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. 2025 Jun 13:12:1570771.
doi: 10.3389/fnut.2025.1570771. eCollection 2025.

ZJU index as a predictive biomarker of gestational diabetes mellitus: a prospective cohort analysis

Ziyi Xu  1 , Xuewei Li  2 , Hui Wang  2 , Liuyang Xu  1 , Changhui Li  1
Affiliations

ZJU index as a predictive biomarker of gestational diabetes mellitus: a prospective cohort analysis

Ziyi Xu et al. Front Nutr. .

Abstract

Background: The ZJU index, incorporating fasting plasma glucose (FPG), lipid profiles, liver enzymes, and body mass index (BMI), serves as a multidimensional tool for assessing metabolic dysregulation. This prospective investigation examined first-trimester ZJU index associations with both gestational diabetes mellitus (GDM) risk and nonalcoholic fatty liver disease (NAFLD) during pregnancy, while simultaneously evaluating the relationships between lipid profiles, liver enzymes, and GDM development.

Methods: We conducted analyses using multivariable logistic regression and restricted cubic splines (RCS) to assess associations of the ZJU index, liver enzymes, and blood lipids with GDM, as well as the association between the ZJU index and NAFLD. Subgroup analyses were conducted to evaluate the correlation between the ZJU index (stratified by age and reproductive history) and GDM. The receiver operating characteristic (ROC) curve assessed the ZJU index's predictive power. The robustness of the findings was verified via sensitivity analyses.

Results: In the multivariable regression model, the ZJU index showed a significant positive association with GDM, after adjusting for confounders [OR = 1.22, 95% CI (1.13-1.32)]. The RCS analysis revealed a linear dose-response relationship between the ZJU index and GDM. The area under the curve (AUC) for the ZJU index was 0.802, indicating a high predictive ability for GDM. Associations between the ZJU index and GDM remained consistent across subgroups and sensitivity analyses.

Conclusion: The ZJU index is closely associated with GDM prevalence.

Keywords: ZJU; early pregnancy; gestational diabetes mellitus; lipid index; liver enzyme.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study design.
Figure 2
Figure 2
Dose-response relationship between ZJU with GDM and NAFLD. (A) Dose-response relationship between ZJU with GDM. (B) Dose-response relationship between ZJU with NAFLD.
Figure 3
Figure 3
ROC curves for predicting GDM. AUC, area under the curve; BMI, body mass index; TG, triglyceride; HDL, high-density lipoprotein cholesterol; FPG, fasting plasma glucose, ALT, alanine aminotransferase; AST, aspartate aminotransferase; HOMA-IR, homeostatic model assessment of insulin resistance; GDM, gestational diabetes mellitus.
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