空腹血糖正常人群中甘油三酯-葡萄糖指数与新发糖尿病风险的 U 型关联：基于人群的纵向队列研究。
U-shaped association between the triglyceride-glucose index and the risk of incident diabetes in people with normal glycemic level: A population-base longitudinal cohort study.
机构信息
Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan.
出版信息
Clin Nutr. 2021 Apr;40(4):1555-1561. doi: 10.1016/j.clnu.2021.02.037. Epub 2021 Mar 4.
BACKGROUND
Previous studies have shown that a high baseline triglyceride-glucose (TyG) index is a potential risk factor for type 2 diabetes mellitus (T2DM). However, for a low TyG index, findings have been inconsistent. Moreover, the association between the baseline TyG index and incident T2DM in individuals with normal glycemic levels remains unclear. Therefore, this longitudinal study further examined and characterized the association between the baseline TyG index and incident T2DM in Japanese adults with normal glycemic levels. .
METHODS
The participants (7857 men and 6440 women) were selected from the NAGALA (NAfld in the Gifu Area Longitudinal Analysis) study that was conducted from 2004 to 2015. Cox proportional hazards models were used to evaluate the associations between baseline TyG index and T2DM incidence, and a two-piecewise linear regression model was used to examine the threshold effect of the baseline TyG index on incident T2DM using a smoothing function.
RESULTS
During a median follow-up period of 5.26 (women) and 5.88 (men) years, 47 women and 182 men developed T2DM. The risk of T2DM was strongly associated with the baseline TyG index in the fully adjusted model in men but not in women, and no dose-dependent positive relationship between incident T2DM and the TyG index was observed across the TyG tertiles. Interestingly, the two-piecewise linear regression analysis revealed a U-shaped association between the baseline TyG index and incident T2DM. Baseline TyG index lower than the threshold values (TyG index < 7.27 in women and <7.97 in men) were negatively associated with incident T2DM (hazard ratio [HR] = 0.09, 95% confidence interval [CI] = 0.01-0.93, P = 0.0435 for women and HR = 0.21, 95% CI = 0.08-0.57, P = 0.0021 for men). In contrast, baseline TyG index higher than the threshold values (TyG index > 7.27 in women and >7.97 in men) were positively associated with incident T2DM (HR = 2.76, 95% CI = 1.20-6.34, P = 0.0166 for women and HR = 2.42, 95% CI = 1.66-3.53, P < 0.0001 for men).
CONCLUSIONS
A U-shaped association was observed between the baseline TyG index and incident T2DM in a Japanese population.
背景
先前的研究表明，较高的基线甘油三酯-葡萄糖（TyG）指数是 2 型糖尿病（T2DM）的潜在危险因素。然而，对于较低的 TyG 指数，研究结果并不一致。此外，在血糖水平正常的个体中，基线 TyG 指数与 T2DM 事件之间的关联仍不清楚。因此，本纵向研究进一步探讨和描述了血糖水平正常的日本成年人中基线 TyG 指数与 T2DM 事件之间的关联。
方法
参与者（7857 名男性和 6440 名女性）选自 NAGALA（岐阜地区非酒精性脂肪肝纵向分析）研究，该研究于 2004 年至 2015 年进行。使用 Cox 比例风险模型评估基线 TyG 指数与 T2DM 发病率之间的关联，并用两段线性回归模型通过平滑函数检验基线 TyG 指数对 T2DM 发病的阈值效应。
结果
在中位随访期为 5.26 岁（女性）和 5.88 岁（男性）期间，47 名女性和 182 名男性发生了 T2DM。在完全调整模型中，男性的基线 TyG 指数与 T2DM 风险强烈相关，但女性则不然，而且 TyG 三分位组之间未观察到与 TyG 指数呈剂量依赖性的阳性 T2DM 发病关系。有趣的是，两段线性回归分析显示基线 TyG 指数与 T2DM 事件之间呈 U 形关联。低于阈值的基线 TyG 指数（女性 TyG 指数<7.27，男性 TyG 指数<7.97）与 T2DM 发病呈负相关（风险比[HR]为 0.09，95%置信区间[CI]为 0.01-0.93，P=0.0435；男性 HR 为 0.21，95% CI 为 0.08-0.57，P=0.0021）。相比之下，高于阈值的基线 TyG 指数（女性 TyG 指数>7.27，男性 TyG 指数>7.97）与 T2DM 发病呈正相关（女性 HR 为 2.76，95% CI 为 1.20-6.34，P=0.0166；男性 HR 为 2.42，95% CI 为 1.66-3.53，P<0.0001）。
结论
在日本人群中观察到基线 TyG 指数与 T2DM 发病之间呈 U 形关联。
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