Dose-Response Associations of Metabolic Score for Insulin Resistance Index with Nonalcoholic Fatty Liver Disease among a Nonobese Chinese Population: Retrospective Evidence from a Population-Based Cohort Study

Abstract

Purpose. This study is aimed at investigating the association between the metabolic score for insulin resistance (METS-IR) index and nonalcoholic fatty liver disease (NAFLD) in the nonobese population and its predictive value. Methods. 10730 nonobese subjects were selected from longitudinal cohort research conducted from January 2010 to December 2014. Cox proportional hazards models were employed to assess the relationship between METS-IR and new-onset NAFLD. Generalized additive models were used to identify nonlinear relationships. In addition, we performed subgroup analyses and interaction tests. The time-dependent receiver operating curve (ROC) and area under the ROC (AUC) were utilized to measure the discriminatory ability of METS-IR for new-onset NAFLD. Beyond clinical risk factors, the incremental predictive value of METS-IR was appraised using integrated discrimination improvement (IDI), C-index, and net reclassification index (NRI). Results. Over a median period of 804.50 days of follow-up, 1859 (17.33%) participants had a new onset of NAFLD. After adjusting for confounders, the HR for new-onset NAFLD in the Q4 group was 6.40 compared with the Q1 group. When METS-IR was considered a continuous variable, the risk of NAFLD increased by 34% for every 1 SD increase in METS-IR. The smoothing curve shows the dose-response relationship between METS-IR and the presence of new-onset NAFLD. Using a two-piecewise linear regression model, we derived a METS-IR inflection point of 36. HRs were 1.31 on the left side of the inflection point and 1.04 on the right side of the inflection point (log-likelihood ratio test, P < 0.001 ). Subgroup analyses and interaction tests revealed an interaction between gender and SBP in the association between METS-IR and new-onset NAFLD. In the subgroup analysis of gender and SBP, we observed a higher risk of new-onset NAFLD in men and in those with abnormal SBP levels. We evaluated the ability of METS-IR to identify new-onset NAFLD at different time points. The AUCs at 1, 2, 3, and 4 years were 0.784, 0.756, 0.758, and 0.752, respectively, which represent good discrimination of new-onset NAFLD. The addition of METS-IR greatly improved the reclassification and differentiation of clinical risk factors, with an NRI of 0.276 and an IDI of 0.068. In addition, the addition of METS-IR increased the C-index from 0.719 to 0.771. Conclusion. In a nonobese Chinese population, elevated METS-IR was independently associated with an enhanced risk of NAFLD development and a dose-response relationship existed. In addition, METS-IR might be a reliable indicator for screening individuals at risk for early NAFLD, especially in nonobese populations.

Association Between Triglyceride Glucose Index-Waist Circumference and Risk of First Myocardial Infarction in Chinese Hypertensive Patients with Obstructive Sleep Apnoea: An Observational Cohort Study

“…Variables with VIF > 5 were considered inappropriate for inclusion in the Cox regression model. 43 , 44 We eliminated two variables with multicollinearity (AHI, and Cr). Three multivariate Cox proportional hazard regressions were established to estimate the independent association between baseline the TyG-WC and the risk of first MI, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated.…”

Metabolic Score for Insulin Resistance Is Inversely Related to Incident Advanced Liver Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease

“…Therefore, homeostatic model assessment for IR (HOMA-IR) and other non-insulin-based indices for assessing IR, such as the triglyceride-glucose (TyG) index and metabolic score for IR (METS-IR), were developed for use instead of the hyperinsulinemic–euglycemic clamp technique. Several studies have reported the usefulness of three indicators separately as surrogates for NAFLD [ 9 , 10 , 11 ]. However, the relationship between markers related to IR and liver fibrosis is more complex.…”

An Elevated METS-IR Index Is Associated With Higher Asthma Morbidity and Earlier Age of First Asthma in US Adults: Results Based on a Cross-Sectional Study

“…METS-IR was first mentioned in 2018 and is considered to be a reliable and intuitive predictor of IR ( 14 , 15 , 31 ). In recent years, multiple studies have indicated that insulin resistance can cause asthma onset or exacerbation.…”

“…However, this finding is limited by the small sample size and requires further confirmation by a multicenter prospective study of a large sample. METS-IR was first mentioned in 2018 and is considered to be a reliable and intuitive predictor of IR (14,15,31). In recent years, multiple studies have indicated that insulin resistance can cause asthma onset or exacerbation.…”