Zhang Wenkang, Chen Chen, Li Mingkang, Yan Gaoliang, Tang Chengchun
School of Medicine Southeast University, Nanjing, Jiangsu, China.
Department of Cardiology Zhongda Hospital Southeast University, Nanjing, Jiangsu, China.
Int J Endocrinol. 2024 Sep 30;2024:3352531. doi: 10.1155/2024/3352531. eCollection 2024.
Metabolic syndrome (MetS) is closely related to insulin resistance (IR), and the sex differences have not been fully explored. This study was aimed to investigate the sex differences in the associations among IR indexes with MetS in a large population.
A total of 60,799 participants were enrolled in the current study. MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. The following IR indexes were evaluated: triglyceride-glucose (TyG) index, TyG-waist circumference (TyG-WC), TyG-waist to height ratio (TyG-WHtR), TyG-body mass index (TyG-BMI), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C), and metabolic score for IR (MetS-IR). Factors associated with MetS were examined using logistic regressions. The receiver operating characteristic curves were used to evaluate the predictive value of the IR indexes for MetS.
The prevalence of MetS was 11.8% ( = 4097) for males and 5.4% ( = 1390) for females and increased with age in both subgroups. The IR index levels of male patients were higher than female patients (all < 0.001). The IR indexes were independent risk factors for MetS except for TyG-WHtR and TG/HDL-C in female patients. TyG had the greatest area under the curve (AUC) (AUC, 0.930; 95% CI, 0.928-0.933; < 0.001) in the male patients and TyG-WHtR (AUC, 0.916; 95% CI, 0.913-0.920; < 0.001) in the female patients. The AUCs of 6 IR indexes combination were 0.960 (95% CI, 0.957-0.962; < 0.001) and 0.962 (95% CI, 0.959-0.964; < 0.001), with the sensitivities of 91.29% and 90.94%, the specificities of 88.27% and 89.51% in male and female groups, respectively.
The IR index levels are higher in male than female patients. In IR indexes, TyG has the highest AUC in male patients and TyG-WHtR in female patients. The combination of IR indexes improved diagnostic efficiency compared with a single parameter. Moreover, the IR indexes are independently associated with MetS except for TyG-WHtR and TG/HDL-C in female patients. Our findings indicate that the multi-index association of IR indexes may play a potential role in MetS diagnosis, and understanding the sex differences in risk factors for MetS may help doctors properly implement more individualized prevention strategies.
代谢综合征（MetS）与胰岛素抵抗（IR）密切相关，但其性别差异尚未得到充分研究。本研究旨在调查大量人群中IR指标与MetS之间关联的性别差异。
本研究共纳入60799名参与者。采用美国国家胆固醇教育计划成人治疗组第三次报告（NCEP-ATP III）标准定义MetS。评估以下IR指标：甘油三酯-葡萄糖（TyG）指数、TyG-腰围（TyG-WC）、TyG腰高比（TyG-WHtR）、TyG体重指数（TyG-BMI）、甘油三酯与高密度脂蛋白胆固醇之比（TG/HDL-C）以及IR代谢评分（MetS-IR）。使用逻辑回归分析与MetS相关的因素。采用受试者工作特征曲线评估IR指标对MetS的预测价值。
男性MetS患病率为11.8%（n = 4097），女性为5.4%（n = 1390），且在两个亚组中均随年龄增加。男性患者的IR指标水平高于女性患者（均P < 0.001）。除女性患者的TyG-WHtR和TG/HDL-C外，IR指标是MetS的独立危险因素。男性患者中TyG的曲线下面积（AUC）最大（AUC，0.930；95%CI，0.928 - 0.933；P < 0.001），女性患者中TyG-WHtR的AUC最大（AUC，0.916；95%CI，0.913 - 0.920；P < 0.001）。6个IR指标组合的AUC在男性组和女性组分别为0.960（95%CI，0.957 - 0.962；P < 0.001）和0.962（95%CI，0.959 - 0.964；P < 0.001），敏感性分别为91.29%和90.94%，特异性分别为88.27%和89.51%。
男性患者的IR指标水平高于女性患者。在IR指标中，男性患者中TyG的AUC最高，女性患者中TyG-WHtR的AUC最高。与单一参数相比，IR指标组合提高了诊断效率。此外，除女性患者的TyG-WHtR和TG/HDL-C外，IR指标与MetS独立相关。我们的研究结果表明，IR指标的多指标关联可能在MetS诊断中发挥潜在作用，了解MetS危险因素的性别差异可能有助于医生更好地实施更具个性化的预防策略。
