Comparisons of various insulin resistance indices for new-onset metabolic syndrome before midlife: The CHIEF cohort study, 2014-2020

Table 1 Baseline characteristics of participants with new-onset metabolic syndrome and those without

	Without new-onset MetS (n = 2217)	With new-onset MetS (n = 673)	P value
Metabolic index
METS-IR	1.94 ± 0.16	2.13 ± 0.17	< 0.001
TyG index	8.17 ± 0.44	8.58 ± 0.51	< 0.001
ALT/AST	0.93 ± 0.36	1.11 ± 0.42	< 0.001
TC/HDL-C	3.38 ± 0.82	4.12 ± 0.96	< 0.001
TG/HDL-C	1.79 ± 1.15	3.01 ± 2.10	< 0.001
ZJU index	122.64 ± 10.33	131.84 ± 13.57	< 0.001
Age (years)	27.80 ± 5.82	30.29 ± 5.26	< 0.001
Male (%)	1934 (87.2)	647 (96.1)	< 0.001
Alcohol drinking (%)	823 (37.1)	338 (50.2)	< 0.001
Tobacco smoking (%)	711 (32.4)	280 (42.2)	< 0.001
Physical activity, min/week (%)
< 150	497 (22.4)	130 (19.3)	0.15
150-299	848 (38.2)	256 (38.0)
≥ 300	872 (39.9)	287 (42.6)
Systolic BP (mmHg)	114.52 ± 12.77	120.39 ± 12.28	< 0.001
Diastolic BP (mmHg)	68.41 ± 9.49	72.22 ± 9.58	< 0.001
BMI (kg/m2)	23.62 ± 2.83	26.40 ± 2.52	< 0.001
Waist circumference (cm)	79.73 ± 7.69	87.08 ± 6.53	< 0.001
Blood tests
TC (mg/dL)	168.87 ± 30.71	182.25 ± 36.18	< 0.001
LDL-C (mg/dL)	100.57 ± 27.64	114.54 ± 30.58	< 0.001
HDL-C (mg/dL)	51.35 ± 10.01	45.25 ± 8.46	< 0.001
TG (mg/dL)	86.89 ± 45.31	130.00 ± 81.42	< 0.001
FPG (mg/dL)	91.98 ± 8.86	94.67 ± 11.77	< 0.001
ALT (U/L)	18.49 ± 12.63	27.63 ± 22.13	< 0.001
AST (U/L)	18.91 ± 6.94	22.55 ± 10.74	< 0.001

METS-IR: Metabolic score for insulin resistance; TyG: Triglyceride glucose; ALT: Alanine transaminase; AST: Aspartate transaminase; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; TG: Triglyceride; ZJU: Zhejiang University; BP: Blood pressure; BMI: Body mass index; LDL-C: Low-density lipoprotein cholesterol; FPG: Fasting plasma glucose.

Table 2 Associations between various non-insulin-based insulin resistance indices and incident metabolic syndrome

	Model 1			Model 2
	HR	95%CI	P value	HR	95%CI	P value
METS-IR index	78.937	55.157-112.970	< 0.001	32.996	21.706-50.158	< 0.001
TyG index	3.671	3.231-4.172	< 0.001	2.602	2.259-2.997	< 0.001
ALT/AST	2.824	2.421-3.294	< 0.001	1.495	1.238-1.804	< 0.001
TC/HDL-C	1.923	1.801-2.053	< 0.001	1.606	1.489-1.731	< 0.001
TG/HDL-C	1.250	1.222-1.278	< 0.001	1.187	1.157-1.219	< 0.001
ZJU index	1.028	1.025-1.031	< 0.001	1.023	1.019-1.027	< 0.001

Multivariable Cox regression analysis was used to determine the associations with adjustments for age, sex, alcohol consumption status, tobacco smoking status, and physical activity levels in model 1 and further adjustment for waist circumference in model 2. METS-IR: Metabolic score for insulin resistance; TyG: Triglyceride glucose; ALT: Alanine transaminase; AST: Aspartate transaminase; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; TG: Triglyceride; ZJU: Zhejiang University.

Table 3 Receiver operating characteristic curve analysis of various non-insulin-based insulin resistance indices and related components for incidence of metabolic syndrome

	Model 1			Model 2
	AUC	95%CI	P value	AUC	95%CI	P value
METS-IR index	0.781	0.761-0.800	Reference	0.782	0.762-0.801	Reference
TyG index	0.734	0.713-0.755	0.001	0.734	0.713-0.756	0.001
ALT/AST	0.677	0.654-0.699	< 0.001	0.674	0.652-0.697	< 0.001
TC/HDL-C	0.732	0.711-0.753	0.001	0.731	0.709-0.752	< 0.001
TG/HDL-C	0.751	0.731-0.771	0.03	0.752	0.731-0.772	0.04
ZJU index	0.744	0.723-0.765	0.01	0.743	0.722-0.764	0.008
FPG	0.608	0.584-0.632	< 0.001	0.605	0.581-0.630	< 0.001
TG	0.721	0.700-0.743	< 0.001	0.723	0.701-0.744	< 0.001
BMI	0.771	0.752-0.790	0.47	0.771	0.752-0.790	0.43
TC	0.613	0.588-0.638	< 0.001	0.613	0.588-0.638	< 0.001
HDL-C	0.689	0.667-0.712	< 0.001	0.690	0.667-0.712	< 0.001
AST	0.632	0.607-0.656	< 0.001	0.632	0.608-0.656	< 0.001
ALT	0.693	0.671-0.715	< 0.001	0.692	0.670-0.714	< 0.001

Receiver operating characteristic curve analysis was used to determine the area under curve with adjustments for age, sex, alcohol consumption status, tobacco smoking status, and physical activity levels in model 1 and further adjustment for waist circumference in model 2. AUC: Area under curve; METS-IR: Metabolic score for insulin resistance; TyG: Triglyceride glucose; ALT: Alanine transaminase; AST: Aspartate transaminase; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; TG: Triglyceride; ZJU: Zhejiang University; FPG: Fasting plasma glucose; BMI: Body mass index.

Table 4 Sex-specific receiver operating characteristic curve analysis of various non-insulin-based insulin resistance indices for incidence of metabolic syndrome

	Men			Women			P value between men and women
	AUC	95%CI	P value	AUC	95%CI	P value
METS-IR index	0.771	0.751-0.792	Reference	0.764	0.654-0.874	Reference	0.001
TyG index	0.726	0.704-0.748	0.002	0.693	0.575-0.812	0.39	0.001
ALT/AST	0.657	0.633-0.681	< 0.001	0.718	0.614-0.822	0.55	0.001
TC/HDL-C	0.715	0.692-0.738	< 0.001	0.793	0.684-0.901	0.71	0.001
TG/HDL-C	0.741	0.719-0.762	0.04	0.723	0.598-0.848	0.62	0.001
ZJU index	0.734	0.712-0.756	0.01	0.751	0.658-0.844	0.85	0.001

Receiver operating characteristic curve analysis was used to determine the area under curve with adjustments for age, sex, alcohol consumption status, tobacco smoking status, physical activity levels, and waist circumference. AUC: Area under curve; METS-IR: Metabolic score for insulin resistance; TyG: Triglyceride glucose; ALT: Alanine transaminase; AST: Aspartate transaminase; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; TG: Triglyceride; ZJU: Zhejiang University.