10-year T2DM incidence
From 2011 to 2021, a total of 8279 people were enrolled in the study, including 2715 males and 5564 females. During this period, there were 803 newly diagnosed diabetes patients, and the incidence of diabetes was 9.7%.
Quartiles of TyG-WHtR index in the study participants
Baseline clinical and biochemical characteristics of participants by TyG-WHtR index quartiles are presented in Table 1. Through data analysis, we revealed a positive association between TyG-WHtR index quartiles and risk factors of diabetes, such as age, BMI, WC, SBP, DBP, fasting blood glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, current smoking, alcohol consumption, and high prevalence of hypertension and coronary heart disease (all p < 0.001); negatively correlated with high-density lipoprotein cholesterol (p < 0.001). However, no powerful correlations were found between TyG-WHtR index quartiles and tea or coffee consumption.
Table 1 Characteristics according to TyG-WHtR index quartile
|
TyG-WHtR
|
|
Baseline
characteristics
|
Quartile 1
(n=2070)
|
Quartile 2
(n=2069)
|
Quartile 3
(n=2070)
|
Quartile 4
(n=2070)
|
P-value
|
Diabetes 10-year incidence, n(%)
|
50(2.4%)
|
91(4.4%)
|
210(10.1%)
|
452(21.8%)
|
<0.001†
|
age
|
54.44±
9.74
|
57.41±10.25
|
59.14±9.59
|
61.32±9.72
|
<0.001*†
|
Male sex,n(%)
|
682(32.9%)
|
718(34.7%)
|
703(34.0%)
|
605(29.2%)
|
<0.01
|
Weight,kg
|
52.75±7.47
|
57.40±7.99
|
61.31±9.06
|
65.26±10.18
|
<0.001*†
|
BMI,kg/m2
|
20.85±2.32
|
22.93±2.24
|
24.63±2.42
|
26.79±2.92
|
<0.001*†
|
WC,cm
|
76.12±8.31
|
80.67±8.29
|
84.49±8.20
|
89.40±8.25
|
<0.001*†
|
Hipline,cm
|
87.41±6.74
|
92.34±5.80
|
95.67±5.84
|
99.98±7.17
|
<0.001*†
|
WHR
|
0.83±0.07
|
0.87±0.06
|
0.90±0.06
|
0.93±0.06
|
<0.001*†
|
WHtR
|
0.45±0.03
|
0.51±0.03
|
0.54±0.03
|
0.59±0.04
|
<0.001*†
|
SBP,mmHg
|
115±17.46
|
122±18.40
|
127±19.08
|
133±18.84
|
<0.001*†
|
DBP,mmHg
|
72±9.81
|
76±10.31
|
78±10.96
|
80±10.63
|
<0.001*†
|
TC,mmol/L
|
4.19±1.06
|
4.50±1.08
|
4.70±1.07
|
4.95±1.18
|
<0.001*†
|
TG,mmol/L
|
0.89±0.34
|
1.22±0.50
|
1.60±0.79
|
2.61±1.97
|
<0.001*†
|
HDL-cmmol/L
|
1.37±0.38
|
1.28±0.34
|
1.23±0.32
|
1.14±0.30
|
<0.001*†
|
LDL-c,mmol/L
|
2.27±0.74
|
2.59±0.80
|
2.71±0.80
|
2.74±0.84
|
<0.001*†
|
FBG,mmol/L
|
5.25±0.59
|
5.42±0.73
|
5.64±1.06
|
6.12±1.60
|
<0.001*†
|
HbA1c,%
|
5.75±0.55
|
5.84±0.59
|
5.97±0.75
|
6.27±1.08
|
<0.001*†
|
ALT,mmol/L
|
11.18(11.19,11.98)
|
13.60(113.18,14.02)
|
15.41(14.96,15.86)
|
18.84(18.24,19.45)
|
<0.001*†
|
AST,mmol/L
|
19.55(19.10,20.01)
|
20.54(20.12,20.95)
|
21.64(21.12,22.16)
|
23.77(23.16,24.38)
|
<0.001*†
|
TyG
|
8.15±0.37
|
8.49±0.39
|
8.78±0.43
|
9.25±0.59
|
<0.001*†
|
Family history of diabetes,
n(%)
|
408(19.7%)
|
357(17.3)
|
372(18.0%)
|
318(15.4%)
|
<0.01
|
Hypertension
|
124(6.0%)
|
246(11.9%)
|
366(17.7%)
|
554(26.8%)
|
<0.001*
|
Coronary disease
|
45(2.2%)
|
39(1.9%)
|
63(3.0%)
|
99(4.8%)
|
<0.001*
|
Smoking
|
|
|
|
|
0.05
|
Never
|
1740
|
1750
|
1770
|
1810
|
|
Former
|
54
|
53
|
57
|
50
|
|
Current
|
276
|
266
|
243
|
210
|
|
Drinking
|
605(29.3%)
|
627(30.3%)
|
504(29.2%)
|
537(26.0%)
|
<0.01
|
Never
|
1465
|
1442
|
1466
|
1533
|
|
Fomer
|
451
|
451
|
424
|
364
|
|
Current
|
154
|
176
|
180
|
173
|
|
Coffee
|
150(7.2%)
|
141(6.8%)
|
144(7.0%)
|
130(6.3%)
|
0.66
|
tea
|
1071(51.7%)
|
1121(54.2%)
|
1101(53.2%)
|
1051(50.8%)
|
0.42
|
The values were expressed as mean (standard deviation), medians (quartile interval), or n (%).
Abbreviations: FPG fasting plasma glucose, TG triglyceride, TC total cholesterol, LDL-C low-density lipid cholesterol, HDL-c high-density lipid cholesterol, ALT alanine aminotransferase, AST aspartate aminotransferase.
* p < 0.001.
† Q2/Q3/Q4 vs Q1; p < 0.001
all p values for TyG-WHtR index quartiles were determined by using an analysis of variance with Bonferroni post hoc method.
TyG-WhtR and diabetes incidence over 10 years
The analysis revealed a total of 803 patients with newly diagnosed diabetes during the 10-year follow-up period, with an incidence of n = 44 (2.1%), n = 89 (4.3%), n = 184 (8.9%), n = 486 (23.5%) in the baseline TyG-WHtR quartiles (Table 1). It can be found that with the increase of TyG-WHtR index, the prevalence of diabetes also increased (5.5%, 11.1%, 22.9% and 60.5%, respectively). To adjust for other residual confounders, we performed a conditional logistic regression analysis with a binary outcome of diabetes in relation to TyG-WHtR index (Table 2). Diabetes risk was higher in the second (1.044, 95% CI 0.718–1.519), third (1.613, 95% CI 1.085–2.400), and fourth (1.898, 95% CI 1.127–3.196) quartiles of TyG-WHtR index than in the first (p < 0.001). There were a number of factors taken into account in the analysis, including age; gender; WHR; WHtR; BMI; SBP; DBP; FBG; HbA1c; HDL; and LDL; family history of diabetes; cigarette smoking; drinking coffee; tea; coronary disease; and hypertension. Finally, diabetes risk increased significantly and steadily as the TyG-WHtR index quartile increased.
Table2 Correlation between TyG-WHtR index and diabetes risk
|
Per 1-unit increase in TyG-WHtR
|
Q1
|
Q2
|
Q3
|
Q4
|
Modle 1
|
3.554(3.185,3.965)
|
Ref
|
1.056(0.726,1.536)
|
1.639(1.103,2.437)
|
1.930(1.147,3.246)
|
Modle 2
|
3.571(3.191,3.996)
|
Ref
|
1.044(0.718,1.519)
|
1.613(1.085,2.400)
|
1.898(1.127,3.196)
|
Modle 3
|
8.889(4.703,16.801)
|
Ref
|
1.099(0.738,1.636)
|
1.655(1.067,2.568)
|
1.851(1.030,3.324)
|
Modle 1 crude
Modle 2 adjusted for age and sex
Modle 3 adjusted for age, sex, WHR, WHtR, BMI, SBP, DBP, FBG, HbA1c, ALT, AST, TG, HDL, LDL, family history of diabetes, smoke, drink, coffee, tea, coronary disease, and hypertension.
As illustrated in Figure.1,survival statistics analysis were performed using Kaplan–Meier survival curve with log rank test, and the results indicated that the aggregate prevalence of diabetes was significantly different among the four TyG-WHtR index groups (P< 0.001) . Increases in the TyG-WHtR index were significantly associated with an increased risk of developing diabetes.
Subgroups analysis
As previously stated, TyG-WHtR is an indicator that can more accurately reflect the body's metabolic state. In order to explore the effect of additional risk factors on the correlation between TyG-WHtR index and future diabetes risk, subgroup comparisons were conducted using the previously mentioned stratification factors. Table 3 summarizes the different interactions for the different between-study subgroup analysis. TyG-WHtR index and diabetes risk were found to have additive interactions in age, BMI, as well as hypertension (P < 0.05). Participants between the ages of 71 and 80, with BMI < 24 kg/m2, and without hypertension were found to have the strongest interrelations. However, the outcomes of this survey did not show significant interactions among gender, family history of diabetes, coronary disease, smoking, drinking, or tea consumption.
Table 3 Association of TyG-WHtR with diabetes risk in subgroup analysis
Subgroup
|
No. of participants
|
Unadjusted HR (95%CI)
|
Adjusted HR
(95%CI)
|
P-value for interaction
|
Gender
|
|
|
|
0.577
|
Male
|
2708
|
3.117(2.645,3.674)
|
18.869(6.359,55.989)
|
|
Female
|
5571
|
2.948(2.655,3.274)
|
10.833(5.545,21.163)
|
|
Age(years)
|
|
|
|
<0.001
|
<51
|
1963
|
4.079(3.184,5.224)
|
7.120(1.907,26.574)
|
|
51-60
|
2802
|
2.914(2.512,3.381)
|
27.324(9.172,81.405)
|
|
61-70
|
2305
|
2.717(2.346,3.147)
|
9.031(3.613,22.574)
|
|
71-80
|
1031
|
2.541(1.955,3.302)
|
59.461(7.963,443.980)
|
|
>80
|
178
|
2.058(0.764,5.547)
|
0.000(0.000,5.664E+9)
|
|
BMI(kg/m2)
|
|
|
|
0.002
|
<24
|
4516
|
3.985(3.355,4.734)
|
37.073(13.188,104.221)
|
|
≥ 24, < 28
≥28
|
2891
872
|
3.071(2.601,3.626)
2.294(1.803,2.919)
|
15.118(6.092,37.519)
2.913(0.860,9.871)
|
|
Family history of diabetes
|
|
|
|
0.493
|
No
|
6824
|
3.020(2.735,3.335)
|
18.100(8.925,36.706)
|
|
Yes
|
1455
|
2.807(2.329,3.383)
|
5.885(2.043,16.950)
|
|
Hypertension
No
Yes
|
6989
1290
|
3.029(2.725,3.367)
2.472(2.075,2.945)
|
13.813(7.067,26.997)
7.613(2.659,21.796)
|
0.033
|
Coronary disease
No
Yes
|
8033
246
|
2.979(2.723,3.259)
2.440(1.591,3.741)
|
11.961(6.726,21.271)
7.037(0.431,114.794)
|
0.403
|
Smoking
|
|
|
|
0.435
|
None
|
7070
|
2.931(2.667,3.220)
|
11.223(6.210,20.282)
|
|
Occasionally
|
214
|
3.587(1.902,6.765)
|
6.361(0.058,701.821)
|
|
Daily
|
995
|
3.270(2.503,4.273)
|
35.972(4.527,285.805)
|
|
Drinking
|
|
|
|
0.106
|
none
|
5906
|
2.841(2.566,3.146)
|
9.843(5.086,19.049)
|
|
Occasionally
|
1690
|
3.485(2.829,4.293)
|
37.413(9.849,142.122)
|
|
Weekly
|
683
|
3.341(2.403,4.647)
|
7.447(1.477,37.537)
|
|
Coffee
No
Yes
|
7714
565
|
2.971(2.712,3.256)
2.999(2.178,4.129)
|
11.889(6.642,21.279)
23.784(2.280,248.092)
|
0.998
|
Tea
No
Occasionally
Used to often
Often
|
3935
2501
86
1757
|
2.786(2.448,3.171)
3.058(2.617,3.574)
2.049(0.704,5.962)
3.307(2.741,3.990)
|
8.470(3.830,18.735)
28.691(9.374,87.817)
0.000(0.000,8.466E+22)
6.135(1.795,20.970)
|
0.176
|
Adjusted for gender, age, weight, FPG, HbA1c, ALT, AST, TG, HDL-C, SBP. DBP, WHR, WHtR, BMI, smoke, drink, coffee, tea, coronary disease, hypertension and family history of diabetes.
The ability of TyG-WHtR index to predict new-onset diabetes
Receiver operating characteristic (ROC) curves were used to assess the accuracy of TyG-WHtR index in predicting newly diagnosed diabetes (Fig. 2). FBG, BMI, WC, WHtR, TyG, TyG-BMI, TyG-WC and TyG-WHtR had an area under the curve (AUC) of 0.838 (0.822-0.853), 0.649(0.629-0.668), 0.674(0.655-0.693), 0.679 (0.660,0.698), 0.752 (0.735-0.770), 0.723(0.705-0.741), 0.748(0.731-0.765) and 0.750 (0.733-0.767) for predicting new-onset diabetes, respectively. Compared to BMI, WC, WHtR, TyG-BMI and TyG-WC, the AUC of TyG-WhtR was considerably higher (P < 0.0001). However, FPG and TyG performed better than TyG-WhtR in this research when it came to predicting new-onset diabetes. With a 72.98 % sensitivity and 65.10 % specificity, the best cut-off value for TyG-WhtR was 4.746.