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Abstract：
BACKGROUND: The prevalence of obesity-associated insulin resistance (IR) is increasing along with the increase in obesity rates. In this study, we compared the predictive utility of four alternative indexes of IR [triglyceride glucose index (TyG index), metabolic score for insulin resistance (METS-IR), the triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and homeostatic model assessment of insulin resistance (HOMA-IR)] for all-cause mortality and cardiovascular mortality in the general population based on key variables screened by the Boruta algorithm. The aim was to find the best replacement index of IR.
METHODS: In this study, 14,653 participants were screened from the National Health and Nutrition Examination Survey (2001-2018). And TyG index, METS-IR, TG/HDL-C and HOMA-IR were calculated separately for each participant according to the given formula. The predictive values of IR replacement indexes for all-cause mortality and cardiovascular mortality in the general population were assessed.
RESULTS: Over a median follow-up period of 116 months, a total of 2085 (10.23%) all-cause deaths and 549 (2.61%) cardiovascular disease (CVD) related deaths were recorded. Multivariate Cox regression and restricted cubic splines analysis showed that among the four indexes, only METS-IR was significantly associated with both all-cause and CVD mortality, and both showed non-linear associations with an approximate \"U-shape\". Specifically, baseline METS-IR lower than the inflection point (41.33) was negatively associated with mortality [hazard ratio (HR) 0.972, 95% CI 0.950-0.997 for all-cause mortality]. In contrast, baseline METS-IR higher than the inflection point (41.33) was positively associated with mortality (HR 1.019, 95% CI 1.011-1.026 for all-cause mortality and HR 1.028, 95% CI 1.014-1.043 for CVD mortality). We further stratified the METS-IR and showed that significant associations between METS-IR levels and all-cause and cardiovascular mortality were predominantly present in the nonelderly population aged < 65 years.
CONCLUSIONS: In conjunction with the results of the Boruta algorithm, METS-IR demonstrated a more significant association with all-cause and cardiovascular mortality in the U.S. population compared to the other three alternative IR indexes (TyG index, TG/HDL-C and HOMA-IR), particularly evident in individuals under 65 years old.
METHODS: In this study, 14,653 participants were screened from the National Health and Nutrition Examination Survey (2001-2018). And TyG index, METS-IR, TG/HDL-C and HOMA-IR were calculated separately for each participant according to the given formula. The predictive values of IR replacement indexes for all-cause mortality and cardiovascular mortality in the general population were assessed.
RESULTS: Over a median follow-up period of 116 months, a total of 2085 (10.23%) all-cause deaths and 549 (2.61%) cardiovascular disease (CVD) related deaths were recorded. Multivariate Cox regression and restricted cubic splines analysis showed that among the four indexes, only METS-IR was significantly associated with both all-cause and CVD mortality, and both showed non-linear associations with an approximate \"U-shape\". Specifically, baseline METS-IR lower than the inflection point (41.33) was negatively associated with mortality [hazard ratio (HR) 0.972, 95% CI 0.950-0.997 for all-cause mortality]. In contrast, baseline METS-IR higher than the inflection point (41.33) was positively associated with mortality (HR 1.019, 95% CI 1.011-1.026 for all-cause mortality and HR 1.028, 95% CI 1.014-1.043 for CVD mortality). We further stratified the METS-IR and showed that significant associations between METS-IR levels and all-cause and cardiovascular mortality were predominantly present in the nonelderly population aged < 65 years.
CONCLUSIONS: In conjunction with the results of the Boruta algorithm, METS-IR demonstrated a more significant association with all-cause and cardiovascular mortality in the U.S. population compared to the other three alternative IR indexes (TyG index, TG/HDL-C and HOMA-IR), particularly evident in individuals under 65 years old.
摘要：
背景：肥胖相关的胰岛素抵抗（IR）的患病率随着肥胖率的增加而增加。在这项研究中,我们比较了IR[甘油三酯葡萄糖指数(TyG指数)，胰岛素抵抗代谢评分（METS-IR），甘油三酯/高密度脂蛋白胆固醇(TG/HDL-C)比值和胰岛素抵抗稳态模型评估(HOMA-IR)]根据Boruta算法筛选的关键变量,对普通人群的全因死亡率和心血管死亡率进行评估.目的是找到IR的最佳替换指数。
方法：在本研究中，从国家健康和营养检查调查（2001-2018）中筛选了14,653名参与者。而TyG指数,METS-IR,根据给定公式分别计算每个参与者的TG/HDL-C和HOMA-IR。评估了IR替代指数对普通人群全因死亡率和心血管死亡率的预测价值。
结果：中位随访期为116个月，共记录了2085例(10.23%)全因死亡和549例(2.61%)心血管疾病(CVD)相关死亡.多变量Cox回归和有限三次样条分析表明,只有METS-IR与全因死亡率和CVD死亡率显著相关,两者都显示出非线性关联，近似为“U形”。具体来说,基线METS-IR低于拐点(41.33)与死亡率呈负相关[全因死亡率风险比(HR)0.972,95%CI0.950~0.997].相比之下,基线METS-IR高于拐点(41.33)与死亡率呈正相关(全因死亡率为HR1.019,95%CI1.011-1.026,CVD死亡率为HR1.028,95%CI1.014-1.043).我们进一步对METS-IR进行了分层，并显示METS-IR水平与全因死亡率和心血管死亡率之间的显著关联主要存在于65岁以下的非老年人群中。
结论：结合Boruta算法的结果，与其他三个替代IR指数相比，METS-IR与美国人群的全因死亡率和心血管死亡率有更显著的关联（TyG指数，TG/HDL-C和HOMA-IR)，在65岁以下的人群中尤为明显。
方法：在本研究中，从国家健康和营养检查调查（2001-2018）中筛选了14,653名参与者。而TyG指数,METS-IR,根据给定公式分别计算每个参与者的TG/HDL-C和HOMA-IR。评估了IR替代指数对普通人群全因死亡率和心血管死亡率的预测价值。
结果：中位随访期为116个月，共记录了2085例(10.23%)全因死亡和549例(2.61%)心血管疾病(CVD)相关死亡.多变量Cox回归和有限三次样条分析表明,只有METS-IR与全因死亡率和CVD死亡率显著相关,两者都显示出非线性关联，近似为“U形”。具体来说,基线METS-IR低于拐点(41.33)与死亡率呈负相关[全因死亡率风险比(HR)0.972,95%CI0.950~0.997].相比之下,基线METS-IR高于拐点(41.33)与死亡率呈正相关(全因死亡率为HR1.019,95%CI1.011-1.026,CVD死亡率为HR1.028,95%CI1.014-1.043).我们进一步对METS-IR进行了分层，并显示METS-IR水平与全因死亡率和心血管死亡率之间的显著关联主要存在于65岁以下的非老年人群中。
结论：结合Boruta算法的结果，与其他三个替代IR指数相比，METS-IR与美国人群的全因死亡率和心血管死亡率有更显著的关联（TyG指数，TG/HDL-C和HOMA-IR)，在65岁以下的人群中尤为明显。
