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. 2023 Jun 29;22(1):157.
doi: 10.1186/s12933-023-01886-5.

Non-linear association of atherogenic index of plasma with insulin resistance and type 2 diabetes: a cross-sectional study

Bei Yin  1 , Zihong Wu  2 , Yaqing Xia  3 , Shunqiang Xiao  1 , Lingling Chen  4 , Yousheng Li  5
Affiliations

Non-linear association of atherogenic index of plasma with insulin resistance and type 2 diabetes: a cross-sectional study

Bei Yin et al. Cardiovasc Diabetol. .

Abstract

Background: Although there is numerous evidence on the epidemiological risk factors for insulin resistance (IR)-related metabolic diseases, there is still insufficient evidence to explore the non-linear association of Atherogenic Index of Plasma (AIP) with IR. Therefore, we aimed to elucidate the non-linear relationship between AIP and IR and type 2 diabetes (T2D).

Methods: This cross-sectional study was conducted in the National Health and Nutrition Survey (NHANES) from 2009 to 2018. A total of 9,245 participants were included in the study. The AIP was calculated as log10 (triglycerides/high-density lipoprotein cholesterol). The outcome variables included IR and T2D defined by the 2013 American Diabetes Association guidelines. The weighted multivariate linear regression, weighted multivariate logistic regression, subgroup analysis, generalized additive model, smooth fitting curve and two-part logistic regression were adopted to reveal the relationship of AIP with IR and T2D.

Results: After adjustment for age, gender, race, education level, smoking status, alcohol consumption, vigorous/moderate physical activity, body mass index, waist circumference and hypertension, we found that AIP was positively associated with fasting blood glucose (β = 0.08, 95% CI: 0.06, 0.10), glycosylated hemoglobin (β = 0.04, 95% CI: 0.39, 0.58), fasting serum insulin (β = 4.26, 95% CI: 3.73, 4.79), and homeostasis model assessment of insulin resistance (β = 0.22, 95% CI: 0.18, 0.25). Further studies found that AIP was associated with increased risk of IR (OR = 1.29, 95% CI: 1.26-1.32) and T2D (OR = 1.18, 95% CI: 1.15-1.22). However, the positive association between AIP and IR or T2D was more significant in female than in male (IR: P for interaction = 0.0135; T2D: P for interaction = 0.0024). A non-linear and inverse L-shaped association was found between AIP and IR, while a J-shaped association was found between AIP and T2D. In patients with - 0.47 < AIP < 0.45, increased AIP was significantly associated with increased risk of IR and T2D.

Conclusions: AIP showed an inverse L-shaped association with IR and a J-shaped association with T2D, indicating that AIP should be reduced to a certain level to prevent IR and T2D.

Keywords: Atherogenic index of plasma; Cross-sectional study; Insulin resistance; NHANES; Type 2 diabetes.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of participants selection from the NHANES 2009–2018
Fig. 2
Fig. 2
The proportions of T2D and IR by quartile of AIP
Fig. 3
Fig. 3
Smooth curve fitting using GAM to evaluate the nonlinear relationship between AIP and the risk of IR. The red solid line represents the probability of IR occurrence and the blue dotted line represents the 95% CI curve
Fig. 4
Fig. 4
Smooth curve fitting using GAM to evaluate the nonlinear relationship between AIP and the risk of T2D. The red solid line represents the probability of T2D occurrence and the blue dotted line represents the 95% CI curve
See this image and copyright information in PMC

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