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Chen J, Li YT, Niu Z, He Z, Xie YJ, Hernandez J, Huang W, Wang HHX. Investigating the causal association of generalized and abdominal obesity with microvascular complications in patients with type 2 diabetes: A community-based prospective study. Diabetes Obes Metab 2024; 26:2796-2810. [PMID: 38695216 DOI: 10.1111/dom.15598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 06/05/2024]
Abstract
AIM The paradoxical protective association between overweight/obesity and diabetic microvascular complications (DMC), a phenomenon well-known as the obesity paradox, has been considered a non-causal association based on methodological influences. We aimed to investigate the association of generalized and abdominal obesity, as measured by body mass index (BMI) and waist circumference (WC), respectively, with DMC in patients with type 2 diabetes (T2D), using a causal inference approach. MATERIALS AND METHODS We enrolled 1436 patients with clinically diagnosed T2D but not DMC at baseline in a community-based prospective cohort in China between 2017 and 2019 and followed them annually until 2022 with new-onset DMC recorded. Marginal structural Cox models with inverse probability weighting were constructed to determine the causal association. Subgroup analyses were performed to identify potential effect modifiers. RESULTS We observed 360 incident DMC cases, including 109 cases of diabetic nephropathy (DN) and 277 cases of diabetic retinopathy (DR) during four follow-up visits. Multivariable-adjusted hazard ratios (95% confidence intervals) for overall DMC, DN and DR were 1.037 (1.005-1.071), 1.117 (1.062-1.175) and 1.018 (0.980-1.059) for 1 kg/m2 increase in BMI, and 1.005 (0.994-1.017), 1.034 (1.018-1.051) and 1.000 (0.987-1.014) for 1 cm increase in WC, respectively. Similar patterns were observed across the BMI and WC categories, while the positive association appeared to be more pronounced in women. CONCLUSIONS Generalized but not abdominal obesity was associated with an increased risk for the overall DMC, whereas both obesities were causally related to DN, albeit not DR, in T2D. Routine weight management should not be neglected in diabetes care, particularly in women.
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Affiliation(s)
- Jiaheng Chen
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yu Ting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zimin Niu
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhanpeng He
- Liwan Central Hospital of Guangzhou, Guangzhou, People's Republic of China
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
| | - Jose Hernandez
- Faculty of Medicine and Health, EDU, Digital Education Holdings Ltd., Kalkara, Malta
- Green Templeton College, University of Oxford, Oxford, UK
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Harry H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
- Usher Institute, Deanery of Molecular, Genetic & Population Health Sciences, The University of Edinburgh, Edinburgh, UK
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Kalfaoglu ME. Evaluation of Hepatic/Renal and Splenic/Renal Echointensity Ratio Using Ultrasonography in Diabetic Nephropathy. Diagnostics (Basel) 2023; 13:2401. [PMID: 37510145 PMCID: PMC10377935 DOI: 10.3390/diagnostics13142401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
The objective of this study is to assess the hepatic/renal and splenic/renal echointensity ratios in ultrasonography in patients with and without diabetic nephropathy. This retrospective study included patients with diabetes mellitus who underwent ultrasound examinations at our hospital between January 2023 and May 2023. Ultrasound examinations were conducted using renal cortical echogenicity and corticomedullary differentiation by using B-mode ultrasonography. The hepatic/renal and splenic/renal echo intensity ratios were compared among study groups (diabetic patients with diabetic nephropathy and without nephropathy). The diabetic nephropathy group exhibited significantly higher right renal echointensity and left renal echointensity compared to the non-nephropathic group. Additionally, the splenic/renal echointensity ratio and hepatic/renal echointensity ratio were significantly lower in the diabetic nephropathy group. Urinary microalbumin levels were significantly correlated with right renal echointensity (r = 0.65, p < 0.001) and left renal echointensity (r = 0.69, p < 0.001). There was also a significant inverse correlation between the urinary albumin and splenic/renal echointensity ratio (r = -0.58, p < 0.001). Ultrasonography, specifically the assessment of hepatic/renal and splenic/renal echointensity ratios, shows promise as a noninvasive and cost-effective method for evaluating morphological changes in the kidneys in patients with diabetic nephropathy. These findings suggest that ultrasonography can be a valuable tool for monitoring the progression of diabetic nephropathy and contributing to its early detection and management.
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Lonardo A. The heterogeneity of metabolic syndrome presentation and challenges this causes in its pharmacological management: a narrative review focusing on principal risk modifiers. Expert Rev Clin Pharmacol 2023; 16:891-911. [PMID: 37722710 DOI: 10.1080/17512433.2023.2259306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Metabolic syndrome (MetS), i.e. the cluster of cardiometabolic risk factors comprising visceral obesity, impaired glucose metabolism, arterial hypertension and atherogenic dyslipidemia, is prevalent globally and exacts a heavy toll on health care expenditures. AREAS COVERED The pathophenotypes of individual traits of the MetS in adults are discussed first, with strong emphasis on nonalcoholic fatty liver disease (NAFLD) and sex differences. Next, I discuss recent studies on phenotypic and outcome heterogeneity of the MetS, highlighting the role of NAFLD, sex, reproductive status, and depressive disorders. In the second half of the article, the therapeutic implications of the variable MetS types and features are analyzed, focusing on the most recent developments, and guidelines. EXPERT OPINION I have identified physiological, pathological, social and medical sources of phenotypical heterogeneity in the MetS and its constitutive traits. Improved understanding of these variables may be utilized in the setting of future precision medicine approaches in the field of metabolic disorders and target organ damage.
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Affiliation(s)
- Amedeo Lonardo
- Operating Unit of Metabolic Syndrome, Azienda Ospedaliero-Unversitaria di Modena, Ospedale Civile di Baggiovara, Baggiovara, Modena, Italy
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Yan S, Wang D, Jia Y. Comparison of insulin resistance-associated parameters in US adults: a cross-sectional study. Hormones (Athens) 2023; 22:331-341. [PMID: 36972006 DOI: 10.1007/s42000-023-00448-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Triglyceride-glucose (TyG) is correlated with cardiovascular events caused by insulin resistance (IR). The aim of this study was to analyze the relationship between TyG and its related indicators and IR among US adults from 2007 to 2018 in the National Health and Nutrition Examination Survey (NHANES) database so as to identify more accurate and reliable predictors of IR. METHODS This is a cross-sectional study including 9884 participants (2255 with IR and 7629 without IR). TyG, TyG-body mass index (TyG-BMI), TyG waist circumference (TyG-WC), and TyG waist-to-height ratio (TyG-WtHR) were measured using standard formulas. RESULTS TyG, TyG-BMI, TyG-WC, and TyG-WtHR were significantly correlated with IR in the general population, with TyG-WC being the most strongly correlated, with an odds ratio of 8.00 (95% confidence interval 5.05-12.67) for the fourth quartile of TyG-WC compared with the first quartile in the adjusted model. Receiver operating characteristic (ROC) analysis of the participants showed that the maximum area under the TyG-WC curve was 0.8491, which was significantly higher than that of the other three indicators. Moreover, this trend was stable both among people of both genders and among patients with coronary heart disease (CHD), hypertension, and diabetes. CONCLUSIONS The present study confirms that the TyG-WC index is more successful than TyG alone in identifying IR. In addition, our findings demonstrate that TyG-WC is a simple and effective marker for screening the general US adult population and those with CHD, hypertension, and diabetes and can be effectively used in clinical practice.
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Affiliation(s)
- Shaoyi Yan
- Department of Cardiovascular Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.
| | - Di Wang
- Department of Cardiovascular Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongping Jia
- Department of Cardiovascular Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.
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Hulkoti V, Acharya S, Shukla S, Kumar S, Kabra R, Dubey A, Lahane V, Giri A. Visceral Adiposity Index in Type 2 Diabetes Mellitus (DM) and Its Correlation With Microvascular Complications. Cureus 2022; 14:e31279. [DOI: 10.7759/cureus.31279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
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Ma YL, Jin CH, Zhao CC, Ke JF, Wang JW, Wang YJ, Lu JX, Huang GZ, Li LX. Waist-to-height ratio is a simple and practical alternative to waist circumference to diagnose metabolic syndrome in type 2 diabetes. Front Nutr 2022; 9:986090. [PMID: 36419559 PMCID: PMC9676651 DOI: 10.3389/fnut.2022.986090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/20/2022] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND As an indicator of abdominal obesity, waist circumference (WC) varied with race and gender in diagnosing metabolic syndrome (MetS). Therefore, it is clinically important to find an alternative indicator of abdominal obesity independent of these factors to diagnose MetS. Our aims were to evaluate the association between waist-to-height ratio (WHtR) and MetS and further determine whether WHtR could be used as a simple and practical alternative to WC to diagnose MetS in patients with type 2 diabetes mellitus (T2DM). METHODS This cross-sectional, real-world study recruited 8488 hospitalized T2DM patients including 3719 women (43.8%) aged from 18 to 94 years and 4769 men (56.2%) aged from 18 to 91 years. A WHtR cut-off of 0.52 was used to diagnose MetS in both men and women T2DM patients based on our previous study. The association of WHtR with MetS in T2DM patients was analyzed by binary logistic regression. The consistency of two diagnostic criteria for MetS according to WC and WHtR was determined by Kappa test. RESULTS The prevalence of MetS according to WHtR was 79.4% in women and 68.6% in men T2DM patients, which was very close to the prevalence of MetS according to WC in both women (82.6%) and men (68.3%). The prevalence of MetS diagnosed by WC in both men and women with WHtR ≥ 0.52 was significantly higher than in those with WHtR < 0.52 after adjustment for age and duration of diabetes (89.2 vs. 38.7% for men; 92.8 vs. 57.4% for women; respectively, all p < 0.001). Binary logistic regression analysis displayed that after adjusting for confounding factors, WHtR was significantly associated with the presence of MetS in both men and women (men: OR = 4.821, 95% CI: 3.949-5.885; women: OR = 3.096, 95% CI: 2.484-3.860; respectively, all p < 0.001). Kappa test revealed that there was an excellent consistency between the diagnosis of MetS based on WC and on WHtR in T2DM patients (men: kappa value = 0.929, 95% CI: 0.918-0.940; women: kappa value = 0.874, 95% CI: 0.854-0.894; total: kappa value = 0.911, 95% CI: 0.901-0.921; respectively, all p < 0.001). CONCLUSION WHtR is independently associated with the presence of MetS and can be used as a simple and practical alternative to WC to diagnose MetS regardless of gender in T2DM patients.
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Affiliation(s)
- Yi-Lin Ma
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Chun-Hua Jin
- Department of Endocrinology and Metabolism, Shanghai Songjiang District Central Hospital, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage), Shanghai, China
| | - Cui-Chun Zhao
- Department of VIP, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang-Feng Ke
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Jun-Wei Wang
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yu-Jie Wang
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Jun-Xi Lu
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Gao-Zhong Huang
- Department of VIP, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lian-Xi Li
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
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Niu C, Liu L, Li Y, Li X. Impact of Diabetic Nephropathy on Pulmonary Function and Clinical Outcomes. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8164034. [PMID: 36072729 PMCID: PMC9441358 DOI: 10.1155/2022/8164034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/27/2022]
Abstract
Objective The main objective is to study the effect of diabetic nephropathy on pulmonary function and clinical outcomes. Methods The method is to retrospectively analyze patients with diabetic nephropathy (DN) in our hospital from April 2018 to March 2022 as study subjects. The differences in baseline data, serum indicators, renal function indicators, and pulmonary function of patients at different clinical stages were analyzed and then explored. Finally, logistic regression was used to analyze the risk factors affecting patients' clinical outcomes and to evaluate the diagnostic effects. Results Baseline information (age, disease duration, BMI, and systolic and diastolic blood pressure), serum indicators (HbA1c, FBG, 2hPG, TG, TC, and LDLC), renal function indicators (CysC, BUN, and Scr), and pulmonary function (TLC, VC, FEV1, FEV1/FVC, MVV, MEF25, MEF50 MEF75, DLCO, and DLCO/VA) were significantly different (P < 0.01); multiple logistic regression analysis showed that SBP, HbA1c, FBG, 2hPG, BUN, Scr, TLC, VC, FEV1/FVC, MVV, DLCO, and DLCO/VA were all key factors in the development of clinical outcomes in DN (P < 0.05). ROC analysis showed that all of these important factors had an AUC greater than 0.75 for the diagnosis of DN with high sensitivity and specificity. Conclusion Serum and renal function indices of DN patients gradually increased with stage, accompanied by a decrease in pulmonary ventilation, and diffusion function; SBP, HbA1c, FBG, 2hPG, BUN, Scr, TLC, VC, FEV1/FVC, MVV, DLCO, and DLCO/VA were all key factors affecting the clinical outcome of DN; controlling blood glucose, lipids, improving pulmonary ventilation, and diffusion function can better prevent the occurrence and worsening of DN.
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Affiliation(s)
- Chunbo Niu
- First School of Clinical Medical to Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Lu Liu
- First School of Clinical Medical to Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Yang Li
- Department of Respiration and Critical Medicine in Cadre Ward, Gansu Provincial Hospital, Lanzhou 730000, China
| | - Xiaoqi Li
- Department of Respiration and Critical Medicine in Cadre Ward, Gansu Provincial Hospital, Lanzhou 730000, China
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Hukportie DN, Li F, Zhou R, Zheng J, Wu X, Zou M, Wu X. Lipid variability and risk of microvascular complications in Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: A post hoc analysis. J Diabetes 2022; 14:365-376. [PMID: 35668633 PMCID: PMC9366577 DOI: 10.1111/1753-0407.13273] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/28/2022] [Accepted: 05/09/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Greater lipid variability may cause adverse health events among diabetic patients. We aimed to examine the effect of lipid variability on the risk of diabetic microvascular outcomes among type 2 diabetes mellitus patients. METHODS We assessed the association between visit-to-visit variability (measured by variability independent of mean) in high-density lipoprotein (HDL) cholesterol, low-density lipoprotein-cholesterol (LDL), triglyceride, and remnant cholesterol (RC) measurements among participants involved in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the risk of incident microvascular outcomes, including nephropathy, neuropathy, and retinopathy. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for potential confounders. RESULTS There were 2400, 2470, and 2468 cases of nephropathy, neuropathy, and retinopathy during a follow-up period of 22 600, 21 542, and 26 701 person-years, respectively. Higher levels of HDL, triglyceride, and RC variability were associated with an increased risk of incident nephropathy and neuropathy. Compared with the lowest quartile, the fully adjusted HRs (95% CI) for the highest quartile of HDL, triglyceride, and RC variability for nephropathy risk were 1.57 (1.22, 2.01), 1.50 (1.18, 1.92), and 1.40 (1.09, 1.80), respectively; and for neuropathy, the corresponding risks were 1.36 (1.05, 1.75), 1.47 (1.14, 1.91), and 1.35 (1.04, 1.74), respectively. Null association was observed between LDL variability and all microvascular complications. Additionally, all associations of variability in the other lipids with retinopathy risk were null. CONCLUSION Among individuals with type 2 diabetes mellitus, HDL, triglyceride, and RC variability were associated with increased risks of nephropathy and neuropathy but not retinopathy. TRIAL REGISTRATION ClinicalTrials.gov., no. NCT00000620.
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Affiliation(s)
- Daniel Nyarko Hukportie
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Fu‐Rong Li
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
- School of Public Health and Emergency ManagementSouthern University of Science and TechnologyShenzhenChina
| | - Rui Zhou
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Jia‐Zhen Zheng
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Xiao‐Xiang Wu
- Department of General Surgery157 Hospital, General Hospital of Guangzhou Military CommandGuangzhouChina
| | - Meng‐Chen Zou
- Department of Endocrinology and Metabolism, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Xian‐Bo Wu
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
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Xuan W, Liu D, Zhong J, Luo H, Zhang X. Impacts of Triglyceride Glucose-Waist to Height Ratio on Diabetes Incidence: A Secondary Analysis of A Population-Based Longitudinal Data. Front Endocrinol (Lausanne) 2022; 13:949831. [PMID: 35937805 PMCID: PMC9354460 DOI: 10.3389/fendo.2022.949831] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The anthropometric indices (body mass index [BMI], waist circumference [WC] and waist-to-height ratio [WHtR]), triglyceride-glucose (TyG) index and TyG-related indicators (TyG-WHtR, TyG-BMI, TyG-WC) have been well documented to be highly correlated with insulin resistance (IR) and type 2 diabetes mellitus (T2DM). However, it was not immediately obvious which indicator would be optimal for screening people at risk of T2DM. Hence, this study intended to compare the predictive effects of the aforementioned markers on T2DM and to investigate the relation between baseline TyG-WHtR and incident T2DM. METHODS This longitudinal study included 15464 study population who were involved in the NAGALA (NAfld in the Gifu Area Longitudinal Analysis) study from 2004 to 2015. The TyG index was defined as ln [FPG (mg/dL) ×fasting TG (mg/dL)/2]. And the TyG-WHtR was calculated as TyG index ×WHtR. We divided the participants into four groups according to the TyG-WHtR quartiles. The primary endpoint was the incidence of diabetes. RESULTS After a median follow-up of 5.4 years, 2.4% (373/15464) participants developed diabetes. The incidence of diabetes increased with ascending TyG-WHtR quartiles (P for trend<0.001). Multivariable Cox proportional hazard analysis showed that a one-unit increase in TyG-WHtR was independently correlated with a 2.714-fold higher risk of diabetes [hazard ratio (HR) 2.714, 95% confidence interval (CI) 1.942-3.793; P<0.001). Stratification analysis revealed that increased TyG-WHtR (per 1-unit) was consistently correlated with diabetes incidence in different subgroups. Moreover, TyG-WHtR outperformed the other parameters by presenting the biggest area under the ROC curve (AUC) in men (AUC 0.746, 95% CI 0.716-0.776, P<0.001). However, all pairwise comparisons of AUC between TyG-WHtR and other indicators were not statistically different except TyG-WHtR vs. WHtR in women. CONCLUSIONS A high TyG-WHtR is an important predictor of the increased cumulative risk of diabetes development. TyG-WHtR outperforms TyG, WHtR, TyG-WC and TyG-BMI in screening individuals who are susceptible to T2DM, especially in men.
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Affiliation(s)
- Wenting Xuan
- Department of Endocrinology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People’s Hospital), Dongguan, China
| | - Dixing Liu
- Department of Endocrinology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People’s Hospital), Dongguan, China
| | - Jiana Zhong
- Department of Endocrinology, The Dongguan Affiliated Hospital of Jinan University, Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Huijin Luo
- Department of Endocrinology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People’s Hospital), Dongguan, China
| | - Xiuwei Zhang
- Department of Endocrinology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People’s Hospital), Dongguan, China
- *Correspondence: Xiuwei Zhang,
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