Comparisons of various insulin resistance indices for new-onset metabolic syndrome before midlife: The CHIEF cohort study, 2014-2020

Abstract

Background: Some non-insulin-based insulin resistance (IR) indices have been found to be associated with metabolic syndrome (MetS); however, few cohort studies have compared the capacities of these indices for predicting incident MetS in young adults.

Aim: To investigate the associations of various non-insulin-based IR (NI-IR) indices with new-onset MetS in young military personnel.

Methods: A total of 2890 armed forces personnel in Taiwan who were aged 18-39 years and did not have MetS at baseline were followed to monitor the incidence of new-onset MetS from 2014 to the end of 2020. Six NI-IR indices, including the metabolic score for IR (METS-IR), triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio, TG glucose (TyG) index, Zhejiang University (ZJU) index, total cholesterol (TC)-to-HDL-C ratio, and alanine transaminase (ALT)-to-aspartate transaminase (AST) ratio, were defined according to specific criteria. Incident MetS was identified on the basis of each annual health examination using the International Diabetes Federation criteria. Multiple Cox regression analyses were conducted, adjusting for age, sex, waist circumference, smoking status, alcohol consumption status, and physical activity, to assess the associations of the NI-IR indices with incident MetS. The area under the receiver operating characteristic curve (AUROC) was used to compare the capacities of these NI-IR indices for predicting new-onset MetS.

Results: During a median follow-up of 5.8 years, there were 673 patients with new-onset MetS (23%). All six of the NI-IR indices were significantly and positively associated with incident MetS. In the entire cohort, the greatest AUROC was found for the METS-IR [0.782; 95% confidence interval (CI): 0.762-0.801; all P values compared to the other NI-IR indices < 0.05], followed by the TG/HDL-C ratio (0.752; 95%CI: 0.731-0.772), ZJU index (0.743; 95%CI: 0.722-0.764), TyG index (0.734; 95%CI: 0.713-0.756), TC/HDL-C ratio (0.731; 95%CI: 0.709-0.752), and then the ALT/AST ratio (0.734; 95%CI: 0.713-0.756).

Conclusion: This study suggests that almost all the NI-IR indices are associated with the development of MetS in military young adults. The METS-IR is the strongest predictor of new-onset MetS before midlife.

Keywords: Cohort study; Insulin resistance indices; Metabolic syndrome; Young adults.

Figure 1

Flow diagram of selection of eligible participants for follow-up of new-onset metabolic syndrome in the CHIEF cohort study, 2014-2020.

Figure 2

Receiver operating characteristic curve analysis of non-insulin-based insulin resistance indices for new-onset metabolic syndrome. All non-insulin-based insulin resistance (NI-IR) indices demonstrated significant predictive capacities for incident metabolic syndrome. Among the NI-IR indices, the metabolic score for insulin resistance index revealed the greatest area under the receiver operating characteristic of 0.782 (optimal cut-off point: 2.03), followed by 0.752 (optimal cut-off point: 1.88) with the triglyceride/high-density lipoprotein cholesterol (HDL-C) ratio, 0.743 (optimal cut-off point: 125.71) with the Zhejiang University index, 0.734 (optimal cut-off point: 8.37) with the triglyceride glucose index, 0.731 (optimal cut-off point: 3.55) with the total cholesterol/HDL-C ratio, and 0.674 (optimal cut-off point: 0.95) with the alanine transaminase/aspartate transaminase ratio. ROC: Receiver operating characteristic; METS-IR: Metabolic score for insulin resistance; TyG: Triglyceride glucose; ALT: Alanine transaminase; AST: Aspartate transaminase; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; TG: Triglyceride; ZJU: Zhejiang University.