Impacts of Triglyceride Glucose-Waist to Height Ratio on Diabetes Incidence: A Secondary Analysis of A Population-Based Longitudinal Data

Abstract

Background: The anthropometric indices (body mass index [BMI], waist circumference [WC] and waist-to-height ratio [WHtR]), triglyceride-glucose (TyG) index and TyG-related indicators (TyG-WHtR, TyG-BMI, TyG-WC) have been well documented to be highly correlated with insulin resistance (IR) and type 2 diabetes mellitus (T2DM). However, it was not immediately obvious which indicator would be optimal for screening people at risk of T2DM. Hence, this study intended to compare the predictive effects of the aforementioned markers on T2DM and to investigate the relation between baseline TyG-WHtR and incident T2DM.

Methods: This longitudinal study included 15464 study population who were involved in the NAGALA (NAfld in the Gifu Area Longitudinal Analysis) study from 2004 to 2015. The TyG index was defined as ln [FPG (mg/dL) ×fasting TG (mg/dL)/2]. And the TyG-WHtR was calculated as TyG index ×WHtR. We divided the participants into four groups according to the TyG-WHtR quartiles. The primary endpoint was the incidence of diabetes.

Results: After a median follow-up of 5.4 years, 2.4% (373/15464) participants developed diabetes. The incidence of diabetes increased with ascending TyG-WHtR quartiles (P for trend<0.001). Multivariable Cox proportional hazard analysis showed that a one-unit increase in TyG-WHtR was independently correlated with a 2.714-fold higher risk of diabetes [hazard ratio (HR) 2.714, 95% confidence interval (CI) 1.942-3.793; P<0.001). Stratification analysis revealed that increased TyG-WHtR (per 1-unit) was consistently correlated with diabetes incidence in different subgroups. Moreover, TyG-WHtR outperformed the other parameters by presenting the biggest area under the ROC curve (AUC) in men (AUC 0.746, 95% CI 0.716-0.776, P<0.001). However, all pairwise comparisons of AUC between TyG-WHtR and other indicators were not statistically different except TyG-WHtR vs. WHtR in women.

Conclusions: A high TyG-WHtR is an important predictor of the increased cumulative risk of diabetes development. TyG-WHtR outperforms TyG, WHtR, TyG-WC and TyG-BMI in screening individuals who are susceptible to T2DM, especially in men.

Keywords: TyG-WHtR; insulin resistance; obesity; triglyceride−glucose index; type 2 diabetes mellitus; waist-to-height ratio.