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. 2025 Sep 11;15(9):606.
doi: 10.3390/metabo15090606.

The Metabolic Vulnerability Index (MVX) in Subclinical Thyroid Disorders and Euthyroidism: A Cross-Sectional Exploratory Analysis from the ELSA-Brasil Study

Carolina Castro Porto Silva Janovsky  1   2 , Vandrize Meneghini  1 , William Tebar  1 , Joao Roberto Maciel Martins  2 , José Augusto Sgarbi  3 , Patrícia de Fatima Dos Santos Teixeira  4 , Itamar de Souza Santos  1 , Steven R Jones  5 , Michael J Blaha  5 , Peter P Toth  5   6 , Marcio S Bittencourt  7 , Raul D Santos  8   9 , Paulo A Lotufo  1 , Layal Chaker  10   11 , Isabela M Bensenor  1
Affiliations

The Metabolic Vulnerability Index (MVX) in Subclinical Thyroid Disorders and Euthyroidism: A Cross-Sectional Exploratory Analysis from the ELSA-Brasil Study

Carolina Castro Porto Silva Janovsky et al. Metabolites. .

Abstract

Background: Recently, a new biomarker index that reflects inflammation and protein energy malnutrition has emerged as a predictor of mortality in cardiovascular diseases. The metabolic vulnerability index (MVX) derives from blood-based inflammation (IVX) and malnutrition (MMX) markers measured by nuclear magnetic resonance (NMR) spectroscopy. We aimed to explore the association of subclinical hypothyroidism and thyroid-related parameters with IVX, MMX, and MVX scores.

Methods: This cross-sectional study used the baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Individuals with normal thyroid function and subclinical hypothyroidism were included. Thyroid-related parameters-thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), the FT3-FT4 ratio, and antithyroperoxidase antibodies (TPOAb)-were the explanatory variables. The primary outcomes, MVX, MMX, and IVX scores, were analyzed as continuous variables. Linear regression analyses were performed for both univariate and multivariable models, with sensitivity and subgroup analyses applied to assess robustness.

Findings: There were 3979 participants (51.4% female) with a mean age of 51.26 (SD: 9.02) years. After full adjustment for potential confounder variables, FT3 levels [B: -1.37 (-2.43;-0.31) p = 0.011] and the FT3-FT4 ratio [B: -0.90 (-1.79;-0.01) p = 0.047] were inversely associated with MVX scores. FT3 levels were also inversely associated with IVX [B: -1.32 (-2.39;-0.24) p = 0.017]. These results were consistent in euthyroid individuals and those with cardiometabolic diseases. In the sex-stratified analysis, FT3 levels were inversely associated with MVX, MMX, and IVX scores for men.

Conclusion: Lower FT3 levels and the FT3-FT4 ratio were associated with a higher metabolic vulnerability in our cohort. Our study sheds light on the importance of metabolic surveillance in these patients, especially for men with cardiometabolic diseases.

Keywords: ELSA-Brasil; inflammation; malnutrition; metabolic vulnerability index; nuclear magnetic resonance; subclinical hypothyroidism.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of the study sample.
Figure 2
Figure 2
Association of standardized thyroid-related parameters with MVX, MMX, and IVX z-scores for (A) men (n = 1933) and (B) women (n = 2046).
See this image and copyright information in PMC

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