Predictive capacity of triglyceride-glucose (TyG) index for insulin resistance and cardiometabolic risk in children and adolescents: a systematic review

Comparison of triglyceride-glucose related indices in prediction of cardiometabolic disease incidence among US midlife women

The effects of triglyceride-glucose (TyG) related indices on cardiometabolic disease (CMD) are still unclear. Our study aimed to investigate the relationship between the TyG-related indices and CMD risk among midlife women. This retrospective observational cohort study utilized data from the 2020 SWAN participants. The TyG index was computed as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Modified TyG indices were created by integrating TyG with body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Multivariate Cox proportional hazards regression and receiver operating characteristic (ROC) analyses were conducted to assess the associations and predictive capacities of TyG and its related indices with CMD incidences. The mean age of participants was 45.7 years, comprising 420 (20.8%) Black, 184 (9.1%) Chinese, 225 (11.1%) Japanese, and 1191 (58.9%) Caucasian or Hispanic women. Over a 10-year follow-up, 837 women (41.4%) developed CMD. Compared to the lowest quartile, the adjusted hazard ratios (95% confidence intervals) for incident CMD in the highest quartile for TyG, TyG-BMI, TyG-WC, and TyG-WHtR were 1.78 (1.41-2.25), 3.26 (2.51-4.24), 3.13 (2.41-4.06), and 3.19 (2.47-4.12), respectively. The area under the ROC curve for modified TyG indices was significantly higher than that for the TyG index alone. Both the TyG and modified TyG indices were significantly associated with new-onset CMD, with modified TyG indices showing superior performance in identifying individuals at risk for CMD.

Comparison of triglyceride glucose index and other insulin resistance indexes in children with overweight and obesity

OBJECTIVES

The aim of the study was to determine the correlation between insulin resistance (IR) indexes in children with overweight or obesity.

METHODS

A total of 276 children with overweight or obesity and 100 normal-weight children were enrolled in the study. IR indexes such as homeostasis model assessment insulin resistance (HOMA-IR), quantitative insulin-sensitivity check index (QUICKI), fasting glucose/insulin ratio (FGIR), Triglyceride glucose index (TyG), and lipid-derived ratios were determined.

RESULTS

The mean ages were 13.0 ± 2.6, 13.1 ± 2.7 and 12.72 ± 2.23 (range:6 - 18 years) for children with overweight, obesity and normal-weight, respectively. A statistically significant positive correlation was found between HOMA-IR and TyG index, and a negative correlation between QUICKI, FGIR and TyG index (r = 0.193, P < 0.001; r = - 0.456, P < 0.001 and r = - 0.392, P < 0.001, respevtively). TyG index, triglyceride (TG)/high-density lipoprotein (HDL), total cholesterol (TC)/HDL, and low-density lipoprotein (LDL)/HDL were higher in children with IR than those without IR (P < 0.05). In receiver operating characteristic curves analysis, cut-off points were found to be ≤ 0.31 for QUICKI (94.31% sensitivity and 97.58% specificity), ≤ 6.3 for FGIR (89.1% sensitivity and 93.94% specificity), and > 4.62 for TyG (49.29% sensitivity and 84.85% specificity).

CONCLUSION

HOMA-IR, FGIR, and QUICKI constitute stronger predictors of IR than TyG index in children with overweight and obesity.

Associations of the triglyceride-glucose index with short-term mortality in patients with cardiogenic shock: a cohort study

BACKGROUND

Cardiogenic shock (CS) is a severe cardiac disorder with a high mortality rate. The triglyceride-glucose (TyG) index, a biomarker of insulin resistance, is associated with cardiovascular disease-related mortality. This study aimed to investigate the association between the TyG index and mortality in patients with CS.

METHODS

This retrospective cohort study analyzed 727 patients with CS from the Medical Information Mart for Intensive Care IV database. The TyG index was calculated as follows: ln[triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Outcomes included 28-day intensive care unit (ICU) mortality and 28-day in-hospital mortality. Kaplan-Meier survival curve models and Cox proportional hazards regression models were used to evaluate the prognostic significance of the TyG index. Receiver Operating Characteristic (ROC) curve analysis was used to determine the predictive efficacy of the TyG index for mortality. Subgroup analyses were conducted to determine the association between the TyG index and mortality across different groups.

RESULTS

Non-survivors had a significantly higher TyG index (ICU: 9.30 vs. 9.13, p = 0.008; in-hospital: 9.29 vs. 9.13, p = 0.004). Adjusted Cox models showed that each 1-unit increase in the TyG index increased ICU mortality risk by 24% (hazard ratio [HR] = 1.24, 95% confidence interval [CI]:1.04-1.48; p = 0.015) and in-hospital mortality by 44% (HR = 1.44, 95% CI:1.11-1.88; p = 0.007). The Quartile 4 TyG index ICU mortality was increased by 77% (HR = 1.77, 95% CI:1.09-2.89) compared to that for Quartile 1 and in-hospital mortality was increased by 61% (HR = 1.61, 95% CI:1.08-2.38). The area under the ROC curve (AUROC) showed a modest standalone predictive ability of 0.56, but when combined with clinical variables, the AUROC improved to 0.80 (ICU) and 0.78 (in-hospital). Subgroup analyses identified stronger associations in patients ≥ 60 years, females, non-septic, and those with acute myocardial infarction or heart failure.

CONCLUSIONS

The TyG index is significantly associated with short-term mortality in patients with CS and may serve as a useful biomarker for risk stratification.

TRIAL REGISTRATION

Not applicable.

Associations of modified triglyceride-glucose indices and the triglyceride/high-density lipoprotein ratio with all-cause and cause-specific mortality in the general population: an analysis of the UK biobank database

BACKGROUND

This study investigates the associations between modified triglyceride-glucose (TyG) indices and the triglyceride-to-high-density lipoprotein (TG/HDL) ratio, which are recognized as simple surrogate indicators of insulin resistance, with all-cause and cause-specific mortality.

METHODS

A cohort of 410,515 participants from the UK Biobank was analyzed. Cox proportional hazard models and restricted cubic spline regression analyses were employed to examine the relationships between the TyG index, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TG/HDL ratio, and all-cause and cause-specific mortality. Structural equation modeling was employed to elucidate the associations between the TyG index, TG/HDL ratio, inflammation, metabolism, and mortality.

RESULTS

The TyG index, TyG-WC, and TG/HDL ratio were associated with an increased risk of all-cause mortality by 3.7% (HR 1.037 [1.016, 1.059]), 0.1% (HR 1.001 [1.024, 1.031]), and 1.5% (HR 1.015 [1.006, 1.025]), respectively. Restricted cubic spline regression models revealed nonlinear trends in the TyG index, TyG-BMI, TyG-WC, and TG/HDL ratio in relation to both all-cause and cause-specific mortality (P for nonlinearity < 0.05). TyG index and TG/HDL ratio exhibited a J-shaped relationship with all-cause mortality as well as mortality from cancer, cardiovascular diseases, and respiratory diseases. Similarly, TyG-BMI demonstrated an L-shaped association with all-cause mortality and mortality due to cancer, cardiovascular diseases, and respiratory diseases. Additionally, TyG-WC was associated with a progressively increasing mortality risk once it exceeded a certain threshold. Structural equation modeling demonstrated that the TyG index and TG/HDL ratio influenced mortality through inflammation and lifestyle factors.

CONCLUSIONS

In conclusion, TyG, TyG-BMI, TyG-WC, and TG/HDL ratio are significantly associated with all-cause and cause-specific mortality in the general population.These associations appear to be linked to inflammation and lifestyle.

Cholesterol, high-density lipoprotein, and glucose index versus triglyceride-glucose index in predicting cardiovascular disease risk: a cohort study

BACKGROUND

Cardiovascular disease (CVD) represents a significant global health challenge, characterized by high incidence rates and substantial morbidity and mortality. A newer index, the Cholesterol, High-Density Lipoprotein, and Glucose (CHG) index, has been proposed as a potential diagnostic tool for metabolic disorders but has not been investigated for its ability to predict CVD risk. This study aims to evaluate the predictive efficacy of the CHG index in comparison to the well-established Triglyceride-Glucose (TyG) index.

METHODS

In this cohort study, 6249 adults aged 45 and older were recruited from the CHARLS database, with data collected from 2011 to 2020. CVD events were tracked over a nine-year follow-up. The TyG and CHG indices were calculated, and their relationships with CVD risk were assessed using univariate and multivariate Cox regression models. Additionally, restricted cubic spline (RCS) analysis was performed to further explore these associations. Receiver operating characteristic (ROC) analysis was conducted to compare the predictive performance of both indices, and subgroup analysis evaluated their applicability in different populations.

RESULTS

Among the 6249 participants, 1667 (26.68%) developed CVD during the nine-year follow-up. In unadjusted Cox regression models, the TyG index had a hazard ratio (HR) of 1.18 (95% confidence interval CI 1.10-1.27, p < 0.001), while the CHG index showed a higher HR of 1.35 (95% CI 1.21-1.51, p < 0.001). In the adjusted models, the relationship still persisted. The RCS models showed that the TyG index exhibited a non-linear relationship with the risk of CVD, while the CHG index demonstrated a positive linear correlation. ROC curve analysis revealed comparable predictive performance for both indices. The subgroup analysis indicated that there was no interaction between the subgroups and the both indices (p for interaction > 0.05).

CONCLUSIONS

An elevated CHG index is significantly correlated with an increased risk of CVD, demonstrating a linear relationship. Furthermore, it exhibits predictive capabilities comparable to those of the TyG index in assessing CVD risk.

TRIAL REGISTRATION

Not applicable.

Predictive Accuracy of Biochemical and Anthropometric Indices for Metabolic Syndrome in Children with Obesity: A Comparative Study

Children with obesity, regardless of gender, are a high-risk population that requires ongoing monitoring not only for present obesity and metabolic syndrome (MetS) but also future risks of metabolic, cardiac, musculoskeletal, and psychiatric complications. Data from a cohort of 185 obese children who underwent a second follow-up in 2019 were used for this retrospective study. The study cohort consisted of 94 boys and 91 girls who were elementary school students with a mean age of 10.2 ± 0.5 years. Following anthropometric and biochemical assessments, the cardio metabolic index (CMI), visceral adiposity index (VAI), triglyceride-glucose index (TyGI), and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated. The overall prevalence of MetS was 19.5% (12.8% in boys and 26.4% in girls). According to the receiver operating characteristic curve analysis, CMI, VAI, and TyGI performed significantly better than HOMA-IR in identifying MetS. CMI was the most accurate predictor of MetS, as indicated by the highest area under the curve value, in both genders. In conclusion, our findings suggest that the CMI can serve as a practical, efficient, and affordable screening tool for the ongoing monitoring of childhood obesity in both daily endocrine clinical practice and primary care settings.

Triglyceride-glucose index mediates the association between residual cholesterol and stroke among middle-aged and older adults in China: a prospective, nationwide, population-based study

Background

Both triglyceride-glucose (TyG) index and residual cholesterol (RC) are predictors of stroke; however, to what extent the RC is associated with stroke through TyG index is unclear. This study examined whether the TyG index mediates the association of RC with incident stroke and the extent of interaction or joint relations of RC and TyG index with stroke in middle-aged and older Chinese adults.

Methods

This is an ongoing prospective cohort study initiated in 2011 that included 10,569 middle-aged and older Chinese adults without stroke at baseline. The exposure was RC, the mediator was TyG index, and the outcome was stroke which followed up from June, 2011, to June, 2018. Mediation analysis was used to explore whether the TyG index mediated the association between RC and stroke risk.

Results

Of the 10,569 participants, 4,978 (47.1%) were men; the mean (SD) age was 59.01 (9.43) years. During a median follow-up of 7.1 years, 734 (7.0%) participants experienced a stroke. In the adjusted Cox models, A one SD increase in RC was associated with an elevated risk of stroke (HR, 1.09; 95% CI, 1.02-1.16), as well as TyG index (HR, 1.14; 95% CI, 1.06-1.23). No significant multiplicative or additive interactions were found between the TyG index and RC on stroke risk (HR for multiplicative: 1.07, 95% CI, 0.67-1.70; Synergy index: 1.05, 95% CI, 0.16-6.88). TyG index mediated the association between RC and stroke (b, -0.16; 95% CI, -0.30 to -0.03). Subgroup analyses and sensitivity analyses showed consistent results.

Conclusions

This study evidence that the TyG index completely mediates the association between RC and stroke risk among middle-aged and older Chinese adults. These findings highlight the importance of considering RC and the TyG index in stroke risk assessment.

Triglyceride-glycaemic index: Insights into predicting fetal macrosomia and its interaction with gestational diabetes mellitus: A cohort study of Chinese pregnant women

OBJECTIVE

This study investigates the association between a new insulin resistance indicator, the triglyceride-glucose (TyG) index, and the risk of macrosomia.

DESIGN

This is a prospective cohort study.

METHODS

This study included 1332 women who delivered at Peking University International Hospital between October 2017 and August 2019. Participants were divided equally into three groups based on the TyG index. Logistic regression and restricted cubic spline (RCS) analyses were used to evaluate the relationship between the TyG index and macrosomia and conducted subgroup analyses. The TyG index's ability to predict macrosomia was assessed using the receiver operating characteristic (ROC) curve.

RESULTS

Multivariable logistic regression analysis revealed that the TyG index is an independent risk factor for macrosomia (Odds ratio [OR] 1.84, 95% confidence interval [CI] 1.02-3.30, p < .05). RCS analysis indicates that the risk of macrosomia increases with the rise of the TyG index (p for nonlinearity <.001) when the TyG index is >6.53. Subgroup analysis showed a synergistic additive interaction between the TyG index and gestational diabetes mellitus (GDM) of macrosomia. The area under the ROC curve for the predictive model was 0.733 (95% CI 0.684, 0.781), with a sensitivity of 76.4% and specificity of 66.9%. Incorporating the TyG index alongside traditional risk factors notably enhances macrosomia prediction (p < .05).

CONCLUSIONS

The TyG index independently predicts macrosomia, and exhibits an additive interaction with GDM in its occurrence. Integrating the TyG index with traditional risk factors improves the prediction of macrosomia.

TRIAL REGISTRY

Clinical trials. gov [NCT02966405].

The clinical evaluation of the triglyceride-glucose index as a risk factor for coronary artery disease and severity of coronary artery stenosis in patients with chronic kidney disease

INTRODUCTION

Insulin resistance (IR) plays an important role in the occurrence and development of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). The triglyceride-glucose (TyG) index is a simple and effective tool to evaluate IR. This study aimed to evaluate the association of the TyG index with coronary artery disease (CAD) and the severity of coronary artery stenosis (CAS) in nondialysis patients with stages 3-5 CKD.

METHODS

Nondialysis patients with stages 3-5 CKD who underwent the first coronary angiography at Zhongda Hospital affiliated with Southeast University from August 2015 to January 2017 were retrospectively analyzed. CAS was measured by coronary angiography, and the CAS score was calculated as the Gensini score. Logistic regression analysis was used to determine the related factors of CAD and severe CAS.

RESULTS

A total of 943 patients were enrolled in this cross-sectional study and 720 (76.4%) of these patients were diagnosed with CAD. The TyG index in the CAD group (7.29 ± 0.63) was significantly higher than that in the non-CAD group (7.11 ± 0.61) (p < 0.001). Multivariate logistic regression analysis showed that a higher TyG index was an independent risk factor for CAD in CKD patients after adjusting for related confounding factors (OR = 2.865, 95% CI 1.681-4.885, p < 0.001). Patients in the CAD group were divided into three groups according to the Gensini integral quantile level. Multivariate logistic regression analysis showed that the TyG index was an independent related factor for severe CAS after adjusting for relevant confounding factors (p < 0.001).

CONCLUSIONS

The TyG index is associated with CAD and the severity of CAS in patients with nondialysis stages 3-5 CKD. A higher TyG index is an independent factor for CAD and severe CAS.

Association between triglyceride-glucose index and the risk of heart failure hospitalization in older diabetic patients received right ventricular pacing: a retrospective cohort study

BACKGROUND

The prognostic value of triglyceride-glucose (TyG) index is not yet known for older diabetic patients received right ventricular pacing (RVP). We aimed to investigate the association between TyG index and the risk of heart failure hospitalization (HFH) in older diabetic patients received RVP.

METHODS

This study was conducted between January 2017 and January 2018 at Fuwai Hospital, Beijing, China, and included older (age ≥ 65 years) diabetic patients that received RVP for the first time. TyG index were obtained before implantation. The primary endpoint was HFH.

RESULTS

A total of 231 patients were divided into three groups according to the tertiles of TyG index: < 8.5 (T1, N = 77), 8.5-9.1 (T2, N = 77), and > 9.1 (T3, N = 77). T3 group had higher rate of HFH (Log-rank = 11.7, P = 0.003). Multivariate analyses showed that, TyG index served as an independent predictor for HFH, both as numerical variable (HR = 1.94, 95% CI 1.21-3.11, P = 0.006), and as categorical variable (HR = 2.31, 95% CI 1.09-4.89, P = 0.03). RCS demonstrated that the risk of HFH was relatively low until TyG index exceeded 8.8, beyond which the risk began to increase rapidly (P-non-linear = 0.006).

CONCLUSION

Preimplantation TyG index emerges as a robust, independent predictor for HFH in older diabetic patients received RVP, and TyG index > 8.8 might be the optimal cut-off value.

Second-trimester triglyceride-glucose index to predict adverse outcomes in women with gestational diabetes mellitus: A retrospective multicenter cohort study

AIMS/INTRODUCTION

Women with gestational diabetes mellitus are at high risk for adverse maternal and neonatal outcomes. The study aimed to evaluate the performance of the triglyceride-glucose index in predicting the risk of developing adverse outcomes in women with gestational diabetes mellitus.

MATERIALS AND METHODS

This retrospective multicenter cohort study included 8,808 pregnant women with gestational diabetes mellitus in two grade-A tertiary hospitals in China during 2018-2022. The triglyceride-glucose index was defined as ln [triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. Significant adverse gestational diabetes mellitus outcomes were chosen by generalized linear models as the main outcomes. Multivariable logistic regression models evaluated their association with the triglyceride-glucose index. Areas under the receiver operating characteristic curves predicted adverse pregnancy outcomes. The prediction efficiency was validated in the sensitivity analysis dataset and validation cohort.

RESULTS

The triglyceride-glucose index was associated with preeclampsia, severe preeclampsia, preterm birth, placenta accreta spectrum, and macrosomia before and after adjusting for confounding factors (P < 0.05). The predictive performance of the triglyceride-glucose index was relatively moderate. Incorporating the triglyceride-glucose index into the baseline clinical risk model improved the area under curves for the diagnosis of preeclampsia (0.749 [0.714-0.784] vs 0.766 [0.734-0.798], P = 0.033) and macrosomia (0.664 [0.644-0.685] vs 0.676 [0.656-0.697], P = 0.002). These predictive models exhibited good calibration and robustness.

CONCLUSIONS

The triglyceride-glucose index is positively associated with preeclampsia, severe preeclampsia, preterm birth, placenta accreta spectrum, and macrosomia and is useful for the early prediction and prevention of adverse outcomes in women with gestational diabetes mellitus.

Exploring Gender Differences in the Association Between TyG Index and COPD: A Cross-Sectional Study from NHANES 1999-2018

Purpose

This study examined gender differences in the association of Triglyceride-Glucose (TyG) index with the prevalence of chronic obstructive pulmonary disease (COPD), particularly in a non-diabetic population.

Methods

The study leveraged data from the National Health and Nutrition Examination Survey (NHANES), spanning from 1999 to 2018, with a cohort of 23,456 participants. Logistic regression and restricted cubic spline analyses were employed to explore the relationship between the TyG index and COPD prevalence.

Results

Statistical analyses revealed a significant positive association between the TyG index and COPD prevalence among non-diabetic women after adjustment for all covariates (OR=1.50; 95% CI, 1.08-2.08), supported by a linear relationship (P for non-linearity=0.298). No equivalent significant association was found in non-diabetic men (OR=1.00; 95% CI, 0.67-1.48). Within the diabetic group, the TyG index did not show a significant association with COPD prevalence, regardless of gender.

Conclusion

Our study reveals a significant positive correlation between the TyG index and COPD prevalence in the non-diabetic population, marked by notable gender differences.

Mediation effect of body mass index on the association between serum magnesium level and insulin resistance in children from Mexico City

BACKGROUND/OBJECTIVES

Reduced serum magnesium (Mg) levels have been associated with obesity, insulin resistance (IR), type 2 diabetes, and metabolic syndrome in adults. However, in the children population, the evidence is still limited. In this cross-sectional study, we aimed to analyze the association of serum Mg levels with the frequency of overweight and obesity and cardiometabolic traits in 189 schoolchildren (91 girls and 98 boys) between 6 and 12 years old from Mexico City.

SUBJECTS/METHODS

Anthropometrical data were collected and biochemical parameters were measured by enzymatic colorimetric assay. Serum Mg level was analyzed by inductively coupled plasma mass spectrometry (ICP-MS). The triglyceride-glucose (TyG) index was used as a surrogate marker to evaluate IR.

RESULTS

Serum Mg level was negatively associated with overweight (Odds ratio [OR] = 0.377, 95% confidence interval [CI] 0.231-0.614, p < 0.001) and obesity (OR = 0.345, 95% CI 0.202-0.589, p < 0.001). Serum Mg level resulted negatively associated with body mass index (BMI, β = -1.16 ± 0.26, p < 0.001), BMI z-score (β = -0.48 ± 0.10, p < 0.001) and TyG index (β = -0.04 ± 0.04, p = 0.041). Through a mediation analysis was estimated that BMI z-score accounts for 60.5% of the negative association of serum Mg level with IR (Sobel test: z = 2.761; p = 0.005).

CONCLUSION

Our results evidence that BMI z-score mediate part of the negative association of serum Mg level and IR in Mexican schoolchildren.

Diagnostic and prognostic value of triglyceride glucose index: a comprehensive evaluation of meta-analysis

OBJECTIVE

The present umbrella review aims to collate and summarize the findings from previous meta-analyses on the Triglyceride and Glucose (TyG) Index, providing insights to clinicians, researchers, and policymakers regarding the usefulness of this biomarker in various clinical settings.

METHODS

A comprehensive search was conducted in PubMed, Scopus, and Web of Science up to April 14, 2024, without language restrictions. The AMSTAR2 checklist assessed the methodological quality of the included meta-analyses. Statistical analyses were performed using Comprehensive Meta-Analysis (CMA) software.

RESULTS

A total of 32 studies were finally included. The results revealed significant associations between the TyG index and various health outcomes. For kidney outcomes, a high TyG index was significantly associated with an increased risk of contrast-induced nephropathy (CIN) (OR = 2.24, 95% CI: 1.82-2.77) and chronic kidney disease (CKD) (RR = 1.46, 95% CI: 1.32-1.63). High TyG index was significantly associated with an increased risk of type 2 diabetes mellitus (T2DM) (RR = 3.53, 95% CI: 2.74-4.54), gestational diabetes mellitus (GDM) (OR = 2.41, 95% CI: 1.48-3.91), and diabetic retinopathy (DR) (OR = 2.34, 95% CI: 1.31-4.19). Regarding metabolic diseases, the TyG index was significantly higher in patients with obstructive sleep apnea (OSA) (SMD = 0.86, 95% CI: 0.57-1.15), metabolic syndrome (MD = 0.83, 95% CI: 0.74-0.93), and non-alcoholic fatty liver disease (NAFLD) (OR = 2.36, 95% CI: 1.88-2.97) compared to those without these conditions. In cerebrovascular diseases, a higher TyG index was significantly associated with an increased risk of dementia (OR = 1.14, 95% CI: 1.12-1.16), cognitive impairment (OR = 2.31, 95% CI: 1.38-3.86), and ischemic stroke (OR = 1.37, 95% CI: 1.22-1.54). For cardiovascular outcomes, the TyG index showed significant associations with an increased risk of heart failure (HF) (HR = 1.21, 95% CI: 1.12-1.30), atrial fibrillation (AF) (SMD = 1.22, 95% CI: 0.57-1.87), and hypertension (HTN) (RR = 1.52, 95% CI: 1.25-1.85).

CONCLUSION

The TyG index is a promising biomarker for screening and predicting various medical conditions, particularly those related to insulin resistance and metabolic disorders. However, the heterogeneity and methodological quality of the included studies suggest the need for further high-quality research to confirm these findings and refine the clinical utility of the TyG index.

Long term administration of thiamine disulfide improves FOXO1/PEPCK pathway in liver to reduce insulin resistance in type 1 diabetes rat model

OBJECTIVE

The main objective of this study was to find if thiamine disulfide (TD) lowers blood glucose level and improves insulin resistance (IR) in liver and muscle in rats with chronic type 1 diabetes (T1DM) using euglycemic-hyperinsulinemic clamp technique.

METHODS

A total of fifty male Wistar rats were assigned to five groups consisted of: non-diabetic control (NDC), diabetic control (DC), diabetic treated with thiamine disulfide (D-TD), diabetic treated with insulin (D-insulin), and diabetic treated with both TD and insulin (D-insulin+TD). Diabetes was induced by a 60 mg/kg dose of streptozotocin. Blood glucose levels, pyruvate tolerance test (PTT), intraperitoneal glucose tolerance test (IPGTT), levels of glycosylated hemoglobin (HbA1c), glucose infusion rate (GIR), liver and serum lipid profiles, liver glycogen stores, liver enzymes ([ALT], [AST]), and serum calcium and magnesium levels. were evaluated. Additionally, gene expression levels of phosphoenolpyruvate carboxykinase (Pepck), forkhead box O1 (Foxo1), and glucose transporter type 4 (Glut4) were assessed in liver and skeletal muscle tissues.

RESULTS

Blood glucose level was reduced by TD treatment. In addition, TyG index, HOMA-IR, serum and liver lipid profiles, HbA1c levels, and expressions of Foxo1 and Pepck genes were decreased significantly (P<0.05) in all the treated groups. However, TD did not influence Glut4 gene expression, but GIR as a critical index of IR were 5.0±0.26, 0.29±0.002, 1.5±0.07, 0.9±0.1 and 1.3±0.1 mg.min-1Kg-1 in NDC, DC, D-TD, D-insulin and D-insulin+TD respectively.

CONCLUSIONS

TD improved IR in the liver primarily by suppressing gluconeogenic pathways, implying the potential use of TD as a therapeutic agent in diabetes.

Triglyceride-glucose index and glycemic dynamics in pancreatic ductal adenocarcinoma: implications for disease progression and prognosis

BACKGROUND

To elucidate the relationship between the triglyceride-glycemic index (TyG) and clinical characteristics of pancreatic ductal adenocarcinoma (PDAC).

METHODS

A total of 1,594 individuals diagnosed with pancreatic and periampullary neoplasms were categorized into four groups: PDAC-early (n = 403), locally advanced PDAC (LAPC, n = 315), PDAC-late with distant metastasis (n = 371), and other tumor types (n = 505). TyG-high was defined as a TyG index greater than 8.81 in males and 8.73 in females.

RESULTS

The prevalence of TyG-high status was highest in PDAC-early (68.48%), followed by LAPC (53.33%), and lowest in PDAC-late (44.47%). TyG-high status significantly predicted worse PDAC prognosis (P = 0.0166), particularly in PDAC-late (P = 0.0420). Despite similar blood glucose levels across PDAC groups (P = 0.897), PDAC-early patients showed significantly higher rates of glycemic disturbances (56.33% vs. 32.28%) and TyG-high status (68.48% vs. 47.13%) compared to those with other tumors. Progressive increases in glycemic disturbances and TyG-high status were observed from benign to pre-malignant lesions and PDAC-early. PDAC-early patients at the pancreatic head exhibited higher rates of glycemic disturbances (58.12% vs. 33.33%, P < 0.0001), larger pancreatic duct diameters (0.4056 cm vs. 0.3398 cm, P = 0.0043), and poorer prognosis compared to periampullary cancers, although the TyG-high rate and body mass index were similar.

CONCLUSION

The TyG index exhibits a complex association with PDAC stages, profoundly shaping glycemic profiles. At the initial stages of PDAC, a notable elevation in TyG-high status and glycemic disturbances is observed. However, in advanced PDAC, while the TyG-high rate diminishes, abnormal glucose levels persist.

Triglyceride-Glucose Index as a Predictor of Major Adverse Cardiovascular Events in Post-PCI Patients Diagnosed with In-Stent Restenosis

Background

The triglyceride-glucose index (TyG) is a reliable indicator for predicting the prognosis of patients with coronary heart disease (CAD) after percutaneous coronary intervention (PCI). However, its influence on patients with in-stent restenosis (ISR) is unclear. This study was designed to evaluate the association between the TyG index and the occurrence of major adverse cardiovascular events (MACEs) after PCI in patients with ISR.

Methods

This retrospective study included 1654 patients who underwent PCI between 2016 and 2022 at Nanjing First Hospital. Patients were stratified into three groups based on the quantile level of the TyG index. The TyG index was determined as Ln (triglycerides [mg/dL] × fasting plasma glucose [mg/dL]/2).

Results

Individuals with the highest TyG index showed an increased risk of MACEs compared to those with the lowest level of the TyG index (HR 1.60; 95% CI 1.11-2.30; P = 0.01). When analyzing the TyG index as a continuous variable, each standard deviation increase was associated with an HR of 1.51 (95% CI: 1.11-2.05; P = 0.01). For the male subgroup and the diabetes subgroup, this trend was even more pronounced (HR 1.269; 95% CI 1.055-1.527; P = 0.011; HR 1.385; 95% CI 1.125-1.706; P = 0.002). Additionally, the landmark analysis showed that patients with the highest level of TyG had an increased risk of MACEs 6 months after the PCI (P = 0.019).

Conclusion

Elevated TyG index is associated with increased risk of adverse cardiovascular events in patients with ISR, and the extent of increase in the risk is more significant in male patients with diabetes.

Relationship between triglyceride-glucose index and cognitive function among community-dwelling older adults: a population-based cohort study

Background

The global increase in the aging population presents considerable challenges, particularly regarding cognitive impairment, a major concern for public health. This study investigates the association between the triglyceride-glucose (TyG) index, a measure of insulin resistance, and the risk of cognitive impairment in the elderly.

Methods

This prospective cohort study enrolled 2,959 participants aged 65 and above from the 2015 and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS). The analysis employed a logistic regression model to assess the correlation between the TyG index and cognitive impairment.

Results

The study included 2,959 participants, with a mean age of 71.2 ± 5.4 years, 49.8% of whom were female. The follow-up in 2020 showed a decrease in average cognitive function scores from 8.63 ± 4.61 in 2015 to 6.86 ± 5.45. After adjusting for confounding factors, a significant association was observed between TyG index quartiles and cognitive impairment. Participants in the highest quartile (Q4) of baseline TyG had a higher risk of cognitive impairment compared to those in the lowest quartile (Q1) (odds ratio [OR]: 1.97, 95% confidence intervals [CI]: 1.28-2.62, P<0.001).

Conclusion

The study highlights a significant connection between elevated TyG index levels and cognitive impairment among older adults in China. These findings suggest that targeted interventions to reduce the TyG index could mitigate cognitive impairment and potentially lower the incidence of dementia.

U-shaped association between triglyceride-glucose index and all-cause mortality among critically ill pediatrics: a population-based retrospective cohort study

BACKGROUND

Previous studies have shown that an elevated triglyceride-glucose (TyG) index was associated with all-cause mortality in both general adult individuals and critically ill adult patients. However, the relationship between the TyG index and clinical prognosis in pediatric patients admitted to the intensive care unit (ICU) remains unknown. We aimed to investigate the association of the TyG index with in-hospital all-cause mortality in critically ill pediatric patients.

METHODS

A total of 5706 patients in the Pediatric Intensive Care database were enrolled in this study. The primary outcome was 30-day in-hospital all-cause mortality, and secondary outcome was 30-day in-ICU all-cause mortality. The restricted cubic spline (RCS) curves and two-piecewise multivariate Cox hazard regression models were performed to explore the relationship between the TyG index and outcomes.

RESULTS

The median age of the study population was 20.5 [interquartile range (IQR): 4.8, 63.0] months, and 3269 (57.3%) of the patients were male. The mean TyG index level was 8.6 ± 0.7. A total of 244 (4.3%) patients died within 30 days of hospitalization during a median follow-up of 11 [7, 18] days, and 236 (4.1%) patients died in ICU within 30 days of hospitalization during a median follow-up of 6 [3, 11] days. The RCS curves indicated a U-shape association between the TyG index and 30-day in-hospital and in-ICU all-cause mortality (both P values for non-linear < 0.001). The risk of 30-day in-hospital all-cause mortality was negatively correlated with the TyG index until it bottoms out at 8.6 (adjusted hazard ratio [HR], 0.72, 95% confidence interval [CI] 0.55-0.93). However, when the TyG index was higher than 8.6, the risk of primary outcome increased significantly (adjusted HR, 1.51, 95% CI 1.16-1.96]). For 30-day in-ICU all-cause mortality, we also found a similar relationship (TyG < 8.6: adjusted HR, 0.75, 95% CI 0.57-0.98; TyG ≥ 8.6: adjusted HR, 1.42, 95% CI 1.08-1.85). Those results were consistent in subgroups and various sensitivity analysis.

CONCLUSIONS

Our study showed that the association between the TyG index and 30-day in-hospital and in-ICU all-cause mortality was nonlinear U-shaped, with a cutoff point at the TyG index of 8.6 in critically ill pediatric patients. Our findings suggest that the TyG index may be a novel and important factor for the short-term clinical prognosis in pediatric patients.

The impact of triglyceride-glucose index on the prognosis of post-PCI patients-a meta-analysis

Background

Previous research has demonstrated the validity of the triglyceride-glucose (TyG) index as a robust measure of insulin resistance (IR) and its association with coronary artery disease (CAD). The objective of this study is to elucidate the relationship between the TyG index and the prognosis of patients underwent percutaneous coronary intervention (PCI) through a comprehensive systematic review and meta-analysis. Our goal is to provide a thorough analysis of the available evidence to offer more clarity on this association.

Methods

A systematic and thorough search was carried out in the PubMed, Embase, Cochrane Library, and Web of Science databases, covering studies published in English from the beginning until October 1, 2023. The focus of the search was to gather relevant studies pertaining to the occurrence of major adverse cardiovascular events (MACE). To address the variability among the included studies, random or fixed effect models were utilized to summarize the hazard ratios (HR). In cases where heterogeneity was detected, subgroup or sensitivity analyses were performed to explore potential sources. To evaluate publication bias, the Egger or Begg test was employed.

Results

This study incorporated a total of 17 studies. Individuals with the highest TyG index exhibited an elevated risk of major adverse cardiovascular events (MACEs) compared to those with the lowest TyG index (HR = 1.69; 95% CI: 1.47-1.95; P < 0.001). When analyzing the TyG index as a continuous variable, each standard deviation increase was associated with an HR of 1.60 (95% CI: 1.48-1.73; P < 0.001). Moreover, in patients diagnosed with acute coronary syndrome (ACS), higher TyG index levels showed a trend of increased risk of MACE (HR = 1.54; 95% CI: 1.27-1.86; P < 0.001). Furthermore, an elevated TyG index was found to be associated with a higher risk of in-stent restenosis (HR = 1.62; 95% CI: 1.29-2.03; P < 0.001), new-onset atrial fibrillation (HR = 2.97; 95% CI: 2.10-4.06; P = 0.014), and a reduction in quantitative flow ratio (HR = 1.35; 95% CI: 1.101-1.592; P = 0.005). Subgroup analysis indicated the risk of MACE was comparable between varied durations of follow-up (P = 0.11). Furthermore, regression analysis revealed that the positive association between TyG index and the risk of MACE did not differ between individuals with or without diabetes (P = 0.23).

Conclusion

An increase in the TyG index may lead to a higher vulnerability to major adverse cardiovascular events (MACE) in patients underwent PCI and there was no significant difference in the risk of major adverse cardiovascular events (MACE) between diabetic and non-diabetic individuals.

Developing and validating a predictive model of delivering large-for-gestational-age infants among women with gestational diabetes mellitus

BACKGROUND

The birth of large-for-gestational-age (LGA) infants is associated with many short-term adverse pregnancy outcomes. It has been observed that the proportion of LGA infants born to pregnant women with gestational diabetes mellitus (GDM) is significantly higher than that born to healthy pregnant women. However, traditional methods for the diagnosis of LGA have limitations. Therefore, this study aims to establish a predictive model that can effectively identify women with GDM who are at risk of delivering LGA infants.

AIM

To develop and validate a nomogram prediction model of delivering LGA infants among pregnant women with GDM, and provide strategies for the effective prevention and timely intervention of LGA.

METHODS

The multivariable prediction model was developed by carrying out the following steps. First, the variables that were associated with LGA risk in pregnant women with GDM were screened by univariate analyses, for which the P value was < 0.10. Subsequently, Least Absolute Shrinkage and Selection Operator regression was fit using ten cross-validations, and the optimal combination factors were selected by choosing lambda 1se as the criterion. The final predictors were determined by multiple backward stepwise logistic regression analysis, in which only the independent variables were associated with LGA risk, with a P value < 0.05. Finally, a risk prediction model was established and subsequently evaluated by using area under the receiver operating characteristic curve, calibration curve and decision curve analyses.

RESULTS

After using a multistep screening method, we establish a predictive model. Several risk factors for delivering an LGA infant were identified (P < 0.01), including weight gain during pregnancy, parity, triglyceride-glucose index, free tetraiodothyronine level, abdominal circumference, alanine transaminase-aspartate aminotransferase ratio and weight at 24 gestational weeks. The nomogram's prediction ability was supported by the area under the curve (0.703, 0.709, and 0.699 for the training cohort, validation cohort, and test cohort, respectively). The calibration curves of the three cohorts displayed good agreement. The decision curve showed that the use of the 10%-60% threshold for identifying pregnant women with GDM who are at risk of delivering an LGA infant would result in a positive net benefit.

CONCLUSION

Our nomogram incorporated easily accessible risk factors, facilitating individualized prediction of pregnant women with GDM who are likely to deliver an LGA infant.

Association between triglyceride-glucose index and risk of endometriosis in US population: results from the national health and nutrition examination survey (1999-2006)

Background and Aims

The association of the triglyceride-glucose (TyG) index, a promising novel biomarker for insulin resistance, with the risk of endometriosis has not been investigated to date. This nationwide study aimed to explore the association between the TyG index and the endometriosis risk.

Methods

Data were obtained from the National Health and Nutrition Examination Survey (1999-2006). Female participants who provided complete data on the TyG index and endometriosis were enrolled in the analysis. Multivariate logistic regression analyses were utilized to assess the association of the TyG index with endometriosis, adjusted by multiple potential confounders. Meanwhile, in-depth subgroup analyses were conducted.

Results

A total of 1,590 eligible participants were included, among whom 135 (8.5%) women were diagnosed with endometriosis. The fully adjusted multivariate logistic model showed TyG index was significantly associated with the endometriosis risk (odds ratio [OR]Q4 versus Q1 2.04, 95% confidence interval [CI]: 1.15-3.62; P for trend=0.013). In subgroup analyses, the significantly positive association between TyG index and the risk of endometriosis was also found in parous women (ORQ4 versus Q1 2.18, 95% CI: 1.20-3.96), women without diabetes (OR Q4 versus Q1 2.12, 95% CI: 1.19-3.79), women who smoke currently (OR Q4 versus Q1 3.93, 95% CI: 1.33-11.58), women who drink currently (OR Q4 versus Q1 2.54, 95% CI: 1.27-5.07), and in women who use oral contraceptives (OR Q4 versus Q1 1.91, 95% CI: 1.04-3.51). Additionally, significantly increasing trends in the odds of endometriosis across the quartiles of the TyG index were observed in the above-mentioned subgroups (all P for trend<0.05).

Conclusions

This population-based study found that a higher TyG index, representing an increased level of insulin resistance, was associated with a higher risk of endometriosis among the US population. Our findings suggested TyG index might be a promising tool for the risk assessment of endometriosis. Prospective studies are warranted to further verify these findings.

Interacting and joint effects of triglyceride-glucose index and hypertension on stroke risk in middle-aged and older Chinese adults: a population-based prospective cohort study

Background

Triglyceride-glucose (TyG) index and hypertension were well-established risk factors for stroke. And TyG index was associated with hypertension. However, no prior study has investigated the interactive effects of the TyG index and hypertension on stroke. This study examined whether hypertension mediates associations of TyG index with incident stroke and the extent of interaction or joint relations of TyG index and hypertension with stroke in middle-aged and older Chinese adults.

Methods

The China Health and Retirement Longitudinal Study (CHARLS) is an ongoing nationally representative prospective cohort study initiated in 2011. This cohort study included 9,145 middle-aged and older Chinese adults without stroke at baseline. The eposures were TyG index and the logarithmized product of hypertension, as determined during the baseline health examination. The main outcome was self-reported physician-diagnosed stroke which followed up from June 1, 2011, to June 30, 2018.

Results

Of the 9,145 participants, 4,251 were men (46.5%); the mean (SD) age was 59.20 (9.33) years. During a median follow-up of 7.1 years, 637 (7.0%) participants developed stroke. In multivariable-adjusted models, the TyG index was significantly associated with the risk of hypertension [odds ratio (OR) per 1-SD increase, 1.29; 95% CI, 1.19-1.41] and stroke [hazard ratio (HR) per 1-SD increase, 1.16; 95% CI, 1.02-1.33]. Both multiplicative and additive interactions were observed between TyG index and hypertension on stroke (HR for multiplicative: 2.34, 95% CI, 1.57-3.48; Synergy index: 4.13, 95% CI, 2.73-6.25). Mediation analysis showed that 20.0% of the association between TyG index and stroke was mediated through hypertension.

Conclusions

This study suggests a synergistic effect of TyG index and hypertension on stroke, and a small proportion of the association between TyG index and stroke was mediated by hypertension, indicating the benefit of coordinated control strategies for both exposures.

Fasting glucose: a cardiometabolic indicator for subclinical atherosclerosis on excess weight adolescents

OBJECTIVE

To build a model based on cardiometabolic indicators that allow the identification of overweight adolescents at higher risk of subclinical atherosclerotic disease (SAD).

METHODS

Cross-sectional study involving 161 adolescents with a body mass index ≥ +1 z-Score, aged 10 to 19 years. Carotid intima-media complex thickness (IMT) was evaluated using ultrasound to assess subclinical atherosclerotic disease. Cardiometabolic indicators evaluated included nutritional status, central adiposity, blood pressure, lipidic profile, glycemic profile, as well as age and sex. Data was presented using measures of central tendency and dispersion, as well as absolute and relative frequency. The relationship between IMT measurement (outcome variable) and other variables (independent variables) was assessed using Pearson or Spearman correlation, followed by multiple regression modeling with Gamma distribution to analyze predictors of IMT. Statistical analysis was performed using SPSS and R software, considering a significance level of 5 %.

RESULTS

It was observed that 23.7 % had Carotid thickening, and the prevalence of abnormal fasting glucose was the lowest. Age and fasting glucose were identified as predictors of IMT increase, with IMT decreasing with age by approximately 1 % per year and increasing with glucose by around 0.24 % per mg/dL.

CONCLUSION

The adolescent at higher risk is younger with higher fasting glycemia levels.

Weight Gain from Birth to Adolescence and TyG Index at Age 18 Years: A Cohort Study in Northeast Brazil

BACKGROUND

Developmental models suggest that the phenotypes may arise from an immediate or mediated adaptive metabolic response of the perinatal growth. Evidence on the cumulative effects of growth and factors associated with risk of insulin resistance in adolescents is lacking.

OBJECTIVE

To investigate the association between birthweight, weight gain during infancy, childhood and adolescence and the triglyceride-glucose index in adolescents.

METHODS

This is a cohort of 217 children born at term, followed for the first six months, and reassessed at 8 and 18 years of age. The variables of interest were birthweight, postnatal growth defined as rapid postnatal growth when the weight gain from birth to six months of age was greater than 0.67 z-score, and the same criterion was used for high BMI gain from ages 6 months to 8 years, and from 8 to 18 years. Socioeconomic condition, nutritional status, practice of physical exercises and consumption of ultra-processed foods were verified. Multivariate linear regression analysis was used to verify the effect of the variables on the triglyceride-glucose index.

RESULTS

Birthweight was not associated with triglyceride-glucose index in adolescence. Rapid postnatal growth during the first 6 months, higher BMI gain from 8 to 18 years and higher waist circumference contributed significantly to explain higher triglyceride-glucose index.

CONCLUSION FOR PRACTICE

Our findings suggest that rapid postnatal growth may be one of the first signs of a higher triglyceride-glucose index in adolescence and that attention should be paid to the greater gain in body mass between childhood and adolescence for the risk of a higher triglyceride-glucose index.

Relationships between triglyceride-glucose index and incident gestational diabetes mellitus: a prospective cohort study of a Korean population using publicly available data

BACKGROUND

The connection between the triglyceride-glucose index (TyG index) and gestational diabetes mellitus (GDM) is currently debated. Our study aimed to investigate the connection between the TyG index and GDM within the Korean population.

METHODS

Using publically accessible data in Korea, we performed a secondary study on a sample of 589 pregnant women who were carrying a single fetus. The analysis employed a binary logistic regression model, some sensitivity analyses, and subgroup analysis to investigate the association between the TyG index and the occurrence of GDM. To assess the TyG index's potential to predict GDM, a receiver operating characteristic (ROC) study was also carried out.

RESULTS

The mean age of the pregnant women was 32.065 ± 3.798 years old, while the mean TyG index was 8.352 ± 0.400. The prevalence rate of GDM was found to be 6.112%. Upon adjusting for potential confounding variables, a positive association was detected between the TyG index and incident GDM (OR = 12.923, 95%CI: 3.581-46.632, p = 0.00009). The validity of this connection was further confirmed by subgroup analysis and sensitivity analyses. With an area under the ROC curve of 0.807 (95%CI: 0.734-0.879), the TyG index showed strong predictive power for GDM. The TyG index's ideal cutoff value for detecting GDM was found to be 8.632, with a sensitivity of 78.7% and a specificity of 72.2%.

CONCLUSION

The findings of our study provide evidence that an increased TyG index is significantly associated with the occurrence of GDM. Utilizing the TyG index during the 10-14 week gestational period may be a valuable tool in identifying pregnant individuals at a heightened risk for developing GDM. Early detection enables timely and efficacious interventions, thereby enhancing the prognosis of affected individuals.

Prognostic value of triglyceride-glucose index in patients with chronic coronary syndrome undergoing percutaneous coronary intervention

BACKGROUND

The triglyceride-glucose (TyG) index has been proposed as a reliable surrogate marker of insulin resistance and an independent predictor of major adverse cardiovascular events (MACEs). Several recent studies have shown the relationship between the TyG index and cardiovascular outcomes; however, the role of the TyG index in chronic coronary syndrome (CCS) progression has not been extensively assessed especially in population after revascularization. This study aimed to investigate the prognostic value of the TyG index in predicting MACEs in CCS patients undergoing percutaneous coronary intervention (PCI).

METHODS

The data for the study were taken from the Hospital Information System database in China-Japan Friendship Hospital over the period 2019-2021. Eligible participants were divided into groups according to the TyG index tertiles. The Boruta algorithm was performed for feature selection. Multivariate Cox proportional hazards models and restricted cubic spline (RCS) analysis were applied to examine the dose-response relationship between the TyG index and endpoint, and the results were expressed with hazard ratio (HR) and 95% confidence interval (CI) values. The area under the receiver operating characteristic (ROC) curve (AUC), decision curve analysis (DCA), and clinical impact curve (CIC) were plotted to comprehensively evaluate the predictive accuracy and clinical value of the model. The goodness-of-fit of models was evaluated using the calibration curve and χ2 likelihood ratio test.

RESULTS

After applying inclusion and exclusion criteria, 1353 patients with CCS undergoing PCI were enrolled in the study. After adjusting for all confounders, we found that those with the highest TyG index had a 59.5% increased risk of MACEs over the 1-year follow-up (HR 1.595, 95% CI 1.370 ~ 1.855). Using the lowest TyG index tertile as the reference (T1), the fully adjusted HRs (95% CIs) for endpoints was 1.343 (1.054 ~ 1.711) in the middle (T2) and 2.297 (1.842 ~ 2.864) in highest tertile (T3) (P for trend < 0.001). The TyG index had an excellent predictive performance according to the results of AUC 0.810 (0.786, 0.834) and χ2 likelihood ratio test (χ2 = 7.474, P = 0.486). DCA and CIC analysis also suggested a good overall net benefit and clinical impact of the multivariate model. The results in the subgroup analysis were consistent with the main analyses. RCS model demonstrated that the TyG index was nonlinearly associated with the risk of MACEs within one year (P for nonlinear < 0.001).

CONCLUSION

The elevated TyG index is associated with an increased risk of cardiovascular events and predicts future MACEs in patients with CCS undergoing PCI independently of known cardiovascular risk factors, indicating that the TyG index may be a potential marker for risk stratification and prognosis in CCS patients undergoing PCI.

Triglyceride-glucose index is associated with hypertension incidence up to 13 years of follow-up in mexican adults

The triglyceride-glucose index (TyG index) is an indicator of insulin resistance that has been studied recently. The relationship between insulin resistance and the risk of hypertension has been documented previously. However, there is limited knowledge regarding the association of the TyG index with hypertension incidence. This study aimed to evaluate the association of the TyG index with changes in blood pressure (BP) and hypertension incidence in Mexican adults. This analysis was performed using the Health Workers Cohort Study data. The TyG index was estimated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2] and divided into categories defined by tertiles. The analysis was conducted using fixed-effects linear regression models (n = 1,545) and Cox proportional hazards regression models (n = 1,113), adjusting for potential confounding variables. The incidence rates (95% CI) for the low, medium, and high categories of the TyG index were 22.1 (17.8, 27.5), 35.8 (30.1, 42.7), and 49.4 (42.1, 57.9), respectively. An increase in the levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP) was observed when changing from a low to a medium (DBP: β 2.55 mmHg, 95% CI 0.81, 4.29) and from a low to a high category of the TyG index (SBP: β 3.10 mmHg, 95% CI 1.16, 5.04; DBP: β 4.91 mmHg, 95% CI 2.88, 6.94). Furthermore, participants within the top category of the TyG index had a 56% higher risk of hypertension than those in the bottom category (HR = 1.56; 95% CI 1.18, 2.08). These results support the hypothesis that the TyG index is associated with high blood pressure in Mexican adults.

Comment on Xiang et al. Association between the Triglyceride-Glucose Index and Vitamin D Status in Type 2 Diabetes Mellitus. Nutrients 2023, 15, 639

We read with great interest the article entitled "Association between the Triglyceride-Glucose Index and Vitamin D Status in Type 2 Diabetes Mellitus" by Xiang Q et al. [...].

The triglyceride-glucose index is associated with atherosclerosis in patients with symptomatic coronary artery disease, regardless of diabetes mellitus and hyperlipidaemia

BACKGROUND

Diabetes and hyperlipidaemia are both risk factors for coronary artery disease, and both are associated with a high triglyceride-glucose index (TyG index). The TyG index has been presented as a marker of insulin resistance (IR). Its utility in predicting and detecting cardiovascular disease has been reported. However, few studies have found it to be a helpful marker of atherosclerosis in patients with symptomatic coronary artery disease (CAD). The purpose of this study was to demonstrate that the TyG index can serve as a valuable marker for predicting coronary and carotid atherosclerosis in symptomatic CAD patients, regardless of diabetes mellitus and hyperlipidaemia.

METHODS

This study included 1516 patients with symptomatic CAD who underwent both coronary artery angiography and carotid Doppler ultrasound in the Department of Cardiology at Tianjin Union Medical Center from January 2016 to December 2022. The TyG index was determined using the Ln formula. The population was further grouped and analysed according to the presence or absence of diabetes and hyperlipidaemia. The Gensini score and carotid intima-media thickness were calculated or measured, and the patients were divided into four groups according to TyG index quartile to examine the relationship between the TyG index and coronary or carotid artery lesions in symptomatic CAD patients.

RESULTS

In symptomatic CAD patients, the TyG index showed a significant positive correlation with both coronary lesions and carotid plaques. After adjusting for sex, age, smoking, BMI, hypertension, diabetes, and the use of antilipemic and antidiabetic agents, the risk of developing coronary lesions and carotid plaques increased across the baseline TyG index. Compared with the lowest quartile of the TyG index, the highest quartile (quartile 4) was associated with a greater incidence of coronary heart disease [OR = 2.55 (95% CI 1.61, 4.03)] and carotid atherosclerotic plaque [OR = 2.31 (95% CI 1.27, 4.20)] (P < 0.05). Furthermore, when compared to the fasting blood glucose (FBG) or triglyceride (TG) level, the TyG index had a greater area under the ROC curve for predicting coronary lesions and carotid plaques. The subgroup analysis demonstrated the TyG index to be an equally effective predictor of coronary and carotid artery disease, regardless of diabetes and hyperlipidaemia.

CONCLUSION

The TyG index is a useful marker for predicting coronary and carotid atherosclerosis in patients with symptomatic CAD, regardless of diabetes mellitus and hyperlipidaemia. The TyG index is of higher value for the identification of both coronary and carotid atherosclerotic plaques than the FBG or TG level alone.

Triglyceride glucose index, pediatric NAFLD fibrosis index, and triglyceride-to-high-density lipoprotein cholesterol ratio are the most predictive markers of the metabolically unhealthy phenotype in overweight/obese adolescent boys

Introduction

The prevalence of obesity constantly increases worldwide and definitely increases the risk of premature death in early adulthood. While there is no treatment yet with proven efficacy for the metabolic clamp such as arterial hypertension, dyslipidemia, insulin resistance, diabetes type 2, and fatty liver disease, it is imperative to find a way to decrease cardiometabolic complications. Early prevention strategies beginning in childhood are the most logical step to reduce future cardiovascular morbidity and mortality. Therefore, the aim of the current study is to determine the most sensitive and specific predictive markers of the metabolically unhealthy phenotype with high cardiometabolic risk in overweight/obese adolescent boys.

Methods

This study was carried out at the Ternopil Regional Children's hospital (Western Ukraine) and involved 254 randomly chosen adolescent overweight or obese boys [median age was 16.0 (15.0,16.1) years]. A control group of 30 healthy children with proportional body weight comparable in gender and age to the main group was presented. A list of anthropometrical markers with biochemical values of carbohydrate and lipid metabolism with hepatic enzymes was determined. All overweight/obese boys were divided into three groups: 51.2% of the boys with metabolic syndrome (MetS) based on the IDF criteria; 19.7% of the boys were metabolically healthy obese (MHO) without hypertension, dyslipidemia, and hyperglycemia; and the rest of the boys (29.1%) were classified as metabolically unhealthy obese (MUO) with only one criterion (hypertension, dyslipidemia, or hyperglycemia).

Results

Based on multiple logistic regression analysis that included all anthropometric and biochemical values and calculated indexes in boys from the MHO group and MetS, it was revealed that the maximum likelihood in the prediction of MetS makes the combination of triglyceride glucose index, pediatric nonalcoholic fatty liver disease fibrosis index (PNFI), and triglyceride-to-high-density lipoprotein cholesterol ratio (R² =0.713, p<0.000). By tracing the receiver operating characteristic curve, the model is confirmed as a good predictor of MetS (AUC=0.898, odds ratio=27.111 percentage correct=86.03%) in overweight and obese boys.

Conclusion

Triglyceride glucose index, pediatric NAFLD fibrosis index, and triglyceride-to-high-density lipoprotein cholesterol ratio are a valuable combination of predictive markers of the metabolically unhealthy phenotype in Ukrainian overweight/obese boys.

Association of gut microbiota and glucose metabolism in children with disparate degrees of adiposity

OBJECTIVE

To investigate the characteristics of gut microbiota in children with disparate degrees of adiposity, and analyze the association between gut microbiota, glucose metabolism indicators, and inflammatory factors.

METHODS

Clinical data were examined in 89 Chinese children. Children with a body fat percentage ≥ 30% were diagnosed as obese, and ≥ 35% in males and ≥ 40% in females were further defined as severe obesity. The composition of gut microbiota was determined by 16S rDNA-based metagenomics.

RESULTS

The study population (9.75 ± 1.92-year-old) was characterized as normal weight (n = 29), mild obesity (n = 27) and severe obesity (n = 33) groups. Linear discriminant analysis Effect Size (LEfSe) analysis found that compared to the severe obesity group, subjects with mild obesity had more prevalent members of the phylum Fusobacteria, the genus Alistipes, and fewer members of genus Granulicatella and Clostridium (p < 0.05). For subjects with mild obesity, Spearman's correlation analysis revealed that fasting plasma glucose positively correlated with species A. indistinctus, A. putredinis, and negatively correlated with species Ruminococcus gnavus; LBP negatively correlated with species Clostridium hathewayi, and Blautia producta. For subjects with severe obesity, oral glucose tolerance test 2 h plasma glucose (OGTT2HPG) negatively correlated with the phylum Synergistetes, genus Pyramidobacter, species Veillonella parvula, P. piscolens, and positively correlated with species B. producta, INS and HOMA-IR negatively correlated with the genus Haemophilus, species H. parainfluenzae, lipopolysaccharide-binding protein (LBP) negatively correlated with the phylum Actinobacteria, genus Bifidobacterium, Lactobacillus, and species B. longum (all p < 0.05). Phylogenetic investigation of communities by reconstruction of unobserved states 2 (PICRUSt2) analysis discerned that the glucose metabolism pathway, gluconeogenesis I was curtailed in the severe obesity group.

CONCLUSION

The gut microbiota could favourably compensate for glucose metabolism in children with obesity. Genus Haemophilus and Bifidobacterium longum may influence glucose tolerance and insulin resistance in children with severe obesity.

Association of the triglycerides and glucose index and the homeostatic model assessment of insulin resistance with lipoprotein(a), apolipoprotein AI, and apolipoprotein B concentrations in children with normal-weight

The aim of this study was to compare the association of the triglycerides and glucose (TyG) index and homeostatic model assessment of insulin resistance (HOMA-IR) with lipoprotein(a) (lp[a]), apolipoprotein AI (apoAI), and apoliprotein B (apoB) concentrations in children with normal-weight. Children with normal weight aged 6-10 years and Tanner 1 stage were included in a cross-sectional study. Underweight, overweight, obesity, smoking, alcohol intake, pregnancy, acute or chronic illnesses, and any kind of pharmacological treatment were exclusion criteria. According to the lp(a) levels, children were allocated into the groups with elevated concentrations and normal values. A total of 181 children with normal weight and an average age of 8.4 ± 1.4 years were enrolled in the study. The TyG index showed a positive correlation with lp(a) and apoB in the overall population (r = 0.161 and r = 0.351, respectively) and boys (r = 0.320 and r = 0.401, respectively), but only with apoB in the girls (r = 0.294); while the HOMA-IR had a positive correlation with lp(a) levels in the overall population (r = 0.213) and boys (r = 0.328). The linear regression analysis showed that the TyG index is associated with lp(a) and apoB in the overall population (B = 20.72; 95%CI 2.03-39.41 and B = 27.25; 95%CI 16.51-37.98, respectively) and boys (B = 40.19; 95%CI 14.50-65.7 and B = 29.60; 95%CI 15.03-44.17, respectively), but only with apoB in the girls (B = 24.22; 95%CI 7.90-40.53). The HOMA-IR is associated with lp(a) in the overall population (B = 5.37; 95%CI 1.74-9.00) and boys (B = 9.63; 95%CI 3.65-15.61).   Conclusion: The TyG index is associated with both lp(a) and apoB in children with normal-weight. What is Known: • The triglycerides and glucose index has been positively associated with an increased risk of cardiovascular disease in adults. What is New: • The triglycerides and glucose index is strongly associated with lipoprotein(a) and apolipoprotein B in children with normal-weight. • The triglycerides and glucose index may be a useful tool to identify cardiovascular risk in children with normal-weight.

Triglyceride-glucose index for predicting repeat revascularization and in-stent restenosis in patients with chronic coronary syndrome undergoing percutaneous coronary intervention

BACKGROUND

The triglyceride-glucose (TyG) index, a reliable surrogate indicator of insulin resistance, is independently associated with coronary artery disease of various clinical manifestations. This study aimed to investigate the prognostic value of the TyG index in predicting repeat revascularization and in-stent restenosis (ISR) in chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI).

METHODS

A total of 1414 participants were enrolled and divided into groups according to the tertiles of the TyG index. The primary endpoint was a composite of PCI complications, including repeat revascularization and ISR. The associations between the TyG index and the primary endpoint were assessed by multivariable Cox proportional hazards regression analysis with restricted cubic splines (RCS). The TyG index was calculated as Ln (fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2).

RESULTS

Over a median follow-up of 60 months, 548 (38.76%) patients had experienced at least one primary endpoint event. The follow-up incidence of the primary endpoint increased with the TyG index tertiles. After adjusting for potential confounders, the TyG index was independently associated with the primary endpoint in CCS patients (HR, 1.191; 95% CI 1.038-1.367; P = 0.013). Additionally, the highest tertile of the TyG group was correlated with a 1.319-fold risk of the primary endpoint compared with the lowest tertile of the TyG group (HR, 1.319; 95% CI 1.063-1.637; P = 0.012). Furthermore, a linear and dose-response relationship was observed between the TyG index and the primary endpoint (non-linear P = 0.373, P overall = 0.035).

CONCLUSIONS

An increased TyG index was associated with elevated risk for long-term PCI complications, including repeat revascularization and ISR. Our study suggested that the TyG index could be a potent predictor in evaluating the prognosis of CCS patients undergoing PCI.

Comparison of the ability of HOMA-IR, VAI, and TyG indexes to predict metabolic syndrome in children with obesity: a cross-sectional study

BACKGROUND

The increasing trend in childhood obesity needs to be closely monitored and intervened due to long-term health issues such as metabolic syndrome, cardiovascular diseases, hypertension, and type 2 diabetes. We aimed to determine and compare the cut-off values for the visceral adiposity index (VAI), triglyceride-glucose index (TyG), and HOMA-IR for predicting metabolic syndrome (MetS).

METHODS

This population-based cross-sectional study was conducted in May 2019 in Samsun, Turkey. The study included 169 children with obesity aged 9 and 10 years. After anthropometric and clinical evaluation, fasting blood samples were collected from the children. The areas under the curve of the visceral adiposity index, triglyceride-glucose index, and HOMA-IR were compared by receiver-operating-characteristic (ROC) analysis in predicting the MetS.

RESULTS

The total prevalence of MetS was 21.3% in children with obesity, and it was two times higher in girls than in boys. The mean values of TyG and VAI were significantly different in those who have and have not MetS in both genders. However, the HOMA-IR index was higher only in girls with MetS and did not differ in boys by having MetS. The VAI and the TyG index both had statistically significant cut-off values in both sexes and a larger ROC area than the HOMA-IR index in predicting MetS.

CONCLUSIONS

The VAI and TyG index are effective indicators in assessing the MetS risk in children with obesity. Both indexes can be considered useful tools in pediatric research and the evaluation of interventions. However, the HOMA-IR index formula needs to be developed taking into account age, gender, and ethnicity.

Association between the Triglyceride-Glucose Index and Vitamin D Status in Type 2 Diabetes Mellitus

BACKGROUND

Vitamin D deficiency (VDD) increases the risk for type 2 diabetes mellitus (T2DM), which might be related to insulin resistance (IR). We aimed to explore the association between the triglyceride-glucose (TyG) index, a reliable indicator of IR, and VDD in patients with T2DM.

METHODS

There were 1034 participants with T2DM enrolled in the Second Xiangya Hospital of Central South University. The TyG index was calculated as ln (fasting triglyceride (TG, mg/dL) × fasting blood glucose (mg/dL)/2). VDD was defined as 25-hydroxyvitamin D [25(OH)D] level <50 nmol/L.

RESULTS

Correlation analysis showed a negative association between the TyG index and 25(OH)D level. After adjustments for clinical and laboratory parameters, it was revealed that when taking the Q1 quartile of TyG index as a reference, an increasing trend of VDD prevalence was presented in the other three groups divided by TyG index quartiles, where the OR (95% CI) was 1.708 (1.132-2.576) for Q2, 2.041 (1.315-3.169) for Q3, and 2.543 (1.520-4.253) for Q4 (all p < 0.05).

CONCLUSIONS

Patients with higher TyG index were more likely to have an increased risk of VDD in T2DM population, which may be related to IR.

Assessment of a consensus definition of obesity and metabolic health phenotypes in children at different pubertal stages

Not all individuals with obesity develop metabolic complications, which has brought about the concepts of metabolically healthy and unhealthy obesity (MHO/MUO). However, inconsistent definitions of these conditions have limited their understanding. We assessed whether a recently-proposed consensus definition for MHO/MUO correlates with adiposity and reflects metabolic risk parameters during puberty. Low-middle income children from the Growth and Obesity Cohort Study (Santiago, Chile) were included (n = 949; 1692 visits at Tanner (T)2, T4 and/or one-year post menarche (1YPM)). Anthropometry, body composition and metabolic parameters were compared between MUO and MHO, and also in children without obesity. The risk for presenting MUO phenotype was significantly elevated with higher waist-height ratio (T2), zBMI (T2, T4), trunk fat, and C-reactive protein (T4). Elevated cardiometabolic indices were important predictors of the "unhealthy" phenotype allocation in children with or without obesity. Our observations suggest that the consensus definition in children at T2, T4 and 1YPM reflects metabolic risk and central obesity. Metabolic health phenotype allocation by this equation enables easy detection of risk factors that call for action to prevent long-term metabolic derangements in children with obesity and, importantly, also those without obesity.

Association between the triglyceride–glucose index and chronic kidney disease in adults

BACKGROUND

Chronic kidney disease (CKD) is characterized as a progressive dysfunction of the kidney, and it might have a close relationship with insulin resistance. We utilized the triglyceride-glucose (TyG) index, a reliable marker of insulin resistance, to evaluate the association between the TyG index and CKD in adults from the general population.

METHODS

This was a cross-sectional study obtaining data from the 2015-2018 National Health and Nutrition Examination Survey. The estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) served as kidney function indicators. We defined CKD as the existence of either low eGFR (eGFR < 60 mL/min/1.73 m² BSA) or albuminuria (UACR > 30 mg/g). Multivariate regressions, correlated subgroup analyses, and interaction terms were performed in this study.

RESULTS

For 4361 recruited participants, the mean TyG index was 8.60 ± 0.68, and the prevalence of CKD was 13.35%. Participants with a higher TyG index showed a higher UACR level (β = 25.10, 95% CI: 6.76, 43.44, P = 0.0074) and higher levels of CKD (OR = 1.34, 95% CI: 1.13, 1.59, P = 0.0006). The positive relationship between the TyG index and CKD became stronger and remained significant in the overweight (OR = 1.61, 95% CI: 1.18, 2.20, P = 0.0027) and obese (OR = 2.48, 95% CI: 1.95, 3.15, P < 0.0001) groups and in people with diabetes (OR = 1.94, 95% CI: 1.46, 2.56, P < 0.0001).

CONCLUSIONS

Higher TyG index was strongly associated with a higher UACR level and higher values of albuminuria and CKD, which might be useful in kidney function screening especially among people in disadvantageous socioeconomic conditions with no availability for direct measurement of kidney function. However, more well-designed studies are still needed to validate this relationship.

Association between serum 25-hydroxyvitamin-D and Triglycerides-Glucose index among Indian adolescents

Background

Vitamin D deficiency has been found to associated with numerous skeletal and non-skeletal diseases including Diabetes Mellitus. Insulin Resistance (IR) is considered as one of the primary reasons of Type-2 Diabetes Mellitus (T2DM). The association between vitamin D deficiency and IR has been extensively explore in previous studies, but none of them focused on Indian adolescents, and none of them used the TyG index as IR marker. Hence, this population-based cross-sectional study investigates the relationship between insulin resistance (IR) assessed using the Triglycerides Glucose Index (TyG index) and vitamin D measured by serum 25-hydroxyvitamin-D (25(OH)D).

Methods

For this study, we utilized data from the Comprehensive National Nutrition Survey (CNNS, 2016–18). The study is based on a sample size of 10,167 adolescents aged 10–19 years. The TyG index cut-off value of 4.65 was used to classify IR. We examined associations between the TyG index and serum 25(OH)D using multiple linear regression models adjusted for potential confounders. Odds of Insulin Resistance among vitamin D deficient/insufficient adolescents were assessed using multivariable logistic regression.

Results

A significant negative association was found between serum 25(OH)D and the TyG index, where a 10% increase in serum 25(OH)D was associated with 0.56 (95% CI = -0.67, -0.45) unit decrement in the TyG index. The odds of having IR were 90% higher among vitamin D deficient adolescents (OR: 1.90; 95% CI = 1.62—2.23) compared to adolescents with adequate levels of vitamin D. The association between vitamin D deficiency and IR was independent of sex; in other words, the association between vitamin D and IR was significant in both the sexes.

Conclusion

Independent of sex, this study found a significant inverse association between vitamin D and insulin resistance in Indian adolescents. The findings of this study highlight the utility of TyG index and the importance of vitamin D in lowering the risk of T2DM in future generations of the country.

Association between triglyceride-glucose index and nonalcoholic fatty liver disease in type 2 diabetes mellitus

BACKGROUND

Lipid and glucose metabolism abnormalities are associated with nonalcoholic fatty liver disease (NAFLD). The triglyceride-glucose (TyG) index is a recently developed indicator that can identify individuals at risk for NAFLD. However, the applicability of the TyG index for identifying NAFLD in patients with type 2 diabetes mellitus (T2DM) is unclear. The aim of this study was to investigate the ability of the TyG index to identify individuals at risk for NAFLD in the T2DM population.

METHODS

A total of 2280 participants with T2DM were recruited in this cross-sectional study. The TyG index was calculated, and NAFLD was diagnosed by ultrasonography. Binary logistic regression models were used to evaluate the association of the TyG index, glycemic parameters and lipid parameters with NAFLD.

RESULTS

Logistic regression analysis showed that the TyG index was significantly associated with NAFLD in subjects with T2DM, the odds ratio (OR) were 3.27 (95% confidence interval [CI], 2.03-5.27; P < 0.001) for NAFLD in the highest TyG quartile after adjustment for known confounders. In stratified analysis, an elevated TyG index were more remarkably associated with NAFLD in younger patients (< 65 years; OR, 2.35; 95% CI, 1.83-3.02; P < 0.001), females (OR, 2.69; 95% CI, 1.67-4.32; P < 0.001), patients with BMI < 25 kg/m² (OR, 2.80; 95% CI, 2.01-3.91; P < 0.0001), and with lower high-density lipoprotein cholesterol (< 1 mmol/L; OR, 2.76; 95% CI, 1.98-3.83; P < 0.001).

CONCLUSION

The TyG index is significantly associated with NAFLD and shows superior ability for identify NAFLD risk compared with other lipid and glycemic parameters in T2DM.

TyGIS: improved triglyceride-glucose index for the assessment of insulin sensitivity during pregnancy

Background

The triglyceride-glucose index (TyG) has been proposed as a surrogate marker of insulin resistance, which is a typical trait of pregnancy. However, very few studies analyzed TyG performance as marker of insulin resistance in pregnancy, and they were limited to insulin resistance assessment at fasting rather than in dynamic conditions, i.e., during an oral glucose tolerance test (OGTT), which allows more reliable assessment of the actual insulin sensitivity impairment. Thus, first aim of the study was exploring in pregnancy the relationships between TyG and OGTT-derived insulin sensitivity. In addition, we developed a new version of TyG, for improved performance as marker of insulin resistance in pregnancy.

Methods

At early pregnancy, a cohort of 109 women underwent assessment of maternal biometry and blood tests at fasting, for measurements of several variables (visit 1). Subsequently (26 weeks of gestation) all visit 1 analyses were repeated (visit 2), and a subgroup of women (84 selected) received a 2 h-75 g OGTT (30, 60, 90, and 120 min sampling) with measurement of blood glucose, insulin and C-peptide for reliable assessment of insulin sensitivity (PREDIM index) and insulin secretion/beta-cell function. The dataset was randomly split into 70% training set and 30% test set, and by machine learning approach we identified the optimal model, with TyG included, showing the best relationship with PREDIM. For inclusion in the model, we considered only fasting variables, in agreement with TyG definition.

Results

The relationship of TyG with PREDIM was weak. Conversely, the improved TyG, called TyGIS, (linear function of TyG, body weight, lean body mass percentage and fasting insulin) resulted much strongly related to PREDIM, in both training and test sets (R² > 0.64, p < 0.0001). Bland–Altman analysis and equivalence test confirmed the good performance of TyGIS in terms of association with PREDIM. Different further analyses confirmed TyGIS superiority over TyG.

Conclusions

We developed an improved version of TyG, as new surrogate marker of insulin sensitivity in pregnancy (TyGIS). Similarly to TyG, TyGIS relies only on fasting variables, but its performances are remarkably improved than those of TyG.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-022-01649-8.

Distinct racial and ethnic metabolic syndrome characteristics: A comparative assessment in low-income children 7-10 years of age

BACKGROUND

Pediatric MetS prevalence varies due to lack of consensus on evaluative criteria and associated thresholds, with most not recommending a diagnosis <10 years. However, MetS risk components are becoming evident earlier in life and affect races and ethnicities disproportionately.

OBJECTIVES

To compare the prevalence of MetS based on existing definitions and elucidate racial- and ethnic-specific characteristics associated with MetS prevalence.

METHODS

The baseline and follow-up samples included 900 and 557 children 7-10 years, respectively. Waist circumference, BMI percentile, blood pressure, fasting plasma glucose (FPG), insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C) were measured. Agreement between MetS definitions was quantified via kappa statistics. MetS and risk factor prevalence and the predictability of metabolic parameters on MetS eight months later was evaluated via logistic regression. McFadden pseudo-R2 was reported as a measure of predictive ability, and the Akaike information criterion evaluated fit of each model.

RESULTS

The baseline sample was 55.0% male and 71.6% Hispanic, followed by non-Hispanic White (NHW) (17.3%) and non-Hispanic Black (NHB) (11.1%), with an average age of 9.2 years. MetS prevalence ranged from 7.6% to 21.4%, highest in Hispanic (9.0%-24.0%) and lowest in NHB children (4.0%-14.0%). Highest agreement was between Ford et al. and Cook et al. definitions (K = 0.88) and lowest agreements were consistently with the International Diabetes Federation criteria (K ≤ 0.57). Compared to NHW children, Hispanic children had higher odds for MetS (OR: 1.7; p = 0.03) and waist circumference, HDL-C, and FPG risk factors (p < 0.05), while NHB children had higher odds for the FPG risk factor (p ≤ 0.007) and lower odds for the plasma triglycerides risk factor (p = 0.002), across multiple MetS definitions. In longitudinal analyses, HDL-C was the strongest independent predictor of MetS in Hispanic and NHW children (p < 0.001 and p < 0.01, respectively), while plasma triglycerides was the strongest independent predictor of MetS in NHB children (p < 0.05).

CONCLUSIONS

MetS prevalence was high in children ≤10 years, and proposed criteria are susceptible to racial and ethnic bias, diagnosing some populations more than other populations with high cardiovascular risk. Earlier preventative measures should be imposed in clinical settings, accounting for racial and ethnic differences, to mitigate disease onset.

Triglyceride Glucose-Waist Circumference (TyG-WC) Is a Reliable Marker to Predict Non-Alcoholic Fatty Liver Disease

The triglyceride and glucose index (TyG index), a marker of insulin resistance, is positively associated with NAFLD. Modified TyG indices, combining body composition markers including body-mass index (BMI) or waist circumference (WC) with the TyG index, are reported to enhance predictability of insulin resistance. This study aimed to compare the usefulness of modified TyG indices for predicting NAFLD with the TyG index and fatty liver index (FLI). This cross-sectional study included 12,757 Korean adults. The TyG index and FLI were calculated using established formulas, and TyG-BMI and TyG-WC were calculated as TyG × BMI and TyG × WC, respectively. All measures were divided into quartiles. NAFLD severity (grade 0–3) was compared using ANOVA by quartiles of each index. Odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD were calculated using a multiple logistic regression analysis. ROC and AUROC analyses were performed to compare the predictability of NAFLD using WC, BMI, TyG, TyG-BMI, TyG-WC, and FLI. A higher TyG index, TyG-BMI, TyG-WC, and FLI were associated with a higher grade of NAFLD. ORs (CIs) for NAFLD increased in all indices, especially in TyG-WC (39.251 (31.304–49.215)) and FLI (38.937 (31.145–48.678)). AUROC was 0.848 (0.840–0.855) for TyG-WC and 0.850 (0.842–0.857) for FLI. TyG-WC is a reliable indicator for the presence of NAFLD in Korean adults.

Study of common hypertriglyceridaemia genetic variants and subclinical atherosclerosis in a group of women with SLE and a control group

OBJECTIVE

SLE is associated with increased cardiovascular risk (CVR). High serum concentrations of triglyceride-rich lipoproteins and apolipoprotein B-rich particles constitute the characteristic dyslipidaemia of SLE.

METHODS

A cross-sectional study was conducted to study the relationship between genetic variants involved in polygenic hypertriglyceridaemia, subclinical atherosclerosis and lipoprotein abnormalities. 73 women with SLE and 73 control women age-matched with the case group were recruited (age range 30-75 years). Serum analysis, subclinical atherosclerosis screening studies for the detection of plaque, and genetic analysis of the APOE, ZPR1, APOA5 and GCKR genes were performed.

RESULTS

Triglyceride concentrations and the prevalence of hypertension, dyslipidaemia and carotid atherosclerosis were higher in women with SLE than in the control group. Multivariate logistic regression showed that CC homozygosity for the GCKR rs1260326 gene (OR=0.111, 95% CI 0.015 to 0.804, p=0.030) and an increase of 1 mmol/L in triglyceride concentrations were associated with a greater risk of carotid plaque in women with SLE (OR=7.576, 95% CI 2.415 to 23.767, p=0.001).

CONCLUSIONS

GCKR CC homozygosity (rs1260326) and serum triglyceride concentrations are independently associated with subclinical carotid atherosclerosis in women with SLE. Subclinical carotid atherosclerosis is also more prevalent in these women compared with the control group. The study of GCKR rs1260326 gene variants may contribute to more precise assessment of CVR and modulation of the intensity of lipid-lowering treatment in patients with SLE.

Association of the triglyceride-glucose index with weight-adjusted appendicular lean mass in Chinese adolescents aged 12-18 years old

There is no study exploring the association between triglyceride-glucose (TyG) index and skeletal muscle mass in Chinese adolescents. Therefore, the objective of this study is to explore the association between TyG index and appendicular lean mass (ALM) in Chinese adolescents. In this study, 1336 adolescents (805 boys, 60.25%) aged 12-18 years in China were randomly selected through a stratified cluster sampling. According to the tertiles of TyG index, we separated all participants into three groups, and LM was measured by Bioelectrical Impedance Analysis. The TyG index was negatively related to ALM/weight in Chinese adolescents whether stratified by gender (boys: β = - 0.293; girls: β = - 0.195; all P < 0.001). After adjusting for age and BMI, a significant correlation between the TyG index and ALM/weight was observed only in boys (β = - 0.169, P = 0.001). The highest TyG index tertile was significantly associated with low ALM/weight after adjusting for all covariates in the full sample (OR = 3.04, 95% CI 1.12-8.26, P = 0.029) and boys (OR = 4.68, 95% CI 1.22-17.95, P = 0.025) only in overweight/obese group. Our findings suggested elevated levels of TyG index may be a risk factor of low ALM/weight in Chinese adolescents, especially in boys.

Triglyceride-glucose index associates with incident heart failure: a cohort study

AIMS

Triglyceride-glucose (TyG) index has been proposed as a simple surrogate marker of insulin resistance. However, few studies have investigated the association of TyG index with heart failure (HF). We aimed to explore the relationship between TyG index and incident HF.

METHODS

A total of 138,620 participants from the Kailuan study were included for analysis. TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL) / 2]. Cox proportional hazard models were used to investigate the association between TyG index and the risk of HF. Restricted cubic spline analysis was applied to evaluate the dose-response relationship between TyG index and the risk of HF.

RESULTS

There were 1602 incident HF cases among the 138,620 participants during a median follow-up of 8.78 years. Compared with those in the lowest quartile group of TyG index, participants with the highest quartile of TyG index had a 24% higher risk of HF (HR=1.24, 95%CI=1.07-1.44) after adjusting for other risk factors. Restricted cubic spline analysis showed a significant J-shaped dose-response relationship between TyG index and risk of HF (P for non-linearity < 0.001). The significant association was still observed among the men and participants with or without abdominal obesity in subgroup analyses.

CONCLUSION

The TyG index was positively associated with the risk of HF, which indicates that the TyG index might be useful to identify people at high-risk for developing HF.

Triglyceride-Glucose Index and the Prognosis of Patients with Acute Ischemic Stroke: A Meta-Analysis

A higher triglyceride-glucose (TyG) index has been related to an increased incidence of stroke in community population. A meta-analysis was performed to evaluate the association between TyG index and prognosis in patients with acute ischemic stroke (IS). Observational studies, which evaluated the influence of TyG index on functional outcome and mortality in patients with acute IS were retrieved by search the PubMed, Embase, Web of Science, Wanfang and China National Knowledge Infrastructure databases from inception to February 20, 2022. Two authors independently collected the data of study characteristics and outcomes. A random-effect model was used to pool the results via incorporating the influence of possible between-study heterogeneity. Eight cohort studies involving 34 076 patients with acute IS contributed to the study. Pooled results showed that a higher TyG index was independently associated with increased risks of all-cause mortality (OR: 1.60, 95% CI: 1.19-2.15, p=0.002; I2=78%) and poor functional outcome (OR: 1.37, 95% CI: 1.11-1.69, p=0.004; I2=71%). Further sensitivity analyses by excluding one cohort study at a time showed consistent results (p all<0.05). Subgroup analyses showed similar results in prospective and retrospective cohort studies, in non-diabetic and diabetic patients, and in studies with follow-up durations within 3 months and of 12 months (p for subgroup analyses all>0.05). In conclusion, higher TyG index is a predictor of all-cause mortality and poor functional outcome in patients with acute IS, and TyG index may be useful for prognostic evaluation in these patients.

Altered triglyceride glucose index and fasted serum triglyceride high-density lipoprotein cholesterol ratio predict incidence of cardiovascular disease in the Mashhad cohort study

The triglyceride glucose (TyG) index and triglyceride/high lipoprotein density cholesterol (TG/HDL-C) are two important risk markers to evaluate the insulin resistance and cardiovascular diseases (CVDs). To assess the association between TG/HDL-C and TyG index and CVDs. The Mashhad stroke and heart association disorder cohort study started in 2010 and has been continued until 2020. During 6-year follow-up of 9704 participants, 235 events including 118 acute coronary syndrome (ACS), 83 chronic coronary syndrome, 27 myocardial infarction, and 27 cardiac death were confirmed. SPSS software (version 21) was used for statistical analysis and figures were drawn by GraphPad Prism 6 software. The prevalence of ACS and cardiac death were higher in the fourth quartile of serum TG/HDL-C (>4.43) and higher prevalence of ACS was considered in subjects classified in the fourth quartile of TyG index (>8.98). A high TyG index was associated with an increased risk of ACS and cardiac death [1.362 (95% confidence interval [CI]: [1.013-1.831]) and 2.3 (95% CI: [1.247-4.241])] respectively; based on Cox regression analysis elevated TyG and TG/HDL-C increased the chance of CVD by [1.634 (95% CI: 1.304-2.047) and 1.068 (95% CI: 1.031-1.105)], respectively. Our results strongly showed that TyG index and TG/HDL-C are independent risk factors for incident CVD, suggesting that TyG index and TG/HDL-C may be as an important unique biomarker for predicting CVD outcomes and progression.

Triglyceride-glucose index predicts the risk of gestational diabetes mellitus: a systematic review and meta-analysis

AIMS

We aimed to investigate the potential predictive efficacy of triglyceride-glucose (T/Gly) index for gestational diabetes mellitus (GDM) in a systematic review and meta-analysis.

MATERIALS AND METHODS

Cohort studies demonstrating the association between T/Gly index measured at the first trimester or before pregnancy and the subsequent incidence of GDM were identified by search of PubMed, Embase, China National Knowledge Infrastructure, and WanFang databases. A random-effect model incorporating the heterogeneity was applied to pool the results. Five cohort studies including 382,213 women were included in this meta-analysis.

RESULTS

Compared to those with the lowest category of T/Gly index, women with the highest category of T/Gly index were independently associated with higher risk of subsequent GDM (odds ratio [OR]: 2.52, 95% confidence interval [CI]: 1.33 ∼ 4.67, I²=65%, p=.004) after adjustment of potential confounding factors including age, body mass index, and family history of diabetes. The association was stronger in prospective cohort studies than retrospective cohort studies (p for subgroup difference=.007), and a significant association was detected in Asian women (OR: 3.30, 95% CI: 1.50-7.28, p =.003), but not in non-Asian women (OR: 0.96, 95% CI: 0.35-2.63, p=.94).

CONCLUSIONS

Higher T/Gly index may independently predict the risk of GDM in Asian women.

Association between triglyceride glucose index and risk of cancer: A meta-analysis

BACKGROUND

Triglyceride glucose (TyG) index as a more convenient and reliable predictor of insulin resistance (IR) is thought to be associated with many diseases, but its relationship with cancer remains unclear.

METHODS

The meta-analysis was conducted to evaluate the effects of TyG index on cancer risk utilizing the available evidence. PubMed, EMBASE, Medline, Cochrane Library and Web of Science were searched from their inception up to July 2022. A random-effects model was used to calculate the effect estimates and 95% confidence intervals (CIs).

RESULTS

A total of 6 observational studies met our inclusion criteria, which including 992292 participants. The meta-analysis indicated that the higher TyG index increased cancer risk compared to the lower TyG index group (total effect size =1.14, 95% CI [1.08, 1.20], P<0.001).

CONCLUSIONS

Our meta-analysis found that higher TyG index may increase the risk of cancer. More prospective cohort studies and basic research are warranted to verify the relationship.