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Simple calculation estimates metabolic health among Chinese adults
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The product of fasting triglyceride and glucose concentrations is a simple and cost-effective indicator of insulin resistance for use in assessing metabolic health among Chinese adults, according to findings published in the Journal of Diabetes Investigation.
“Two subgroups of obesity have received increasing interest in recent years: metabolically unhealthy normal-weight individuals and metabolically healthy obese individuals,” Qiuhe Ji, PhD, a professor in the department of endocrinology at Xijing Hospital, The Fourth Military Medical University in China, and colleagues wrote in the study background. “However, there is a lack of consensus on the definition of metabolic unhealth. ... [Metabolic syndrome] appears to be caused by a complex array of cross-connected mechanisms, and [insulin resistance] seems to play an important role. ... Because of this connection, we hypothesize that metabolic abnormalities can be assessed based on the degree of [insulin resistance].”
Ji and colleagues compared three methods for estimating insulin resistance against a definition of metabolic health based on metabolic syndrome components. They used data from 30,291 Chinese adults older than 20 years (mean age, 43.26 years; 60.4% women) who were included in the China National Diabetes and Metabolic Disorders Study, a nationwide population-based cross-sectional survey conducted from June 2007 to May 2008.
The three surrogate indices for insulin resistance included the product of fasting triglycerides and glucose; triglycerides divided by HDL cholesterol; and the metabolic score for insulin resistance, which is a mathematical formula based on values for fasting glucose, triglycerides, HDL cholesterol and BMI.
Metabolic syndrome was identified in participants who had more than three of the following conditions: hyperglycemia, hypertension, hypertriglyceridemia, HDL cholesterol less than 40 mg/dL in men or less than 50 mg/dL in women, and central obesity. Metabolically healthy participants met one or none of these criteria.
Each surrogate index was evaluated based on how close its diagnostic curve was to a receiver operating characteristic curve, which was used as reference and measured sensitivity and specificity. The closer the area under the curve reading of an index was to the reference curve, the more accurate it was. The product of fasting triglycerides and glucose had the curve closest to reference both in men (0.863; 95% CI, 0.857-0.869) and women (0.867; 95% CI, 0.862-0.872) compared with triglycerides divided by HDL cholesterol (men 0.841; 95% CI, 0.834-0.848; women 0.857; 95% CI, 0.852-0.862) and metabolic score for insulin resistance (men 0.81; 95% CI, 0.803-0.817; women 0.805; 95% CI, 0.799-0.81).
In additional analysis, the researchers found that the AUC was greater in the product of fasting triglycerides and glucose when evaluating men with normal waist circumference (0.857; 95% CI, 0.849-0.864) vs. men with increased waist circumference (0.839; 95% CI, 0.826-0.851). When considering age of a participant, the researchers found that the product of fasting triglycerides and glucose index was most effective in participants aged 20 to 30 years (men 0.879; 95% CI, 0.866-0.892; women 0.887; 95% CI, 0.875-0.898) and aged 31 to 40 years (men 0.877; 95% CI, 0.864-0.888; women 0.87; 95% CI, 0.86-0.879).
“Because testing for insulin sensitivity is expensive, the use of surrogate markers to assess insulin resistance might help to maximize medical resources while minimizing costs and inconvenient side effects for both clinical practice and epidemiological purposes,” the researchers wrote. “Although the [the product of fasting triglycerides and glucose] index is determined on the basis of just two parameters of easily obtained routine clinical laboratory data, it had the highest value for the identification of metabolically unhealthy individuals.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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