Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Medical Research Center for Hypertension Diseases, Urumqi, China.
Xinjiang Medical University, Urumqi, China.
Dis Markers. 2022 Feb 23;2022:4930355. doi: 10.1155/2022/4930355. eCollection 2022.
This study is aimed at investigating the association between the metabolic score for insulin resistance (METS-IR) index and nonalcoholic fatty liver disease (NAFLD) in the nonobese population and its predictive value.
10730 nonobese subjects were selected from longitudinal cohort research conducted from January 2010 to December 2014. Cox proportional hazards models were employed to assess the relationship between METS-IR and new-onset NAFLD. Generalized additive models were used to identify nonlinear relationships. In addition, we performed subgroup analyses and interaction tests. The time-dependent receiver operating curve (ROC) and area under the ROC (AUC) were utilized to measure the discriminatory ability of METS-IR for new-onset NAFLD. Beyond clinical risk factors, the incremental predictive value of METS-IR was appraised using integrated discrimination improvement (IDI), C-index, and net reclassification index (NRI).
Over a median period of 804.50 days of follow-up, 1859 (17.33%) participants had a new onset of NAFLD. After adjusting for confounders, the HR for new-onset NAFLD in the Q4 group was 6.40 compared with the Q1 group. When METS-IR was considered a continuous variable, the risk of NAFLD increased by 34% for every 1 SD increase in METS-IR. The smoothing curve shows the dose-response relationship between METS-IR and the presence of new-onset NAFLD. Using a two-piecewise linear regression model, we derived a METS-IR inflection point of 36. HRs were 1.31 on the left side of the inflection point and 1.04 on the right side of the inflection point (log-likelihood ratio test, < 0.001). Subgroup analyses and interaction tests revealed an interaction between gender and SBP in the association between METS-IR and new-onset NAFLD. In the subgroup analysis of gender and SBP, we observed a higher risk of new-onset NAFLD in men and in those with abnormal SBP levels. We evaluated the ability of METS-IR to identify new-onset NAFLD at different time points. The AUCs at 1, 2, 3, and 4 years were 0.784, 0.756, 0.758, and 0.752, respectively, which represent good discrimination of new-onset NAFLD. The addition of METS-IR greatly improved the reclassification and differentiation of clinical risk factors, with an NRI of 0.276 and an IDI of 0.068. In addition, the addition of METS-IR increased the C-index from 0.719 to 0.771.
In a nonobese Chinese population, elevated METS-IR was independently associated with an enhanced risk of NAFLD development and a dose-response relationship existed. In addition, METS-IR might be a reliable indicator for screening individuals at risk for early NAFLD, especially in nonobese populations.
本研究旨在探讨代谢胰岛素抵抗评分（METS-IR）指数与非肥胖人群中非酒精性脂肪性肝病（NAFLD）之间的关联及其预测价值。
从 2010 年 1 月至 2014 年 12 月的纵向队列研究中选择了 10730 名非肥胖受试者。使用 Cox 比例风险模型评估 METS-IR 与新发 NAFLD 之间的关系。使用广义加性模型来识别非线性关系。此外，我们进行了亚组分析和交互检验。时间依赖性接收器工作曲线（ROC）和 ROC 下面积（AUC）用于测量 METS-IR 对新发 NAFLD 的判别能力。除临床危险因素外，还使用综合判别改善（IDI）、C 指数和净重新分类指数（NRI）评估 METS-IR 的增量预测价值。
在中位数为 804.50 天的随访期间，1859 名（17.33%）参与者出现了新发 NAFLD。在调整混杂因素后，与 Q1 组相比，Q4 组新发 NAFLD 的 HR 为 6.40。当将 METS-IR 视为连续变量时，METS-IR 每增加 1SD，NAFLD 的风险增加 34%。平滑曲线显示了 METS-IR 与新发 NAFLD 之间的剂量-反应关系。使用两段线性回归模型，我们得出 METS-IR 的拐点为 36。拐点左侧的 HR 为 1.31，右侧的 HR 为 1.04（对数似然比检验，<0.001）。亚组分析和交互检验显示，METS-IR 与新发 NAFLD 之间存在性别和 SBP 的交互作用。在性别和 SBP 的亚组分析中，我们观察到男性和 SBP 异常水平的人群新发 NAFLD 的风险更高。我们评估了 METS-IR 在不同时间点识别新发 NAFLD 的能力。1、2、3 和 4 年时的 AUC 分别为 0.784、0.756、0.758 和 0.752，表明对新发 NAFLD 有较好的判别能力。添加 METS-IR 极大地改善了临床危险因素的重新分类和区分，NRI 为 0.276，IDI 为 0.068。此外，添加 METS-IR 后，C 指数从 0.719 增加到 0.771。
在中国非肥胖人群中，升高的 METS-IR 与 NAFLD 发展风险增加独立相关，且存在剂量-反应关系。此外，METS-IR 可能是筛查早期 NAFLD 风险人群的可靠指标，尤其是在非肥胖人群中。
