School of Public Health, Anhui Medical University, Hefei, China.
Hongguang Street Community Health Service Center, Hefei, China.
Ann Med. 2022 Dec;54(1):622-632. doi: 10.1080/07853890.2022.2039956.
Previous study have shown that lipid accumulation product (LAP), visceral adiposity index (VAI), triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C) and triglycerides/glucose index (TyG index) could be simple clinical indicators of insulin resistance (IR) based on anthropometric and/or biochemical parameters. However, the rational and preferred surrogate marker of IR in different population has yet to be validated. The aim of this study was evaluating the practicability of the LAP, VAI, TG/HDL-C, and TyG in predicting IR in middle-aged Chinese population.
A cross-sectional study was conducted in 569 Chinese participants (mean age was 48.5; man 67.7%), and each participant completed a questionnaire survey, anthropometric measurement, and biochemical testing. One-way ANOVAs, Chi-squared test, Pearson's correlation, and multiple logistic regression were used to evaluate the association between VAI, LAP, TG/HDL-C, and TyG with IR. To correctly discriminate individuals with insulin resistance, a receiver operating characteristic (ROC) analysis was conducted for each evaluated variable and the overall diagnostic accuracy was quantified using the area under the ROC curve (AUC). The AUC of evaluated variables were compared using a nonparametric approach. The optimal cut-off points were determined by the Youden's index, and the corresponding sensitivity and specificity were provided.
Significant positive correlation was identified between HOMA-IR with TG/HDL-C ( = 0.306), VAI ( = 0.217), LAP ( = 0.381), and TyG ( = 0.371), respectively (all < .001). After adjustment for potential confounders of IR, compared with the lowest tertiles, odds ratio (95% CI) having IR in the highest tertiles of TG/HDL-C, VAI, LAP and TyG were 6.07 (2.89-12.71), 10.89 (4.37-27.13), 4.68 (2.00-10.92), and 12.20 (5.04-29.56). The area under ROC curves to predict HOMA-diagnosed IR was 0.773 for TG/HDL-C, 0.767 for VAI, 0.806 for LAP, and 0.800 for TyG, respectively. Among those, LAP showed the greatest value of AUC [0.806 (0.763-0.850)] and highest specificity (0.804).
Compared with other indicators, the LAP and TyG are simple, relatively accurate, clinically available surrogate markers of insulin resistance in middle-aged population in Hefei, China. Among 4 evaluated parameters, the LAP have the highest specificity and the TyG have the highest sensitivity.Key MessagesLAP and TyG could be used as simple and alternative methods to identify the individuals at risk for insulin resistance.LAP and TyG have relatively high predictive ability in diagnosis of IR compared with VAI and TG/HDL-C.No significant difference is observed between LAP and TyG in the ability of predicting insulin resistance.
先前的研究表明，脂质蓄积产物（LAP）、内脏脂肪指数（VAI）、甘油三酯/高密度脂蛋白胆固醇比值（TG/HDL-C）和甘油三酯/葡萄糖指数（TyG 指数）可作为基于人体测量和/或生化参数的胰岛素抵抗（IR）的简单临床指标。然而，不同人群中 IR 的合理和首选替代标志物仍有待验证。本研究旨在评估 LAP、VAI、TG/HDL-C 和 TyG 在预测中国中年人群中 IR 的实用性。
在 569 名中国参与者（平均年龄 48.5 岁，男性 67.7%）中进行了一项横断面研究，每位参与者完成了问卷调查、人体测量和生化检测。采用单因素方差分析、卡方检验、Pearson 相关分析和多因素逻辑回归分析评估 VAI、LAP、TG/HDL-C 和 TyG 与 IR 之间的关系。为了正确区分胰岛素抵抗个体，对每个评估变量进行了受试者工作特征（ROC）分析，并通过 ROC 曲线下面积（AUC）量化了整体诊断准确性。使用非参数方法比较评估变量的 AUC。通过 Youden 指数确定最佳截断点，并提供相应的敏感性和特异性。
HOMA-IR 与 TG/HDL-C（r=0.306）、VAI（r=0.217）、LAP（r=0.381）和 TyG（r=0.371）呈显著正相关（均 P<.001）。在校正 IR 的潜在混杂因素后，与 TG/HDL-C、VAI、LAP 和 TyG 的最低三分位相比，最高三分位的 OR（95%CI）分别为 6.07（2.89-12.71）、10.89（4.37-27.13）、4.68（2.00-10.92）和 12.20（5.04-29.56）。用于预测 HOMA 诊断的 IR 的 ROC 曲线下面积分别为 TG/HDL-C 为 0.773、VAI 为 0.767、LAP 为 0.806 和 TyG 为 0.800。其中，LAP 的 AUC 值最大[0.806（0.763-0.850）]，特异性最高[0.804]。
与其他指标相比，LAP 和 TyG 是中国合肥中年人群中简单、相对准确、临床可用的胰岛素抵抗替代标志物。在 4 个评估参数中，LAP 的特异性最高，TyG 的敏感性最高。
LAP 和 TyG 可作为识别胰岛素抵抗风险人群的简单替代方法。LAP 和 TyG 在诊断 IR 方面的预测能力与 VAI 和 TG/HDL-C 相比具有相对优势。LAP 和 TyG 在预测胰岛素抵抗方面的能力无显著差异。
