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

Wei-Nung Liu; Yi-Chiung Hsu; Yen-Po Lin; Kun-Zhe Tsai; Yen-Chen Lin; Pang-Yen Liu; Gen-Min Lin

doi:10.4239/wjd.v16.i5.101840

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

World J Diabetes. 2025 May 15;16(5):101840. doi: 10.4239/wjd.v16.i5.101840.

Authors

Wei-Nung Liu¹, Yi-Chiung Hsu^{2

3}, Yen-Po Lin⁴, Kun-Zhe Tsai⁵, Yen-Chen Lin⁶, Pang-Yen Liu¹, Gen-Min Lin^{1

7}

Affiliations

¹ Department of Medicine, Tri-Service General Hospital, Taipei 114, Taiwan.
² Department of Biomedical Sciences and Engineering, Center for Astronautical Physics and Engineering, National Central University, Taoyuan 320, Taiwan.
³ Department of Medical Research, Cathay General Hospital, Taipei 106, Taiwan.
⁴ Department of Critical Care Medicine, Taipei Tzu Chi General Hospital, New Taipei 23142, Taiwan.
⁵ Department of Stomatology of Periodontology, Mackay Memorial Hospital, Taipei 104, Taiwan.
⁶ Department of Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
⁷ Department of Medicine, Hualien Armed Forces General Hospital, Hualien 970, Taiwan. farmer507@yahoo.com.tw.

Abstract

Background: Some non-insulin-based insulin resistance (IR) indices have been found to be associated with metabolic syndrome (MetS); however, few cohort studies have compared the capacities of these indices for predicting incident MetS in young adults.

Aim: To investigate the associations of various non-insulin-based IR (NI-IR) indices with new-onset MetS in young military personnel.

Methods: A total of 2890 armed forces personnel in Taiwan who were aged 18-39 years and did not have MetS at baseline were followed to monitor the incidence of new-onset MetS from 2014 to the end of 2020. Six NI-IR indices, including the metabolic score for IR (METS-IR), triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio, TG glucose (TyG) index, Zhejiang University (ZJU) index, total cholesterol (TC)-to-HDL-C ratio, and alanine transaminase (ALT)-to-aspartate transaminase (AST) ratio, were defined according to specific criteria. Incident MetS was identified on the basis of each annual health examination using the International Diabetes Federation criteria. Multiple Cox regression analyses were conducted, adjusting for age, sex, waist circumference, smoking status, alcohol consumption status, and physical activity, to assess the associations of the NI-IR indices with incident MetS. The area under the receiver operating characteristic curve (AUROC) was used to compare the capacities of these NI-IR indices for predicting new-onset MetS.

Results: During a median follow-up of 5.8 years, there were 673 patients with new-onset MetS (23%). All six of the NI-IR indices were significantly and positively associated with incident MetS. In the entire cohort, the greatest AUROC was found for the METS-IR [0.782; 95% confidence interval (CI): 0.762-0.801; all P values compared to the other NI-IR indices < 0.05], followed by the TG/HDL-C ratio (0.752; 95%CI: 0.731-0.772), ZJU index (0.743; 95%CI: 0.722-0.764), TyG index (0.734; 95%CI: 0.713-0.756), TC/HDL-C ratio (0.731; 95%CI: 0.709-0.752), and then the ALT/AST ratio (0.734; 95%CI: 0.713-0.756).

Conclusion: This study suggests that almost all the NI-IR indices are associated with the development of MetS in military young adults. The METS-IR is the strongest predictor of new-onset MetS before midlife.

Keywords: Cohort study; Insulin resistance indices; Metabolic syndrome; Young adults.