Can adiposity measures enhance the predictive power of the triglyceride-glucose index for metabolic syndrome in adults in the United States?

Background

Insulin resistance is a hallmark feature of metabolic syndrome (MetSyn). The triglyceride-glucose (TyG) index is considered a reliable surrogate measure of insulin resistance. However, the efficacy of the TyG-index combined with adiposity measures for identifying MetSyn in U.S. adults is unknown.

Methods

In the present cross-sectional study, 2746 men and women from the 2017–2020 National Health and Nutrition Examination Survey (NHANES) with physical and laboratory characteristics were included. Predictive powers (estimated by the area under the curve of receiver operating characteristic [ROC-AUC]) of TyG-index combined with adiposity for MetSyn were compared with other traditional surrogate markers of insulin resistance including the TyG index, homeostatic assessment of insulin resistance (HOMA-IR), 1/fasting insulin, and quantitative insulin sensitivity check index (QUICKI).

Results

Predictive power of TyG-WHtR (ROC-AUC: 0.875) for MetSyn was highest, followed by TyG-WC (0.866), TyG-BMI (0.845), TyG index (0.832), HOMA-IR (0.820), QUICKI (0.820) and 1/fasting insulin (0.786). TyG-WHtR and TyG-WC showed significantly higher ROC-AUCs compared with TyG-index, HOMA-IR, 1/fasting insulin, and QUICKI (p ≤ 0.001).

Conclusions

TyG index combined with adiposity metrics is more effective in predicting MetSyn when compared to insulin resistance surrogates (TyG index, HOMA-IR, 1/fasting insulin, and QUICKI) which has been widely used in large cohort observational studies.