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. 2025 Sep;46(5):327-332.
doi: 10.4082/kjfm.23.0141. Epub 2024 Aug 20.

Association between e-cigarette smoking and insulin resistance using the triglyceride-glucose index in Korean adults: Korea National Health and Nutrition Examination Survey

Dahae Lim  1 , Jung In Choi  1 , Ryuk Jun Kwon  1 , Sang Yeoup Lee  1   2   3 , Young Hye Cho  1   2 , Eun Ju Park  1 , Youngin Lee  1 , Sae Rom Lee  1 , Soo Min Son  1 , Yun Jin Kim  4 , Jeong Gyu Lee  4 , Yu Hyeon Yi  4 , Young Jin Tak  4 , Seung Hun Lee  4 , Gyu Lee Kim  4 , Young Jin Ra  4
Affiliations

Association between e-cigarette smoking and insulin resistance using the triglyceride-glucose index in Korean adults: Korea National Health and Nutrition Examination Survey

Dahae Lim et al. Korean J Fam Med. 2025 Sep.

Abstract

Background: Insulin resistance contributes to the development of cardiovascular disease and type 2 diabetes mellitus. Smoking leads to an increase in triglyceride levels, which, in turn, increases insulin resistance. Although the number of e-cigarette users has increased in recent years, few studies have investigated the association between ecigarette use and insulin resistance. Therefore, this study aimed to determine the association between e-cigarette use and insulin resistance using the triglyceride-glucose (TyG) index in Korean adults.

Methods: This study included 4,404 healthy adults aged ≥20 years who participated in the Korea National Health and Nutrition Examination Survey between 2019 and 2020. Participants were categorized as never-smokers or ecigarette users, and the TyG index was categorized into low- and high-TyG index groups according to the median value (9.22). A logistic regression analysis was performed to determine the association between e-cigarette smoking and insulin resistance.

Results: E-cigarette users had a higher TyG index than never smokers (e-cigarette: mean=9.35; never: mean=9.18; P<0.001). The ecigarette users had a higher risk of being in the high TyG index group than never-smokers (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.03-1.84). In the subgroup analysis stratified by sex, age, and body mass index, a higher OR for a high TyG index was observed in men (OR, 1.46; 95% CI, 1.03-2.08) and individuals aged 60 years or older (OR, 3.74; 95% CI, 1.14-12.30).

Conclusion: Our findings suggest that e-cigarette use is significantly associated with insulin resistance.

Keywords: Electronic Nicotine Delivery Systems; Insulin Resistance; Smoking; Triglyceride-Glucose Index.

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Conflict of interest statement

Conflict of interest

Sang Yeoup Lee is an editorial board member of the journal but was not involved in the peer reviewer selection, evaluation, or decision process of this article. Except for that, no other potential conflicts of interest relevant to this article were reported.

Comment in

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