Associations between non-insulin-based insulin resistance indices and heart failure prevalence in overweight/obesity adults without diabetes mellitus: evidence from the NHANES 2001-2018

Abstract

Background: The triglyceride glucose (TyG) index and triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio are recognized as simple non-insulin-based insulin resistance indices. Our study aimed to explore the relationship between these two indicators and heart failure (HF) in overweight or obesity individuals without diabetes.

Methods: This cross-sectional study selected 13,473 participants from the National Health and Nutrition Examination Survey (NHANES) 2001-2018 dataset. Weighted multivariable logistic regression and subgroup analysis were employed to evaluate the relationships between TyG index, TG/HDL-C ratio, and HF prevalence, respectively. Additionally, smooth curve fitting was utilized to analyze the dose-response relationships.

Results: A total of 13,473 obesity or overweight people without diabetes were included in this study through screening, among whom 291 (2.16%) had comorbid HF. The results of multivariable logistic regression suggested that the highest TyG index (OR = 2.4, 95% CI = 1.4-4.2, p = 0.002) and the highest TG/HDL-C ratio (OR = 1.2, 95% CI = 1.1-1.3, p < 0.001) both increased the prevalence of HF, especially in the non-Hispanic population. Dose-response relationships suggested nonlinear relationships between these two indicators and HF.

Conclusion: Our study demonstrated that elevated TyG index and TG/HDL-C ratio were closely associated with the prevalence of HF, and both exhibited nonlinear relationships with HF prevalence in overweight/obesity adults without diabetes. Based on these findings, additional prospective studies are needed for further validation.

Keywords: Heart failure; Overweight/obesity; Triglyceride-glucose index; Triglyceride-to-high-density lipoprotein cholesterol ratio.

Fig. 1

Flow chart of participants selection from the NHANES 2001–2018

Fig. 2

Subgroup analysis of the association between the prevalence of HF and TyG index (A), TG/HDL-C ratio (B). Adjusted for age, sex, ethnicity, systolic blood pressure (mmHg), diastolic blood pressure (mmHg), albumin(g/dl), creatinine (mg/dL), low density lipoprotein (mg/dl), total cholesterol (mg/dl), smoke statue, stroke and CHD, except the stratified factor itself. IFG, impaired fasting glucose; CHD, coronary heart disease; SBP, systolic blood pressure

Fig. 3

Smooth curve fitting using Generalized Additive Model (GAM) to evaluate the nonlinear relationship between TyG index (A), TG/HDL-C ratio (B) and the proportion of HF. The red solid line represents the probability of HF occurrence and the blue dotted line represents the 95% CI curve