next 2-12 years in females than males with more consistent predictive thresholds in females.

Conclusions

This study highlighted a significant gender difference in the association between LAP and future diabetes risk. The risk of diabetes associated with LAP was greater in females than in males. Furthermore, LAP showed superior predictive ability for diabetes at different time points in the future in females and had more consistent and stable predictive thresholds in females, particularly in the medium and long term.

CT-based measurement of visceral adipose tissue volume as a reliable tool for assessing metabolic risk factors in prediabetes across subtypes

Visceral adipose tissue (VAT) is a well-established risk factor for the development of diabetes in individuals with prediabetes. We aimed to evaluate various adiposity and metabolic indices, including visceral adipose tissue (VAT) volume measured by CT, in individuals with prediabetes, based on their different subtypes. This retrospective study included 78 prediabetes individuals aged ≥ 20 years whose VAT volumes were evaluated by CT. Individuals were classified into prediabetes subtypes: impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and combined IFG and IGT (C-IFG/IGT). We conducted a comparison of the patients' adiposity indices and their associations with one other, as well as with insulin resistance, based on the different prediabetes subtypes. Individuals with C-IFG/IGT had higher levels of visceral obesity than those with IFG or IGT. VAT volume was more strongly associated with insulin resistance than other adiposity indices, regardless of prediabetes subtypes. Additionally, VAT volume and liver attenuation index showed a significant correlation with the other indices studied across the prediabetes subtypes. CT-based measurement of VAT volume may be a valuable tool for evaluating metabolic risk factors among individuals with prediabetes.

Association of novel lipid indicators with the risk of stroke among participants in Central China: a population-based prospective study

Background

Several easily and inexpensively measured indicators of visceral adiposity dysfunction are currently available, but it remains unclear whether they are correlated with stroke risk in the community-dwelling population. We aimed to examine the longitudinal association of the triglyceridemic-waist phenotypes, the triglyceride glucose (TyG) index, as well as TyG-related indicators with stroke risk.

Methods

In this study, we conducted a prospective cohort study in Hunan, a region located in Central China, where the prevalence of stroke is relatively high. We included a total of 20185 subjects aged ≥40 years between November 2017 and December 2018. Triglyceride glucose-body mass index (TyG-BMI) and triglyceride glucose-waist circumference (TyG-WC) were calculated as multiplying TyG index by BMI and WC, respectively. Triglyceride waist phenotypes were categorized into four phenotypes: HTGW (elevated triglyceride and enlarged WC), NTNW (normal triglyceride and normal WC); HTNW (high triglyceride and normal WC), and NTGW (normal triglyceride and enlarged WC). We constructed a multivariable Cox regression model to assess the association between these novel lipid indicators and the risk of stroke. Subgroup analysis was conducted to test the robustness of our research findings. ROC curve was used for assessing the predictive ability of different stroke risk indices.

Results

After 2 years of follow- up, 135 participants experienced new stroke events. After adjusting for potential confounders, we found that participants with HTGW had higher likelihood of stroke (HR: 1.96, 95% CI: 1.21 to 3.16). However, we did not find significant associations for HTNW (HR: 1.42, 95% CI: 0.91 to 2.21) and NTGW (HR: 1.09, 95% CI 0.67 to 1.78). when compared to participants in the first TyG quartile, those in the fourth TyG quartile were associated with a 2.06-fold (95% CI: 1.22, 3.50) risk of stroke. Each 1-SD increase in TyG, TyG-BMI, and TyG-WC was associated with a higher risk of stroke, with adjusted HRs of 1.34 (95% CI: 1.11 to 1.61), 1.35 (95% CI: 1.14 to 1.59), and 1.23 (95% CI: 1.04 to 1.46), respectively. In subgroup analyses, those positive relationships appeared to be stronger among male participants with lower levels of physical activity and smoking.

Conclusion

HTGW, along with higher levels of TyG and TyG-related indicators, were found to be associated with an elevated risk of stroke. HTGW and these novel lipid indicators might be reliable indicators to identify populations at elevated risk of stroke.

Usefulness of different adiposity indexes for identification of metabolic disturbances in patients with obesity

CONTEXT

Despite the role of BMI as a classical obesity index, other indexes reflecting mainly abdominal obesity, usually outperform BMI in terms of metabolic complications prediction.

OBJECTIVE

The aim of the present study is to compare the usefulness of different adiposity indexes for the identification of metabolic disturbances in patients with obesity.

METHODS

In the study, we included 461 patients - group 1 with obesity (n = 182), group 2 with prediabetes (n = 193), and group 3 with newly diagnosed type 2 diabetes (n = 86). Different anthropometric and adiposity indexes were calculated - WHR, WSR, VAI, ABSI, BRI, Hip index, WWI, LAP.

RESULTS

VAI and LAP had the highest predictive value for the presence of carbohydrate disturbances. VAI also showed the strongest correlation with Framingham and SCORE compared to other adiposity indexes.

CONCLUSIONS

VAI and LAP are most useful for the identification of metabolic disturbances and cardiovascular risk in patients with obesity.

Sex-Specific Comparison Between Triglyceride Glucose Index and Modified Triglyceride Glucose Indices to Predict New-Onset Hypertension in Middle-Aged and Older Adults

Background Triglyceride and glucose (TyG) index and TyG-related indices combined with obesity-related markers are considered important markers of insulin resistance. We aimed to examine the association between the TyG index and modified TyG indices with new-onset hypertension and their predictive ability stratified by sex. Methods and Results We analyzed data from 5414 Korean Genome and Epidemiology Study participants aged 40 to 69 years. Multiple Cox proportional hazard regression analyses were conducted to estimate the hazard ratio (HR) and 95% CI for new-onset hypertension according to sex-specific tertile groups after confounder adjustments. To evaluate the predictive performance of these indices for new-onset hypertension, we calculated Harrell's C-index (95% CI). Over a 9.5-year follow-up period, 1014 men and 1012 women developed new-onset hypertension. Compared with the lowest tertile (T) group, the adjusted HR and 95% CI for new-onset hypertension in T3 for TyG, TyG-body mass index, TyG-waist circumference, and TyG-waist-to-height ratio were 1.16 (0.95-1.40), 1.11 (0.84-1.48), 1.77 (1.38-2.27), and 1.68 (1.33-2.13) in men and 1.37 (1.13-1.66), 1.55 (1.16-2.06), 1.43 (1.15-1.79), and 1.64 (1.30-2.07) in women, respectively. The C-indices of TyG-waist-to-height ratio for new-onset hypertension were significantly higher than those of TyG and TyG-body mass index in both men and women. Conclusions TyG and TyG-body mass index were significantly associated with new-onset hypertension only in women. TyG-waist circumference and TyG-waist-to-height ratio were significantly associated with new-onset hypertension in both men and women. A sex-specific approach is required when using TyG and modified TyG indices to identify individuals at risk of incident hypertension.

Interrelation between the lipid accumulation product index and diabetic kidney disease in patients with type 2 diabetes mellitus

Objective

The purpose of this study was to determine the relation between the lipid accumulation product index (LAPI) and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM).

Methods

Herein, 931 patients were enrolled and their data were collected. Then the interrelation between LAPI and DKD was assessed using multivariate logistic regression analyses (LRAs) and by a restricted cubic spline (RCS).

Results

In total, 931 participants (352 females and 579 males) aged 55 years on average were included in the study. After adjusting for several confounders, the odds ratio for DKD was increased evidently in the third LAPI tertile compared with that in the first LAPI tertile. In addition, the RCS revealed a positive interrelation between LAPI and DKD. In the subgroup analyses, age, sex, hyperlipidemia, hypertension, and HbA1c did not significantly interact with LAPI.

Conclusions

LAPI was higher in the DKD group than in the no-DKD group, and LAPI is positively linked with DKD, which may have potential value to diagnose DKD in clinical practice.

Association between Chinese visceral adiposity index and risk of stroke incidence in middle-aged and elderly Chinese population: evidence from a large national cohort study

BACKGROUND

Abdominal obesity has long been considered as a crucial risk factor of stroke. Chinese visceral adiposity index (CVAI), a novel surrogate indicator of abdominal obesity, has been confirmed as a better predictor for coronary heart disease than other indicators in Asian population. However, the data on the relationship of CVAI with stroke is limited. The objective of our study is evaluating the relationship between CVAI and stroke incidence.

METHODS

In the present study, we enrolled 7242 middle-aged and elderly residents from the China Health and Retirement Longitudinal Study (CHARLS) and placed them into groups according to quartile of CVAI. The outcome of interest was stroke. Kaplan-Meier curves were used to estimate the cumulative incidences of stroke. Cox regression analyses and multivariable-adjusted restricted cubic spline (RCS) curves were performed to evaluate the relationship between CVAI and incident stroke. Multiple sensitivity analyses and subgroups analyses were performed to test the robustness of the findings.

RESULTS

During a median 84 months of follow-up, 612 (8.45%) participants experienced incident stroke, and the incidences of stroke for participants in quartiles (Q) 1-4 of CVAI were 4.42%, 7.29%, 9.06% and 13.04%, respectively. In the fully adjusted model, per 1.0-SD increment in CVAI has a significant increased risk of incident stroke: hazard ratio (HR) [95% confidence interval (CI)] was 1.17 (1.07-1.28); compared with participants in Q1 of CVAI, the HRs (95% CI) of incident stroke among those in Q2-4 were 1.47 (1.10-1.95), 1.62 (1.22-2.15), and 1.70 (1.28-2.27), respectively. Subgroups analyses suggested the positive association was significant in male participants, without diabetes, hypertension and heart disease. The findings were robust in all the sensitivity analyses. Additional, RCS curves showed a significant dose-response relationship of CVAI with risk of incident stroke (P for non-linear trend = 0.319).

CONCLUSION

Increased CVAI is significantly associated with higher risk of stroke incidence, especially in male individuals, without hypertension, diabetes and heart disease. The findings suggest that baseline CVAI is a reliable and effective biomarker for risk stratification of stroke, which has far-reaching significance for primary prevention of stroke and public health.

Association of the time course of Chinese visceral adiposity index accumulation with cardiovascular events in patients with hypertension

BACKGROUND

The Chinese visceral adiposity index (CVAI), a simple surrogate measure of visceral fat, is significantly associated with cardiovascular disease (CVD) risk in the general population. This study aimed to evaluate the association of cumulative CVAI (cumCVAI) exposure and its accumulation time course with CVD risk among patients with hypertension.

METHODS

This prospective study involved 15,350 patients with hypertension from the Kailuan Study who were evaluated at least three times in the observation period of 2006 to 2014 (2006-2007, 2010-2011, and 2014-2015) and who were free of myocardial infarction and stroke before 2014. The cumCVAI was calculated as the weighted sum of the mean CVAI for each time interval (value × time). The time course of CVAI accumulation was categorized by splitting the overall accumulation into early (cumCVAI_06 - 10) and late (cumCVAI_10 - 14) accumulation, or the slope of CVAI versus time from 2006 to 2014 into positive and negative.

RESULTS

During the 6.59-year follow-up period, 1,184 new-onset CVD events were recorded. After adjusting for confounding variables, the hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD were 1.35 (1.13-1.61) in the highest quartile of cumCVAI, 1.35 (1.14-1.61) in the highest quartile of the time-weighted average CVAI, 1.26 (1.12-1.43) in those with a cumulative burden > 0, and 1.43 (1.14-1.78) for the group with a 10-year exposure duration. When considering the time course of CVAI accumulation, the HR (95% CI) for CVD was 1.33 (1.11-1.59) for early cumCVAI. When considering the combined effect of cumCVAI accumulation and its time course, the HR (95% CI) for CVD was 1.22 (1.03-1.46) for cumCVAI ≥ median with a positive slope.

CONCLUSIONS

In this study, incident CVD risk depended on both long-term high cumCVAI exposure and the duration of high CVAI exposure among patients with hypertension. Early CVAI accumulation resulted in a greater risk increase than later CVAI accumulation, emphasizing the importance of optimal CVAI control in early life.

Lipid accumulation product is a better predictor of metabolic syndrome in Chinese adolescents: a cross-sectional study

Aim

Confirm and compare the degree of associations of non-traditional lipid profiles and metabolic syndrome (MetS) in Chinese adolescents, determine the lipid parameter with better predictive potential, and investigate their discriminatory power on MetS.

Methods

Medical measurements, including anthropometric measurements and biochemical blood tests, were undergone among a total sample of 1112 adolescents (564 boys and 548 girls) aged from 13 to 18 years. Univariate and multivariate logistic regression analyses were applied for assessing the relationships between the levels of traditional/non-traditional lipid profiles and MetS. We performed Receiver Operating Characteristic (ROC) analyses to mensurate the effectiveness of lipid accumulation product (LAP) on the diagnosis of MetS. Meanwhile, areas under the ROC curve and the cut-off values were calculated for MetS and its components.

Results

Univariate analysis showed that all our lipid profiles were closely associated with MetS (P< 0.05). LAP index showed the closest association with MetS than the other lipid profiles. Additionally, ROC analyses indicated that the LAP index showed sufficient capabilities to identify adolescents with MetS and its components.

Conclusion

The LAP index is a simple and efficient tool to identify individuals with MetS in Chinese adolescents.

The association of fasting plasma thiol fractions with body fat compartments, biomarker profile, and adipose tissue gene expression

People with high plasma total cysteine (tCys) have higher fat mass and higher concentrations of the atherogenic apolipoprotein B (apoB). The disulfide form, cystine, enhanced human adipogenesis and correlated with total fat mass in a Middle-Eastern cohort. In 35 European adults with overweight (88.6% women) and with dual-X-ray absorptiometry measurements of regional fat, we investigated how cystine compared to other free disulfides in their association with total regional adiposity, plasma lipid and glucose biomarkers, and adipose tissue lipid enzyme mRNA (n = 19). Most total plasma homocysteine (tHcy) (78%) was protein-bound; 63% of total glutathione (tGSH) was reduced. tCys was 49% protein-bound, 30% mixed-disulfide, 15% cystine, and 6% reduced. Controlling for age and lean mass, cystine and total free cysteine were the fractions most strongly associated with android and total fat: 1% higher cystine predicted 1.97% higher android fat mass (95% CI 0.64, 3.31) and 1.25% (0.65, 2.98) higher total fat mass (both p = 0.005). A positive association between tCys and apoB (β: 0.64%; 95% CI 0.17, 1.12%, p = 0.009) was apparently driven by free cysteine and cystine; cystine was also inversely associated with the HDL-associated apolipoprotein A1 (β: -0.57%; 95% CI -0.96, -0.17%, p = 0.007). No independent positive associations with adiposity were noted for tGSH or tHcy fractions. Plasma cystine correlated with CPT1a mRNA (Spearman's r = 0.68, p = 0.001). In conclusion, plasma cystine-but not homocysteine or glutathione disulfides-is associated with android adiposity and an atherogenic plasma apolipoprotein profile. The role of cystine in human adiposity and cardiometabolic risk deserves investigation. ClinicalTrials.gov identifiers: NCT02647970 and NCT03629392.

Association between triglyceride-glucose index and risk of end-stage renal disease in patients with type 2 diabetes mellitus and chronic kidney disease

Aims

It has been suggested that the triglyceride-glucose (TyG) index is a novel and reliable surrogate marker of insulin resistance (IR). However, its relationship with the risk of end-stage renal disease (ESRD) in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) remains uncertain. Accordingly, we sought to examine the relationship between the TyG index and ESRD risk in patients with T2DM and CKD.

Methods

From January 2013 to December 2021, 1,936 patients with T2DM and CKD hospitalized at Peking University Third Hospital (Beijing, China) were enrolled into the study. The formula for calculating the TyG index was ln[fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. ESRD was defined as an estimated glomerular filtration rate of less than 15 mL/min/1.73 m² or the commencement of dialysis or renal transplantation. The relationship between the TyG index and ESRD risk was analyzed using Cox proportional hazard regression.

Results

105 (5.42%) participants developed ESRD over a mean follow-up of 41 months. The unadjusted analysis revealed a 1.50-fold (95% confidence interval [CI] 1.17-1.93; P = 0.001) increased risk for ESRD per one unit rise in the TyG index, and the positive association remained stable in the fully adjusted model (hazard ratio, 1.49; 95% CI, 1.12-1.99; P = 0.006). Analysis using restricted cubic spline revealed a significant positive association between the TyG index and ESRD risk. In addition, Kaplan-Meier analysis revealed significant risk stratification with a TyG index cutoff value of 9.5 (P = 0.003).

Conclusion

In individuals with T2DM and CKD, a significant and positive association was shown between an elevated TyG index and the risk of ESRD. This conclusion provides evidence for the clinical importance of the TyG index for evaluating renal function decline in individuals with T2DM and CKD.

Association of lipid accumulation product with type 2 diabetes mellitus, hypertension, and mortality: a systematic review and meta-analysis

Purpose

Novel anthropometric measures are simple, applicable, and inexpensive tools for cardiovascular risk assessment. This study evaluates the association of lipid accumulation product (LAP) with hypertension, type 2 diabetes mellitus (T2DM), and all-cause mortality, and compares it with other anthropometric measures.

Methods

PubMed, Web of Science, EMBASE, and Scopus were systematically searched for articles published until May 15, 2021. We included all the studies that had measured LAP predictability for T2DM, all-cause mortality, and hypertension with no limitation in comorbidities and follow-up duration. We assessed the predictability measures of LAP for the aforementioned outcomes. We also performed a meta-analysis on four articles on mortality using an inverse variance method by the "meta" package in R software.

Results

Twenty-nine studies were included in the review after applying the eligibility criteria. The hazard ratio for all-cause mortality per one standard deviation increment of LAP was 1.24 (95% confidence interval [CI]: 1.00-1.53; P = 0.0463) in females, and 1.07 (95% CI: 0.74-1.57; P = 0.709) in males. All included studies found a direct association between LAP with T2DM and hypertension. However, studies used different cut-off points for LAP. Most studies found that LAP was superior in predicting T2DM and hypertension compared to conventional indices, e.g., body mass index and waist circumference. We found that LAP may have higher prognostic significance in females compared to males.

Conclusion

LAP is an inexpensive method to evaluate the risk of all-cause mortality, T2DM, and hypertension, and could outperform conventional anthropometric indices in this regard.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01114-z.

Association between abdominal obesity indices and risk of cardiovascular events in Chinese populations with type 2 diabetes: a prospective cohort study

BACKGROUND

Waist circumference (WC), visceral adiposity index (VAI), lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) are considered surrogate indicators of abdominal fat deposition, but the longitudinal association of these indices with cardiovascular (CV) events in adults with type 2 diabetes (T2D) remains unclear. Our study aimed to examine the associations between abdominal obesity indices and incident CV events among people with T2D and to compare their predictive performance in risk assessment.

METHODS

The present study included 2328 individuals with T2D from the Xinjiang Multi-Ethnic Cohort. Multivariable Cox regression analyses were applied to assess the associations between abdominal obesity indices and CV events. Harrell's concordance statistic (C-statistic), net reclassification improvement (NRI) index, and integrated discrimination improvement (IDI) index were utilized to evaluate the predictive performance of each abdominal obesity index.

RESULTS

At a median follow-up period of 59 months, 289 participants experienced CV events. After multivariable adjustment, each 1-SD increase in WC, VAI, LAP, and CVAI was associated with a higher risk of CV events in people with T2D, with adjusted hazard ratios (HRs) being 1.57 [95% CI (confidence interval): 1.39-1.78], 1.11 (95% CI 1.06-1.16), 1.46 (95% CI 1.36-1.57), and 1.78 (95% CI 1.57-2.01), respectively. In subgroup analyses, these positive associations appeared to be stronger among participants with body mass index (BMI) < 25 kg/m² compared to overweight/obese participants. As for the predictive performance, CVAI had the largest C-statistic (0.700, 95% CI 0.672-0.728) compared to VAI, LAP, WC, and BMI (C-statistic: 0.535 to 0.670, all P for comparison < 0.05). When the abdominal obesity index was added to the basic risk model, the CVAI index also showed the greatest incremental risk stratification (C-statistic: 0.751 vs. 0.701, P < 0.001; IDI: 4.3%, P < 0.001; NRI: 26.6%, P < 0.001).

CONCLUSIONS

This study provided additional evidence that all abdominal obesity indices were associated with the risk of CV events and highlighted that CVAI might be a valuable abdominal obesity indicator for identifying the high risk of CV events in Chinese populations with T2D. These results suggest that proactive assessment of abdominal obesity could be helpful for the effective clinical management of the diabetic population.

Imaging-based body fat depots and new-onset atrial fibrillation in general population: a prospective cohort study

BACKGROUND

Obesity is a well-established risk factor for atrial fibrillation (AF). Whether body fat depots differentially associate with AF development remains unknown.

METHODS

In the prospective population-based Rotterdam Study, body composition was assessed using dual-energy X-ray absorptiometry (DXA) and liver and epicardial fat using computed tomography (CT). A body composition score was constructed by adding tertile scores of each fat depot. Principal component analysis was conducted to identify potential body fat distribution patterns. Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals (HR; 95% CI) per 1-standard deviation increase in corresponding fat depots to enable comparisons.

RESULTS

Over a median follow-up of 9.6 and 8.6 years, 395 (11.4%) and 172 (8.0%) AF cases were ascertained in the DXA and the CT analyses, respectively. After adjustments for cardiovascular risk factors, absolute fat mass (HR; 95% CI 1.33; 1.05-1.68), gynoid fat mass (HR; 95% CI 1.36; 1.12-1.65), epicardial fat mass (HR; 95% CI 1.27; 1.09-1.48), and android-to-gynoid fat ratio (HR; 95% CI 0.81; 0.70-0.94) were independently associated with new-onset AF. After further adjustment for lean mass, associations between fat mass (HR; 95% CI 1.17; 1.04-1.32), gynoid fat mass (HR; 95% CI 1.21; 1.08-1.37), and android-to-gynoid fat ratio (HR; 95% CI 0.84; 0.72-0.97) remained statistically significant. Larger body fat score was associated with a higher AF risk (HR; 95% CI 1.10; 1.02-1.20). Borderline significant association was found between a subcutaneous fat predominant pattern with AF onset (HR; 95% CI 1.21; 0.98-1.49).

CONCLUSIONS

Various body fat depots were associated with new-onset AF. Total fat mass and gynoid fat mass were independently associated with AF after adjustment for body size. The inverse association between android-to-gynoid fat ratio with AF presents a novel finding. A significant dose-response relationship between body fat accumulation and AF was observed. Our results underscore the predominant role of subcutaneous fat on AF development among a middle-aged and elderly population. Associations betw2een body fat depots, fat distribution and new-onset atrial fibrillation.

ABBREVIATIONS

AF, atrial fibrillation.

Altered Visceral Adipose Tissue Predictors and Women’s Health: A Unicenter Study

(1) Background: The excess visceral adipose tissue (VAT) accumulation in women may reflect an early or advanced state of a metabolic disorder and a higher risk of cardiovascular disease than other types of obesity. This study aimed to determine the predictor variables (demographic information, anthropometric data, and blood biomarkers) for changes in VAT in adult women. (2) Methods: This cross-sectional study was conducted with women aged 18–59 years attending nutritional consultation at the Centro Universitário de Brasília (CEUB)’s nutrition school clinic, Brazil. All participants’ medical records were reviewed throughout the study and data of interest were collected. Various anthropometric measurements and biochemical exams were performed and analyzed in a univariate logistic regression model to identify the possible risk factors predictors for the presence of altered VAT. (3) Results: Our logistic regression model considered body mass index (BMI) greater than 25 kg/m², lipid accumulation product (LAP), and waist–hip ratio (WHR) as predictors of altered VAT. (4) Conclusion: LAP has a robust predictive capacity for changes in visceral fat in adult women, followed by WHR and BMI, making these variables effective in assessing the risk for changes in visceral fat and their inclusion essential in the individual and collective clinical practice.

The association of serum sulfur amino acids and related metabolites with incident diabetes: a prospective cohort study

AIM

Plasma total cysteine (tCys) is associated with fat mass and insulin resistance, whereas taurine is inversely related to diabetes risk. We investigated the association of serum sulfur amino acids (SAAs) and related amino acids (AAs) with incident diabetes.

METHODS

Serum AAs were measured at baseline in 2997 subjects aged ≥ 65 years. Diabetes was recorded at baseline and after 4 years. Logistic regression evaluated the association of SAAs [methionine, total homocysteine (tHcy), cystathionine, tCys, and taurine] and related metabolites [serine, total glutathione (tGSH), glutamine, and glutamic acid] with diabetes risk.

RESULTS

Among 2564 subjects without diabetes at baseline, 4.6% developed diabetes. Each SD increment in serum tCys was associated with a 68% higher risk (95% CI 1.27, 2.23) of diabetes [OR for upper vs. lower quartile 2.87 (1.39, 5.91)], after full adjustments (age, sex, other AAs, adiposity, eGFR, physical activity, blood pressure, diet and medication); equivalent ORs for cystathionine were 1.33 (1.08, 1.64) and 1.68 (0.85, 3.29). Subjects who were simultaneously in the upper tertiles of both cystathionine and tCys had a fivefold risk [OR = 5.04 (1.55, 16.32)] of diabetes compared with those in the lowest tertiles. Higher serine was independently associated with a lower risk of developing diabetes [fully adjusted OR per SD = 0.68 (0.54, 0.86)]. Glutamic acid and glutamine showed positive and negative associations, respectively, with incident diabetes in age- and sex-adjusted analysis, but only the glutamic acid association was independent of other confounders [fully adjusted OR per SD = 1.95 (1.19, 3.21); for upper quartile = 7.94 (3.04, 20.75)]. tGSH was inversely related to diabetes after adjusting for age and sex, but not other confounders. No consistent associations were observed for methionine, tHcy or taurine.

CONCLUSION

Specific SAAs and related metabolites show strong and independent associations with incident diabetes. This suggests that perturbations in the SAA metabolic pathway may be an early marker for diabetes risk.

Lipid Accumulation Product Predicts Diabetes Remission After Bariatric Surgery in Chinese Patients with BMI < 35 kg/m2: a Multicenter Cohort Study

PURPOSE

To evaluate whether preoperative visceral fat-related indexes, such as visceral adiposity index (VAI), lipid accumulation product (LAP), Chinese visceral adiposity index (CVAI), and metabolic score for visceral fat (METS-VF), are useful for predicting diabetes remission in Chinese patients with a BMI < 35 kg/m² after bariatric surgery.

MATERIALS AND METHODS

A retrospective, multicenter cohort study enrolled 177 patients. Binary logistic regression and receiver operating characteristic (ROC) curves were used to identify predictors and clinically useful cutoff values, respectively. The correlation between the visceral fat-related index and body fat percentage was assessed.

RESULTS

Complete remission of type 2 diabetes (T2DM) was observed in 66 patients (37.29%) 1 year after surgery. The VAI, LAP, CVAI, and METS-VF showed downward trends postsurgery. Patients with complete remission had a significantly shorter duration of diabetes and higher CVAI, VAI, LAP, and BMI values than those without complete remission. Binary logistic regression and ROC analysis confirmed that diabetes duration and LAP can predict diabetes remission after bariatric surgery, and a LAP of 67.725 is a useful threshold for predicting surgical efficacy. LAP was significantly positively correlated with VAT/total (%) (p < 0.05).

CONCLUSION

Preoperative LAP is a feasible tool for predicting T2DM remission in patients with a BMI < 35 kg/m² after bariatric surgery, and a LAP of 67.725 is a useful threshold for predicting surgical outcomes. LAP was significantly positively correlated with VAT content.

Association of visceral adiposity index with new-onset type 2 diabetes and impaired fasting glucose in hypertensive Chinese adults

PURPOSE

Visceral adiposity index (VAI) is a reliable indicator for the distribution and function of adipose tissue in the body. The relation of VAI with new-onset type 2 diabetes and new-onset impaired fasting glucose (IFG) remains uncertain. We aimed to investigate the prospective relation of VAI with new-onset type 2 diabetes and new-onset IFG in Chinese hypertensive adults.

METHODS

A total of 14,838 hypertensive adults free of type 2 diabetes at baseline were included from the China Stroke Primary Prevention Trial. The primary outcome was new-onset type 2 diabetes, defined as physician-diagnosed diabetes or use of glucose-lowering drugs during follow-up, or fasting glucose ≥ 7.0 mmol/L at the exit visit. The secondary outcome was new-onset IFG, defined as fasting glucose < 6.1 mmol/L at baseline, while fasting glucose ≥ 6.1 mmol/L and < 7.0 mmol/L at the exit visit.

RESULTS

Over a median of 4.5 years' follow-up, 1612 (10.9%) participants developed type 2 diabetes. When VAI was categorized into quartiles, compared with participants in quartile 1-3 (< 2.80), significantly higher risk of new-onset type 2 diabetes (OR 1.30; 95% CI 1.08-1.56) and new-onset IFG (OR 1.28; 95% CI 1.08-1.52) was found in those in quartile 4 (≥ 2.80). Moreover, the positive associations were consistent in participants with or without single abnormal VAI components, including general obesity, abdominal obesity, elevated triglycerides and low high-density lipoprotein cholesterol (HDL-C) levels; or with different numbers of abnormal VAI components (all P interactions > 0.05).

CONCLUSION

Our study suggested a positive relation of VAI with the risk of new-onset type 2 diabetes and new-onset IFG in Chinese hypertensive patients, independent of its components.

LEVEL OF EVIDENCE

Level III, a well-designed cohort.

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.

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.

Visceral Adiposity Index Plays an Important Role in Prognostic Prediction in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome and Type 2 Diabetes Mellitus Undergoing Percutaneous Coronary Intervention

Background: Visceral adiposity index (VAI), a surrogate marker of adiposity and insulin resistance, has been demonstrated to be significantly related to cardiovascular disease. It remains indistinct whether VAI predicts adverse prognosis after percutaneous coronary intervention (PCI) for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and type 2 diabetes mellitus (T2DM). Methods: A total of 798 participants who met the enrollment criteria were finally brought into this study. VAI was determined by waist circumference, body mass index, fasting triglyceride, and high-density lipoprotein cholesterol as previously reported. Adverse prognosis included all-cause death, non-fatal myocardial infarction, non-fatal ischemic stroke, and ischemia-driven revascularization, the composite of which was defined as the primary endpoint. Results: Higher VAI maintained as a significant and independent risk predictor for the primary endpoint, regardless of the adjustment for the various multivariate models [hazard ratio (95% CI) for fully adjusted model: 2.72 (2.02-3.68), p < 0.001]. The predictive value of VAI was further confirmed in sensitivity analysis where VAI was taken as a continuous variate. There was a dose-response relationship of VAI with the risk of the primary endpoint (p for overall association < 0.001). Moreover, the ability of VAI on the prediction of the primary endpoint was consistent between subgroups stratified by potential confounding factors (all p for interaction > 0.05). VAI exhibited a significant incremental effect on risk stratification for the primary endpoint beyond existing risk scores, expressed as increased Harrell's C-index, significant continuous net reclassification improvement, and significant integrated discrimination improvement. Conclusion: VAI is a significant indicator for predicting worse prognosis and plays an important role in risk stratification among patients with NSTE-ACS and T2DM undergoing elective PCI. The present findings require further large-scale, prospective studies to confirm.

Triglyceride-Glucose Index as a Surrogate Marker of Insulin Resistance for Predicting Cardiovascular Outcomes in Nondiabetic Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Aim: The triglyceride-glucose index (TyG index) is proposed as a surrogate parameter for insulin resistance (IR) and, when elevated, is related to increased cardiovascular risks. Whether the TyG index is of great value in predicting adverse prognosis for individuals diagnosed with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), who received elective percutaneous coronary intervention (PCI), and without recognized diabetes remains unclear.

Methods: Overall, 1,510 subjects diagnosed with NSTE-ACS, who received elective PCI, and without recognized diabetes were enrolled in the current study. All participants received a routine follow-up after discharge. The TyG index was obtained from the following equation: napierian logarithmic (ln) [fasting triglyceride (TG, mg/dL)×fasting blood glucose (FBG, mg/dL)/2]. Adverse cardiovascular events included all-cause death, nonfatal myocardial infarction (MI), nonfatal ischemic stroke, and ischemia-driven revascularization, composite of which was defined as the primary endpoint.

Results: Overall, 316 (20.9%) endpoint events were documented during a 48-month follow-up. Despite adjusting for confounding variates, the TyG index remains to be a significant risk predictor for the primary endpoint, with a hazard ratio (HR) [95% confidence interval (CI)] of 2.433 (1.853-3.196) ( P ＜0.001). A significant enhancement on the predictive performance for the primary endpoint emerged when adding the TyG index into a baseline model [area under the receiver-operating characteristic (ROC) curve (AUC), 0.835 for baseline model vs. 0.853 for baseline model＋TyG index, P ＜0.001; net reclassification improvement (NRI), 0.194, P ＜0.001; integrated discrimination improvement (IDI), 0.023, P =0.007].

Conclusions: The TyG index is an independent risk predictor for adverse cardiovascular events in nondiabetic subjects diagnosed with NSTE-ACS and who received elective PCI. Further prospective studies are needed to verify these findings.

Association Between Lipid Accumulation Product and Target Organ Damage in Elderly Population: The Northern Shanghai Study

Introduction

Lipid accumulation product (LAP), calculated from waist circumference (WC) and triglycerides (TG), is a novel index that correlates cardiovascular disease. We aimed to investigate the relationship between LAP and target organ damage (TOD) in elderly Chinese community-dwelling individuals.

Materials and Methods

We enrolled 3363 participants whose age was ≥65 years old. TOD, including left ventricular hypertrophy (LVH), arterial stiffness (AS), lower extremity atherosclerotic (LEA), micro-albuminuria (MAU) and chronic kidney disease (CKD), was measured using standard methods. LAP was calculated as (WC–65) × TG in men and (WC–58) × TG in women. Both quartiles and continuation of LAP were analyzed.

Results

Age-sex adjusted partial correlation analysis showed that LAP was significantly associated with CVD risk factors. With the first quartile (Q1) as a reference, in univariate logistic regression, the fourth quartile (Q4) of LAP was associated with all TOD. In multivariate model, Q4 of LAP was only associated with an increased risk of AS (odds ratio (OR) = 1.88, 95% confidence interval (CI): 1.37–2.58, P_{for trend}< 0.001), MAU (OR = 1.33, 95% CI: 1.01–1.75, P_{for trend}= 0.02) and CKD (OR = 2.39, 95% CI: 1.39–4.12, P_{for trend}< 0.001). But, Q4 of LAP was not associated with an increased risk of LVH (OR = 1.19, 95% CI: 0.85–1.65, P_{for trend}= 0.25) or LEA (OR = 0.87, 95% CI: 0.58–1.29, P_{for trend}= 0.96). Similar associations were found when analyzed continuously.

Conclusion

The novel metabolic parameter LAP is significantly and independently associated with an increased risk of arterial stiffness, chronic kidney disease and micro-albuminuria in Chinese community-dwelling elderly individuals.

Sex differences for predicting metabolic syndrome by adipose dysfunction markers in institutionalized elderly

AIMS

Recent studies have emphasized that metabolic syndrome (MetS) was the most important modifiable risk factor for cardiovascular and cerebrovascular diseases in the institutionalized elderly. In addition, the occurrence of MetS was higher in those with longer age-adjusted institutionalization time. The present study was conducted to assess predictive value of markers of adipose tissue dysfunction for the early screening of MetS in this population.

METHODS AND RESULTS

Two hundred and eleven institutionalized older adults (132 women, aged 74.3 ± 7.3 years; 79 men, aged 71.5 ± 7.3 years) were enrolled in the current cross-sectional study. Lipid accumulation product (LAP), visceral adiposity index (VAI), body adiposity index (BAI), and triglycerides (TG)/high-density lipoprotein (HDL)-cholesterol ratio were determined. The receiver operating characteristic curve was calculated to compare the area under the curve of each index. The total prevalence of MetS was 23.8%. In female group, VAI and TG/HDL ratio presented moderate-high sensitivity (77.78% and 78.38%, respectively) and specificity (77.62% and 73.49%, respectively). In males group, LAP presented moderate-high sensitivity (75%) and specificity (76.9%).

CONCLUSION

Gender played a key role on the prediction of MetS by adipose dysfunction markers in institutionalized elderly. Accordingly, VAI and TG/HDL-cholesterol ratio showed the highest predictive value for MetS in female elderly. LAP was the strongest predictor of MetS in male elderly.

Biomarker-based visceral adiposity score and incident type 2 diabetes in the multiethnic cohort

PURPOSE

Visceral adipose tissue (VAT) may be more important than subcutaneous fat in type 2 diabetes (T2D) etiology. We examined a VAT score developed in reference to MRI measurement of VAT in the Multiethnic Cohort (MEC) as a risk factor for incident T2D.

METHODS

Two nested case-control studies of cancer allowed calculation of the VAT score based on anthropometric measures and 8 biomarkers among 2,556 participants without T2D. Incident cases were identified from Medicare linkages and self-reports after blood draws in 2001-2006. Cox regression with age as time metric was applied to estimate the association of the VAT score with T2D.

RESULTS

During 10.1 ± 2.4 years, 355 incident T2D cases were identified. VAT scores were higher in T2D cases than among those without disease (5.06±0.43 vs. 4.95±0.41; P<0.0001) and significantly associated with T2D (HR = 2.70; 95%CI 1.60, 4.58 per unit) with similar values in men (HR = 2.99; 95%CI 1.03, 8.73) and women (HR = 2.61; 95%CI 1.39, 4.91). A significant association was observed in all five ethnic groups but only statistically significant among Japanese Americans (HR = 6.24; 95%CI 2.34, 16.68).

CONCLUSION

These findings support that VAT as estimated by a biomarker-based score predicts T2D incidence beyond BMI in particular among older adults of Japanese ancestry.

C. Silva T, Bluemke DA, Budoff M, Barr RG, Allison MA, Bertoni AG, Post WS, Lima JAC, Demehri S. Adipose tissue biomarkers and type 2 diabetes incidence in normoglycemic participants in the MESArthritis Ancillary Study: A cohort study

BACKGROUND

Given the central role of skeletal muscles in glucose homeostasis, deposition of adipose depots beneath the fascia of muscles (versus subcutaneous adipose tissue [SAT]) may precede insulin resistance and type 2 diabetes (T2D) incidence. This study was aimed to investigate the associations between computed tomography (CT)-derived biomarkers for adipose tissue and T2D incidence in normoglycemic adults.

METHODS AND FINDINGS

This study was a population-based multiethnic retrospective cohort of 1,744 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) with normoglycemia (baseline fasting plasma glucose [FPG] less than 100 mg/dL) from 6 United States of America communities. Participants were followed from April 2010 and January 2012 to December 2017, for a median of 7 years. The intermuscular adipose tissue (IMAT) and SAT areas were measured in baseline chest CT exams and were corrected by height squared (SAT and IMAT indices) using a predefined measurement protocol. T2D incidence, as the main outcome, was based on follow-up FPG, review of hospital records, or self-reported physician diagnoses. Participants' mean age was 69 ± 9 years at baseline, and 977 (56.0%) were women. Over a median of 7 years, 103 (5.9%) participants were diagnosed with T2D, and 147 (8.4%) participants died. The IMAT index (hazard ratio [HR]: 1.27 [95% confidence interval [CI]: 1.15-1.41] per 1-standard deviation [SD] increment) and the SAT index (HR: 1.43 [95% CI: 1.16-1.77] per 1-SD increment) at baseline were associated with T2D incidence over the follow-up. The associations of the IMAT and SAT indices with T2D incidence were attenuated after adjustment for body mass index (BMI) and waist circumference, with HRs of 1.23 (95% CI: 1.09-1.38) and 1.29 (95% CI: 0.96-1.74) per 1-SD increment, respectively. The limitations of this study include unmeasured residual confounders and one-time measurement of adipose tissue biomarkers.

CONCLUSIONS

In this study, we observed an association between IMAT at baseline and T2D incidence over the follow-up. This study suggests the potential role of intermuscular adipose depots in the pathophysiology of T2D.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00005487.

The triglycerides and glucose index is strongly associated with hepatic steatosis in children with overweight or obesity

Given the worldwide increase prevalence of overweight, obesity, and nonalcoholic fatty liver disease (NAFLD), the objective of this study was to evaluate whether the triglycerides and glucose (TyG) index is associated with hepatic steatosis in children with overweight or obesity. Apparently healthy children aged 5‑17 years were included and allocated into the groups with and without hepatic steatosis. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)]/2. Hepatic steatosis was diagnosed by ultrasonography. A total of 177 children, 66 (37.3%) girls and 111 (62.7%) boys, were included in the study. According to the hepatic ultrasonography, they were allocated into the groups with (n = 100) and without (n = 77) hepatic steatosis. The adjusted analysis by gender, body mass index, and waist circumference revealed that HDL-C (OR 0.96; 95% CI: 0.93-0.99), triglycerides (OR 1.005; 95% CI: 1.001-1.009), AST (OR 1.03; 95% CI: 1.008-1.07), ALT (OR 1.03; 95% CI: 1.01-1.05), and TyG index (OR 4.07; 95% CI: 1.26-13.15) remained associated with hepatic steatosis.Conclusion: Compared to other biochemical markers, the TyG index is highly associated with the presence of fatty liver in children with overweight and obesity. What is known: • The triglycerides and glucose (TyG) index is effective in predicting high risk for incident nonalcoholic fatty liver disease (NAFLD) in adults. What is new: • Compared to other biochemical markers, the TyG index is highly associated with the presence of fatty liver in children with overweight or obesity. • The triglycerides and glucose index may be a useful tool to detect children at high risk of fatty liver.

Comparative evaluation of inflammatory parameters and substitute insulin resistance indices in elderly women with and without type 2 diabetes mellitus

PURPOSE

To analyze the influence of inflammatory parameters and substitute insulin resistance indices on the risk of type 2 diabetes mellitus (DM) development in elderly women, as well as to compare anthropometric measures and metabolic parameters according to the presence of type 2 DM and HbA1c levels.

PATIENTS AND METHODS

One hundred and twenty elderly women (67.9 ± 6.0 years) were submitted to anthropometric analysis, determination of inflammatory and metabolic parameters. They also underwent indices of lipid accumulation product (LAP), high density triglyceride/lipoprotein ratio (TG/HDL), triglyceride glucose index (TyG), as well as TyG by body mass index (BMI) ratio (TyG-BMI) assessment.

RESULTS

Body mass index, tumor necrosis factor alpha, interleukin-2, blood glucose, TG, LAP, TG/HDL, TyG and TyG-BMI were significantly higher in elderly women with DM compared to non-diabetic women. LAP ≥ 55.4 (OR = 2.29; P = .027); TyG ≥ 8.8 (OR = 3.52; P < .001) and TyG-BMI ≥ 264.8 (OR = 3.54; P = .001) were identified as risk factors for DM.

CONCLUSION

High pro-inflammatory parameters, low levels of anti-inflammatory markers and higher levels of substitute insulin resistance indices are risk predictors for DM development in elderly women in primary health care.

Association of the triglyceride and glucose index with low muscle mass: KNHANES 2008-2011

The triglyceride-glucose (TyG) index is a simple surrogate marker of insulin resistance. We evaluated the association of the TyG index with low muscle mass using a nationwide population-based representative data. This is a cross-sectional study that included 9477 participants aged ≥ 40 years from the Korea National Health and Nutrition Examination Survey between 2008 and 2011. The TyG index was calculated as ln[triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2]. Dual-energy X-ray absorptiometry was used to measure appendicular lean mass (ALM). Low muscle mass was defined an ALM/weight of 2 standard deviations (SD) below of young participants. The overall prevalence of low muscle mass was 4.7%. The prevalence of low muscle mass increased linearly with the quartiles of the TyG index, 2.5%, 4.2%, 5.6%, and 6.7% in Q1–Q4, respectively. The TyG index was negatively associated with ALM/weight both in men (r = − 0.302) and women (r = − 0.230). The odds ratio (OR) for low muscle mass was 2.08 in the highest quartile compared to the lowest quartile. High TyG index was associated with an increased risk of low muscle mass (OR for 1SD increase: 1.13). Increased TyG index was associated with the risk of low muscle mass independent of confounding factors.

Implicit Affect, Heart Rate Variability, and the Metabolic Syndrome

OBJECTIVE

Greater negative affect has been associated with an increased risk of the metabolic syndrome (METs). However, all studies to date have examined this association using explicit affect measures based on subjective ratings of emotional experiences. Prior studies suggest that implicit affect, representing the automatic, prereflective appraisal process involved in conscious emotional experiences, is associated with physiological stress responses independent of explicit affect. Furthermore, low resting heart rate variability (HRV) may increase the risk of stress-related diseases. The goals of this study were to evaluate the associations between implicit and explicit affect and METs and to assess whether these associations were amplified by lower HRV.

METHODS

This secondary analysis of a larger study included 217 middle-aged women who completed measures of implicit affect, explicit affect, high-frequency HRV, and the different components of METs.

RESULTS

There was a significant interaction between implicit negative affect and HRV predicting METs (odds ratio = 0.57, 95% confidence interval = 0.35-0.92), such that the combination of higher implicit affect and lower HRV was associated with a greater likelihood of METs. Similarly, there was a main effect of implicit negative affect as well as an interaction between implicit negative affect and HRV on the lipid accumulation product (b (standard error) = -0.06 (0.02), 95% confidence interval = -0.11 to -0.02), a combination of waist circumference and triglycerides.

CONCLUSIONS

Higher implicit negative affect in the context of lower HRV may be related to a greater risk of METs. The present findings highlight the relevance of including implicit affect measures in psychosomatic medicine research.

Association Between the Triglyceride-Glucose Index and the Incidence of Diabetes in People With Different Phenotypes of Obesity: A Retrospective Study

AIM

We aimed to examine the relationship between the Triglyceride-glucose (TyG) index and the incidence of type 2 diabetes in people with different phenotypes of obesity.

METHODS

From May 1, 1994 to December 31, 2016, 15,464 participants were enrolled in the medical examination program at the Murakami Memorial Hospital to determine the relationship between the TyG index and the incidence of type 2 diabetes in people with different phenotypes of obesity after 5.38 years of follow-up.

RESULTS

Besides triglycerides, HbA1c%, and FPG, the incidence of type 2 diabetes was found to be significantly associated with the TyG index (p <0.001), age (p <0.001), BMI (p = 0.033), current smoker (p <0.001), and fatty liver (p <0.001). In participants with visceral fat obesity and/or ectopic fat obesity and normal BMI, the TyG index was significantly associated with the incidence of type 2 diabetes after adjusting for confounding factors. In patients with BMI ≥25 mg/m², although there was a trend of the relationship between the TyG index and the incidence of type 2 diabetes, the relationship was no longer positive.

CONCLUSION

In participants with obesity involving visceral fat obesity and/or fatty liver and normal BMI which is not a measure of body fat distribution, there was a significant association between the TyG index and incidence of T2DM.

Lipid Accumulation Product Combined With Urine Glucose Excretion Improves the Efficiency of Diabetes Screening in Chinese Adults

BACKGROUND

To compare the efficacy of lipid accumulation product (LAP) and urine glucose excretion (UGE) in predicting diabetes and evaluate whether the combination of LAP and UGE would help to improve the efficacy of using LAP alone or UGE alone in identifying diabetes.

METHODS

Data from 7485 individuals without prior history of diabetes who participated in a cross-sectional survey in Jiangsu, China, were analyzed. Each participant underwent an oral glucose-tolerance test. Operating characteristic curves (ROC) and logistic regression analyses were used to evaluate the performance of LAP and UGE in identification of newly diagnosed diabetes (NDM) and prediabetes (PDM).

RESULTS

For subjects with NDM, the area under the ROC curve was 0.72 for LAP and 0.85 for UGE, whereas for PDM, these values were 0.62 and 0.61, respectively. Furthermore, LAP exhibited a comparable sensitivity with UGE in detecting NDM (76.4% vs 76.2%, p = 0.31). In predicting PDM, LAP showed a higher sensitivity than UGE (66.4% vs 42.8%, p < 0.05). The combination of LAP and UGE demonstrated a significantly higher sensitivity than that of LAP alone and UGE alone for identification of NDM (93.6%) and PDM (80.1%). Moreover, individuals with both high LAP and high UGE had significantly increased risk of NDM and PDM than those with both low LAP and low UGE.

CONCLUSIONS

The combination of LAP and UGE substantially improved the efficacy of using LAP and using UGE alone in detecting diabetes, and may be a novel approach for mass screening in the general population.

Triglyceride-glucose index predicts independently type 2 diabetes mellitus risk: A systematic review and meta-analysis of cohort studies

OBJECTIVE

Our objective was to perform a systematic review and meta-analysis of cohort studies evaluating the triglyceride-glucose (TyG) index as a tool for type 2 diabetes (T2D) prediction in adults and older adults.

METHODS

Studies were identified in PubMed, Cochrane, Scopus, and Lilacs. Studies with cohort design, which evaluated the T2D incidence through the hazard ratio (HR) or relative risk (RR) or odds ratio values were included. Were included both studies that evaluated the incidence of T2D from tertiles, quartiles, quintiles, or single TyG index values. First, a meta-analysis only for studies that reported data in HR values was performed. Additionally, given the different association measurements used, the number of T2D cases, non-T2D cases, and the total number of participants were extracted from exposed and non-exposed groups when available. Then the risk ratio was calculated. A meta-analysis using the inverse variance method and the random-effects model was performed. Heterogeneity was assessed by I² statistics and by inspecting funnel plots.

RESULTS

Thirteen cohort studies with a total of 70,380 subjects, both sexes, adults, and older adults were included in the meta-analysis. Ten studies showed a significant association of the TyG index with T2D risk through HR estimative (overall HR: 2.44, 95% CI: 2.17-2.76). After estimating RR for nine studies, we also observed a significant association of the TyG index with T2D risk (RR: 3.12, 95 CI: 2.31-4.21). For all analyses, high heterogeneity was verified by I² and visual inspection of funnel plots.

CONCLUSIONS

TyG index has a positive and significant association with T2D risk, suggesting that the TyG index may become an applicable tool to identify subjects with T2D risk. However, due to the high heterogeneity observed in overall HR and RR analysis, more studies could be necessary to confirm these results.

Triglyceride glucose index for the detection of asymptomatic coronary artery stenosis in patients with type 2 diabetes

Background

Triglyceride Glucose (TyG) index has been associated with an increased risk in cardiovascular events. Silent coronary disease is common in patients with type 2 diabetes. In Vietnam, a low-middle income country, the burden of cardiovascular disease is growing simultaneously with the epidemiologic transition. Our aim was to assess the prevalence of coronary stenoses (CS) in patients with type 2 diabetes and no history or symptom of cardiovascular disease and to investigate the association between TyG index and cardiovascular risk factors and both the presence and severity of CS. Futhermore, we assessed the value of TyG index in predicting subclinical CS.

Methods

This was a cross-sectional observational study. We recruited 166 patients at Ninh Thuan General Hospital, Vietnam. TyG index and HOMA-IR were calculated, and a coronary computed tomography angiography (CCTA) was performed.

Results

The population was classified according to tertiles of TyG index. The highest TyG values were associated with higher BMI, waist circumference, total cholesterol, LDL-cholesterol, triglycerides, plasma glucose, HbA1c levels and HOMA-IR, lower HDL-cholesterol, a higher incidence of metabolic syndrome and less frequent physical activity (p < 0.05 to < 0.0001). TyG index correlated with logHOMA-IR (p < 0.0001). CS ≥ 50% were present in 60 participants and 32 had coronary artery stenosis ≥ 70%. TyG index and HOMA-IR were significantly higher in patients with CS ≥ 70%. The number of narrowed coronary arteries and the degree of stenosis were associated with higher TyG index levels (p = 0.04 and < 0.005 respectively). A TyG index ≥ 10 was significantly associated with an increased risk of multiple coronary artery disease and of more severe CS. After adjusting for confounding factors, including logHOMA-IR, these risks remained mostly significant. A TyG index threshold at 10 resulted in 57% sensitivity and 75% specificity for predicting the presence of CS ≥ 70%. In subgroup analysis TyG index ≥ 10 was associated with an increased risk in CS ≥ 70% in patients treated with statin or antiplatelet therapy.

Conclusion

More than one third of asymptomatic patients with type 2 diabetes had significant CS on CCTA. TyG index may be considered as a marker for insulin resistance and increased TyG index could identify patients with high risk of coronary artery stenoses and is associated with the number and the severity of artery stenoses.

Impacts of triglyceride-glucose index on prognosis of patients with type 2 diabetes mellitus and non-ST-segment elevation acute coronary syndrome: results from an observational cohort study in China

BACKGROUND

The relationship between triglyceride-glucose index (TyG index) and the prevalence and prognosis of cardiovascular disease has been confirmed by former studies. However, it remains uncertain whether TyG index has a prognostic impact in patients with type 2 diabetes mellitus (T2DM) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI).

METHODS

The study retrospectively enrolled 798 patients (mean age: 60.9 ± 8.3 years; 68.3% men) with T2DM and NSTE-ACS who underwent PCI at Beijing Anzhen Hospital from January to December 2015. TyG index was calculated as previously reported: ln [fasting TGs (mg/dL) * FBG (mg/dL)/2]. The primary endpoint was a composite of adverse events as follows: all-cause death, non-fatal myocardial infarction (MI) and ischemia-driven revascularization.

RESULTS

TyG index was significantly higher in patients with a primary endpoint event compared with those without. Multivariate Cox proportional hazards analysis showed that 1-unit increase of TyG index was independently associated with higher risk of primary endpoint, independent of other risk factors [hazard ratio (HR) 3.208 per 1-unit increase, 95% confidence interval (CI) 2.400-4.289, P < 0.001]. The addition of TyG index to a baseline risk model had an incremental effect on the predictive value for adverse prognosis [AUC: baseline risk model, 0.800 vs. baseline risk model + TyG index, 0.856, P for comparison < 0.001; category-free net reclassification improvement (NRI) 0.346, P < 0.001; integrated discrimination improvement (IDI) 0.087, P < 0.001].

CONCLUSIONS

Increased TyG index is a significant predictor of adverse prognosis in patients with T2DM and NSTE-ACS undergoing PCI. Further studies need to be performed to determine whether interventions for TyG index have a positive impact on improving clinical prognosis.

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.

Health Insurance Is Associated with Decreased Odds for Undiagnosed Prediabetes and Type 2 Diabetes in American Adults

Over a third of adults in the United States have prediabetes, and many of those with prediabetes will progress to type 2 diabetes within 3-5 years. Health insurance status may factor into a proper diagnosis of prediabetes and diabetes. This study sought to determine the associations between health insurance and undiagnosed prediabetes and diabetes in a national sample of American adults. Publicly available data from 13,029 adults aged 18-64 years from the 2005-2016 waves of the National Health and Nutrition Examination Survey were analyzed. Health insurance type (Medicaid, Private, Other, None) was self-reported. Prediabetes and diabetes status were assessed with measures of self-report, glycohemoglobin, fasting plasma glucose, and two-hour glucose. Covariate-adjusted logistic models were used for the analyses. Overall, 5976 (45.8%) participants had undiagnosed prediabetes, while 897 (6.8%) had undiagnosed diabetes. Having health insurance was associated with decreased odds ratios for undiagnosed prediabetes: 0.87 (95% confidence interval (CI: 0.79, 0.95)) for private insurance, 0.84 (CI: 0.73, 0.95) for other insurance, and 0.78 (CI: 0.67, 0.90) for Medicaid. Moreover, having private health insurance was associated with 0.82 (CI: 0.67, 0.99) decreased odds for undiagnosed diabetes. Health insurance coverage and screening opportunities for uninsured individuals may reduce prediabetes and diabetes misclassifications.

Objectives, design and main findings until 2020 from the Rotterdam Study

The Rotterdam Study is an ongoing prospective cohort study that started in 1990 in the city of Rotterdam, The Netherlands. The study aims to unravel etiology, preclinical course, natural history and potential targets for intervention for chronic diseases in mid-life and late-life. The study focuses on cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1700 research articles and reports. This article provides an update on the rationale and design of the study. It also presents a summary of the major findings from the preceding 3 years and outlines developments for the coming period.

Comparison of Novel Metabolic Indices in Estimation of Chronic Kidney Diseases in a Southern Chinese Population

BACKGROUND

To determine the optimal cut-off values and evaluate the associations of product of triacylglycerol and glucose (TyG), lipid accumulation product (LAPI), visceral adiposity index (VAI) with chronic kidney diseases (CKD) stratified by sex.

METHODS

From January to April 2018, our team had conducted a large-scale cross-sectional survey that contained 2720 individuals on the southern coast of China. Logistic regression analysis and receiver operating characteristic (ROC) analyses were used to evaluate the optimal cut-off and value of TyG, LAPI, VAI for predicting CKD.

RESULTS

A multivariate logistic regression analysis found that the TyG had the better value of prediction for the presence of CKD for the highest quartile vs the lowest quartile in both males (OR: 3.65; 95% CI, 2.04-6.52; p<0.001) and females (OR: 3.50; 95% CI, 2.20-5.56; p<0.001), followed by LAPI and VAI, when further adjusted for cofounder factors, LAPI and VAI both lost their independence, and only TyG remains its significant association with CKD in both males (OR: 2.81; 95% CI, 1.25-6.30; p<0.001) and females (OR: 3.22; 95% CI, 1.56-6.61; p<0.001). ROC curve showed that TyG had the highest AUC for predicting CKD in males (AUC: 0.618). TyG (AUC: 0.670) and LAPI (AUC: 0.670) both had the highest AUC in females. United predicted models which contain TyG were conducted for predicting CKD in males (AUC: 758) and females (AUC: 0.773) and results indicated that multivariate analysis of TyG and other traditional factors can impressively improve the accuracy of predictive probability for CKD.

CONCLUSION

TyG is a priority to the other two novel indices and may become valuable makers and have strong predictive power for predicting CKD, especially in females.