Baseline Features of General Population.
Of the included 121,702 subjects(73,139 were males and 48,563 were females), 41,547 were found to have TNs, with the prevalence of 34.1%(Table 1). Among those patients with TNs, STNs accounted for 49.7% (N = 20648) of the patients, while MTNs accounted for 50.3% (N = 20899), with the prevalence of 17.0% and 17.2%, respectively. The prevalence of TNs in women (40.6%, N = 19734) was significantly higher than that in men (29.8%, N = 21813) (χ2 = 1517.33, P < 0.001) (Table 1). The mean age of all the subjects was 42.44 ± 13.24 years, the age of those with TNs (47.89 ± 13.97 years) were older than those without TNs (39.62 ± 11.90 years)(P < 0.001) (Table 1). There was a significant difference in age between TNs and those without TNs (W = 1.10×109, P < 0.001) (Table 1). Furthermore, the prevalence of TNs was found to be increased with age (P for trend < 0.001). Of the121,702 healthy subjects, mean BMI was 23.51 ± 4.06 kg/m2, mean WC was 81.37 ± 9.95 cm, mean SBP was 123.61 ± 17.30 mmHg, mean DBP was 75.07 ± 11.54 mmHg, mean FBG was 5.43 ± 1.19 mmol/L, mean TC was 4.91 ± 0.94 mmol/L, mean TG was 1.64 ± 1.49 mmol/L, mean HDL-C was 1.40 ± 0.34 mmol/L, mean LDL-C was 2.96 ± 0.81 mmol/L and mean UA was 350.32 ± 95.51 µmol/L(Table 1). Compared with those without TNs, the individuals with TNs had a significantly higher level of BMI, WC, SBP, DBP, FBG, TC, TG, HDL-C, and LDL-C(P < 0.001) (Table 1).
Table 1
Baseline features of general population(N = 121702 ).
|
Total
|
TNs
|
without TNs
|
χ2/w/t
|
P value
|
Total(%)
|
121702
|
41547(34.1)
|
80155(65.9)
|
|
|
Female
|
48563
|
19734(40.6)
|
28829(59.4)
|
1517.33
|
< 0.001
|
Male
|
73139
|
21813(29.8)
|
51326(70.2)
|
|
|
Age (years)
|
42.44 ± 13.24
|
47.89 ± 13.97
|
39.62 ± 11.90
|
-102.924
|
< 0.001
|
Age(years,%)
|
|
|
|
|
|
≤ 30
|
25455
|
4912(19.3)
|
20543(80.7)
|
1.10×109
|
< 0.001
|
31–40
|
35672
|
8527(23.9)
|
27145(76.1)
|
|
|
41–50
|
27063
|
10080(37.2)
|
16983(62.8)
|
|
|
51–60
|
20062
|
9845(49.1)
|
10217(50.9)
|
|
|
≥ 61
|
13450
|
8183(60.8)
|
5267(39.2)
|
|
|
BMI(Kg/m2)
|
23.51 ± 4.06
|
23.72 ± 3.89
|
23.40 ± 4.15
|
-12.477
|
< 0.001
|
WC(cm)
|
81.37 ± 9.95
|
81.87 ± 9.83
|
81.10 ± 10.00
|
-12.234
|
< 0.001
|
SBP (mmHg)
|
123.61 ± 17.30
|
126.36 ± 18.58
|
122.20 ± 16.42
|
-36.724
|
< 0.001
|
DBP(mmHg)
|
75.07 ± 11.54
|
76.26 ± 11.84
|
74.45 ± 11.33
|
-24.5
|
< 0.001
|
FBG(mmol/L)
|
5.43 ± 1.19
|
5.57 ± 1.35
|
5.36 ± 1.10
|
-26.95
|
< 0.001
|
TC(mmol/L)
|
4.91 ± 0.94
|
4.99 ± 0.95
|
4.87 ± 0.93
|
-20.69
|
< 0.001
|
TG(mmol/L)
|
1.64 ± 1.49
|
1.66 ± 1.48
|
1.63 ± 1.49
|
-2.71
|
< 0.001
|
HDL-C(mmol/L)
|
1.40 ± 0.34
|
1.42 ± 0.35
|
1.39 ± 0.34
|
-12.8
|
< 0.001
|
LDL-C(mmol/L)
|
2.96 ± 0.81
|
3.01 ± 0.82
|
2.93 ± 0.81
|
-15.18
|
< 0.001
|
UA(µmol/L)
|
350.32 ± 95.51
|
340.72 ± 93.52
|
355.26 ± 96.15
|
25.21
|
< 0.001
|
Female
|
279.92 ± 62.28
|
283.38 ± 64.73
|
277.57 ± 60.45
|
-9.827
|
< 0.001
|
Male
|
396.3 ± 84.83
|
391.6 ± 85.34
|
398.29 ± 84.53
|
9.71
|
< 0.001
|
Fatty Liver
|
|
|
|
|
|
No
|
84098
|
27696(32.9)
|
56402(67.1)
|
146.61
|
< 0.001
|
Yes
|
33976
|
12442(36.7)
|
21534(63.3)
|
|
|
TNs: thyroid nodules; BMI: body mass index; WC: waist circumference; SBP: systolic blood pressure; DBP: diastolic blood pressure; FBG: fasting blood glucose; TC: total cholesterol; TG: triglycerides; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; UA: uric acid.
Association Between Metabolic Factors and TNs risk.
As shown in Table 2, the univariate binary logistic regression suggested higher BMI, central obesity, hypertension, higher blood glucose, hypercholesterolemia, hypertriglyceridemia, high level of LDL-C, hyperuricemia, and fatty liver were all positively associated with TNs risk, while no association was found in HDL-C(Table 2). When stratified by gender of the participants, all of the metabolic factors, including HDL-C,were associated with the TNs risk (Table 2).
Table 2
Association between metabolic factors and thyroid nodules analyzed by univariable binary logistic regression(N = 121702 ).
|
Total
|
Male
|
Female
|
|
TNs(N,%)
|
Normal(N,%)
|
OR(95%CI)
|
P value
|
TNs(N,%)
|
Normal(N,%)
|
OR(95%CI)
|
P value
|
TNs(N,%)
|
Normal(N,%)
|
OR(95%CI)
|
P value
|
BMI(Kg/m2)
|
|
|
|
|
|
|
|
|
|
|
|
|
≤ 18.4
|
1321(26.0)
|
3751(74.0)
|
0.71(0.67–0.76)
|
< 0.01
|
319(21.7)
|
1152(78.3)
|
0.73(0.64–0.83)
|
< 0.01
|
1002(28.1)
|
2599(71.9)
|
0.60(0.56–0.65)
|
< 0.01
|
18.5–23.9
|
19603(33.1)
|
39659(66.9)
|
1.0(ref)
|
1.00
|
8333(27.5)
|
22009(72.5)
|
1.0(ref)
|
1.00
|
11270(39.0)
|
17659(61.0)
|
1.0(ref)
|
1.00
|
24.0-27.9
|
13418(36.5)
|
23390(63.5)
|
1.16(1.13–1.19)
|
< 0.01
|
9270(32.2)
|
19509(67.8)
|
1.25(1.21–1.30)
|
< 0.01
|
4148(51.7)
|
3881(48.3)
|
1.67(1.59–1.76)
|
< 0.01
|
≥ 28.0
|
3313(35.7)
|
5976(64.3)
|
1.12(1.07–1.17)
|
< 0.01
|
2418(31.7)
|
5207(68.3)
|
1.23(1.16–1.30)
|
< 0.01
|
895(53.8)
|
769(46.2)
|
1.82(1.65–2.01)
|
< 0.01
|
Central obesity
|
|
|
|
|
|
|
|
|
|
|
|
|
No
|
27488(32.7)
|
56522(67.3)
|
1.0(ref)
|
1.00
|
13025(27.8)
|
33886(72.2)
|
1.0(ref)
|
1.00
|
14463(39.0)
|
22636(61.0)
|
1.0(ref)
|
1.00
|
Yes
|
10133(38.5)
|
16178(61.5)
|
1.29(1.25–1.33)
|
< 0.01
|
7306(34.4)
|
13945(65.6)
|
1.36(1.32–1.41)
|
< 0.01
|
2827(55.9)
|
2233(44.1)
|
1.98(1.87–2.10)
|
< 0.01
|
Hypertension
|
|
|
|
|
|
|
|
|
|
|
|
|
No
|
26954(31.0)
|
60094(69.0)
|
1.0(ref)
|
1.00
|
13406(26.3)
|
37593(73.7)
|
1.0(ref)
|
1.00
|
13548(37.6)
|
22501(62.4)
|
1.0(ref)
|
1.00
|
Yes
|
10829(45.6)
|
12933(54.4)
|
1.87(1.81–1.92)
|
< 0.01
|
6985(40.2)
|
10392(59.8)
|
1.88(1.82–1.95)
|
< 0.01
|
3844(60.2)
|
2541(39.8)
|
2.51(2.38–2.65)
|
< 0.01
|
Glucose status
|
|
|
|
|
|
|
|
|
|
|
|
|
Normal
|
34700(32.5)
|
71915
|
1.0(ref)
|
1.00
|
17328(27.8)
|
45033(72.2)
|
1.0(ref)
|
1.00
|
17372(39.3)
|
26882(60.7)
|
1.0(ref)
|
1.00
|
IGR
|
2324(42.9)
|
3091(57.1)
|
1.56(1.47–1.65)
|
< 0.01
|
1591(38.5)
|
2539(61.5)
|
1.63(1.53–1.74)
|
< 0.01
|
733(57.0)
|
552(43.0)
|
2.05(1.84–2.30)
|
< 0.01
|
DM
|
3446(50.1)
|
3437(49.9)
|
2.08(1.98–2.18)
|
< 0.01
|
2529(46.3)
|
2937(53.7)
|
2.24(2.12–2.37)
|
< 0.01
|
917(64.7)
|
500(35.3)
|
2.84(2.54–3.17)
|
< 0.01
|
TC(mmol/L)
|
|
|
|
|
|
|
|
|
|
|
|
|
≤ 5.2
|
25162(32.1)
|
53194(67.9)
|
1.0(ref)
|
1.00
|
13284(28.9)
|
32705(71.7)
|
1.0(ref)
|
1.00
|
20489(63.3)
|
11878(36.7)
|
1.0(ref)
|
1.00
|
> 5.2
|
15464(37.7)
|
25606(62.3)
|
1.28(1.25–1.31)
|
< 0.01
|
8233(31.4)
|
18008(68.6)
|
1.13(1.09–1.16)
|
0.01
|
7231(48.8)
|
7598(51.2)
|
1.64(1.58–1.71)
|
< 0.01
|
TG(mmol/L)
|
|
|
|
|
|
|
|
|
|
|
|
|
≤ 1.7
|
27586(33.5)
|
54778(66.5)
|
1.0(ref)
|
1.00
|
12307(28.9)
|
30276(71.1)
|
1.0(ref)
|
1.00
|
15279(38.4)
|
24502(61.6)
|
1.0(ref)
|
1.00
|
> 1.7
|
13040(35.2)
|
24022(64.8)
|
1.08(1.05–1.11)
|
< 0.01
|
9210(31.1)
|
20437(68.9)
|
1.11(1.07–1.15)
|
< 0.01
|
3830(51.7)
|
3585(48.3)
|
1.71(1.63–1.80)
|
< 0.01
|
HDL-C(mmol/L)
|
|
|
|
|
|
|
|
|
|
|
|
|
≥ 0.9
|
38754(34.1)
|
74737(65.9)
|
|
1.00
|
20025(29.7)
|
47374(70.3)
|
|
1.00
|
18729(40.6)
|
27363(59.4)
|
|
1.00
|
< 0.9
|
1664(33.5)
|
3309(66.5)
|
0.97(0.91–1.03)
|
0.32
|
1426(31.9)
|
3049(68.1)
|
1.11(1.04–1.18)
|
< 0.01
|
238(47.8)
|
260(52.2)
|
1.34(1.12–1.60)
|
< 0.01
|
LDL-C(mmol/L)
|
|
|
|
|
|
|
|
|
|
|
|
|
≤ 3.1
|
23077(32.6)
|
47762(67.4)
|
1.0(ref)
|
1.00
|
11380(29.1)
|
27678(70.9)
|
1.0(ref)
|
1.00
|
11697(36.8)
|
20084(63.2)
|
1.0(ref)
|
1.00
|
> 3.1
|
17341(36.4)
|
30284(63.6)
|
1.19(1.16–1.21)
|
< 0.01
|
10071(30.7)
|
22745(69.3)
|
1.08(1.04–1.11)
|
< 0.01
|
7270(49.1)
|
7539(50.9)
|
1.66(1.59–1.72)
|
0.01
|
HUA(µmol/L)
|
|
|
|
|
|
|
|
|
|
|
|
|
No
|
31978(34.9)
|
59717(65.1)
|
1.0(ref)
|
1.00
|
15165(30.7)
|
34237(69.3)
|
1.0(ref)
|
1.00
|
25480(60.2)
|
16813(39.8)
|
1.0(ref)
|
1.00
|
Yes
|
8632(31.1)
|
19139(68.9)
|
0.84(0.82–0.87)
|
< 0.01
|
6354(27.8)
|
16512(72.2)
|
0.87(0.84–0.90)
|
< 0.01
|
2278(46.4)
|
2627(53.6)
|
1.31(1.24–1.39)
|
< 0.01
|
Fatty Liver
|
|
|
|
|
|
|
|
|
|
|
|
|
No
|
27696(32.9)
|
56402(67.1)
|
1.0(ref)
|
1.00
|
12533(28.3)
|
31706(71.7)
|
1.0(ref)
|
1.00
|
15163(38.0)
|
24696(62.0)
|
1.0(ref)
|
1.00
|
Yes
|
12442(36.7)
|
21534(63.3)
|
1.18(1.15–1.21)
|
< 0.01
|
8879(32.2)
|
18662(67.8)
|
1.20(1.16–1.24)
|
< 0.01
|
3563(55.4)
|
2872(44.6)
|
2.02(1.92–2.13)
|
< 0.01
|
TNs: thyroid nodules; BMI: body mass index; TC: total cholesterol; TG: triglyceride; HDL-C: high-density lipoprotein cholesterol; LDL-C:low-density lipoprotein cholesterol;DM: diabetes mellitus; IGR: Impaired glucose regulation; HUA: hyperuricemia |
When incorporated all the factors into the multivariable logistic model, results suggested female gender, advanced age, higher BMI, central obesity, hypertension, diabetes, and fatty liver were independently associated with the risk of TNs in the general population (Table 3). These associations were not significantly changed after sub-grouped by the gender of the participants. (Table 4–5)
Table 3
Association between metabolic factors and thyroid nodules in the general population analyzed by multivariate binary logistic regression (N = 121702).
Factors
|
β
|
SE
|
Walds
|
P value
|
OR
|
95% CI
|
Female
|
0.61
|
0.02
|
1552.92
|
< 0.01
|
1.84
|
1.78–1.90
|
Age
|
|
|
|
|
|
|
≤ 30
|
|
|
|
1.00
|
1.0(ref)
|
|
31–40
|
0.24
|
0.02
|
116.29
|
< 0.01
|
1.27
|
1.22–1.33
|
41–50
|
0.86
|
0.02
|
1395.86
|
< 0.01
|
2.36
|
2.26–2.47
|
51–60
|
1.30
|
0.02
|
2737.65
|
< 0.01
|
3.67
|
3.49–3.85
|
≥ 61
|
1.77
|
0.28
|
3995.90
|
< 0.01
|
5.86
|
5.55–6.19
|
BMI
|
|
|
|
|
|
|
≤ 18.4
|
-0.13
|
0.04
|
14.17
|
< 0.01
|
0.87
|
0.81–0.94
|
18.5–23.9
|
|
|
|
1.00
|
1.0(ref)
|
|
24.0-27.9
|
0.06
|
0.02
|
11.54
|
< 0.01
|
1.06
|
1.03–1.10
|
≥ 28.0
|
0.03
|
0.03
|
0.83
|
0.36
|
1.03
|
0.97–1.10
|
Central obesity
|
0.09
|
0.02
|
19.64
|
< 0.01
|
1.10
|
1.05–1.14
|
Hypertension
|
0.16
|
0.02
|
74.50
|
< 0.01
|
1.17
|
1.13–1.21
|
Normal
|
|
|
|
1.00
|
1.0(ref)
|
|
IGR
|
0.02
|
0.03
|
0.53
|
0.47
|
1.02
|
0.96–1.09
|
DM
|
0.18
|
0.03
|
37.32
|
< 0.01
|
1.19
|
1.13–1.26
|
High TC
|
0.00
|
0.02
|
0.01
|
0.93
|
1.00
|
0.96–1.04
|
High TG
|
0.01
|
0.02
|
0.44
|
0.51
|
1.01
|
0.98–1.05
|
High LDL-C
|
-0.03
|
0.02
|
2.30
|
0.13
|
0.97
|
0.93–1.01
|
HUA
|
-0.01
|
0.02
|
0.18
|
0.67
|
0.99
|
0.96–1.03
|
Fatty Liver
|
0.06
|
0.02
|
10.43
|
< 0.01
|
1.06
|
1.02–1.10
|
BMI: body mass index; TC: total cholesterol; TG: triglyceride; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; DM: diabetes mellitus; IGR: Impaired glucose regulation; HUA: hyperuricemia |
Table 4
Association between metabolic factors and thyroid nodules in the male population analyzed by multivariate binary logistic regression (N = 73139).
Factors
|
β
|
SE
|
Walds
|
P value
|
OR
|
95% CI
|
Age
|
|
|
|
|
|
|
≤ 30
|
|
|
|
1.00
|
1.0(ref)
|
|
31–40
|
0.15
|
0.03
|
25.75
|
< 0.01
|
1.16
|
1.10–1.23
|
41–50
|
0.73
|
0.03
|
587.19
|
< 0.01
|
2.08
|
1.96–2.21
|
51–60
|
1.22
|
0.03
|
1446.30
|
< 0.01
|
3.38
|
3.18–3.60
|
≥ 61
|
1.70
|
0.04
|
2329.02
|
< 0.01
|
5.49
|
5.12–5.88
|
BMI
|
|
|
|
|
|
|
≤ 18.4
|
-0.14
|
0.07
|
3.82
|
0.05
|
0.87
|
0.76-1.00
|
18.5–23.9
|
|
|
|
1.00
|
1.0(ref)
|
|
24.0-27.9
|
0.06
|
0.02
|
6.59
|
0.01
|
1.06
|
1.01–1.11
|
≥ 28.0
|
0.03
|
0.04
|
0.43
|
0.47
|
1.03
|
0.95–1.11
|
Central obesity
|
0.10
|
0.02
|
17.757
|
< 0.01
|
1.11
|
1.06–1.16
|
Hypertension
|
0.17
|
0.02
|
65.49
|
< 0.01
|
1.19
|
1.14–1.24
|
Normal
|
|
|
|
1.00
|
1.0(ref)
|
|
IGR
|
0.03
|
0.04
|
0.71
|
0.40
|
1.03
|
0.96–1.11
|
DM
|
0.18
|
0.03
|
29.90
|
< 0.01
|
1.19
|
1.12–1.27
|
High TC
|
-0.01
|
0.03
|
0.28
|
0.60
|
0.99
|
0.94–1.04
|
High TG
|
0.02
|
0.02
|
0.77
|
0.38
|
1.02
|
0.98–1.06
|
Low HDL-C
|
0.06
|
0.04
|
2.61
|
0.11
|
1.06
|
0.99–1.15
|
High LDL-C
|
-0.02
|
0.03
|
0.86
|
0.35
|
0.98
|
0.93–1.03
|
HUA
|
-0.03
|
0.02
|
1.99
|
0.16
|
0.97
|
0.93–1.01
|
Fatty Liver
|
0.05
|
0.02
|
5.55
|
0.02
|
1.05
|
1.01–1.10
|
BMI: body mass index;TC: total cholesterol;TG: triglyceride; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; DM: diabetes mellitus; IGR: Impaired glucose regulation; HUA: hyperuricemia |
Table 5
Association between metabolic factors and thyroid nodules in female population analyzed by multivariate binary logistic regression (N = 48563).
Factors
|
β
|
SE
|
Walds
|
P value
|
OR
|
95% CI
|
Age
|
|
|
|
|
|
|
≤ 30
|
|
|
|
1.00
|
1.0(ref)
|
|
31–40
|
0.35
|
0.03
|
108.22
|
< 0.01
|
1.42
|
1.33–1.52
|
41–50
|
1.03
|
0.04
|
832.77
|
< 0.01
|
2.80
|
2.61-3.00
|
51–60
|
1.38
|
0.04
|
1195.91
|
< 0.01
|
3.98
|
3.68–4.31
|
≥ 61
|
1.82
|
0.05
|
1467.95
|
< 0.01
|
6.19
|
5.64–6.79
|
BMI
|
|
|
|
|
|
|
≤ 18.4
|
-0.11
|
0.04
|
6.27
|
0.01
|
0.90
|
0.82–0.97
|
18.5–23.9
|
|
|
|
1.00
|
1.0(ref)
|
|
24.0-27.9
|
0.07
|
0.03
|
5.21
|
0.01
|
1.08
|
1.01–1.15
|
≥ 28.0
|
0.01
|
0.07
|
0.04
|
0.85
|
1.01
|
0.89–1.15
|
Central obesity
|
0.08
|
0.04
|
3.96
|
< 0.05
|
1.09
|
1.00-1.18
|
Hypertension
|
0.12
|
0.03
|
12.75
|
< 0.01
|
1.13
|
1.06–1.21
|
Normal
|
|
|
|
1.00
|
1.0(ref)
|
|
IGR
|
0.01
|
0.07
|
0.01
|
0.93
|
1.01
|
0.88–1.15
|
DM
|
0.17
|
0.07
|
6.39
|
0.01
|
1.18
|
1.04–1.35
|
High TC
|
0.03
|
0.04
|
0.55
|
0.46
|
1.03
|
0.96–1.10
|
High TG
|
0.00
|
0.03
|
0.00
|
0.99
|
1.00
|
0.94–1.07
|
Low HDL-C
|
0.08
|
0.11
|
0.61
|
0.43
|
1.09
|
0.88–1.34
|
High LDL-C
|
-0.04
|
0.04
|
0.95
|
0.33
|
0.97
|
0.90–1.04
|
HUA
|
0.05
|
0.04
|
1.97
|
0.16
|
1.05
|
0.98–1.13
|
Fatty Liver
|
0.10
|
0.04
|
6.54
|
0.01
|
1.10
|
1.02–1.19
|
BMI: body mass index; TC:total cholesterol; TG:triglyceride; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; DM: diabetes mellitus; IGR: Impaired glucose regulation; HUA: hyperuricemia |
Association Between Metabolic Factors and MTNs compared with STNs.
Univariate binary logistic regression analysis of data of 41,547 individuals with TNs indicated that higher BMI, central obesity, hypertension, high blood glucose, hypercholesterolemia, low level of HDL-C, high level of HDL-C, hyperuricemia, and fatty liver were all significantly associated with the of the prevalence of MTNs compared with STNs, while no association was found between higher TG level and MTNs. (Table 6) All of these metabolic factors were associated with the MTNs in females, but for male, higher BMI, central obesity, hypertension, high blood glucose, low level of HDL-C, high level of HDL-C, and hyperuricemia were associated with the MTNs. (Table 6)
Table 6
Association between metabolic factors and multiple thyroid nodules analyzed by univariable binary logistic regression(vs. single thyroid nodules, N = 41547 ).
|
|
|
Total
|
|
|
|
Male
|
|
|
|
Female
|
|
|
STNs(N,%)
|
MTNs(N,%)
|
OR(95%CI)
|
P value
|
STNs(N,%)
|
MTNs(N,%)
|
OR(95%CI)
|
P value
|
SNs(N,%)
|
MTNs(N,%)
|
OR(95%CI)
|
P value
|
BMI(Kg/m2)
|
|
|
|
|
|
|
|
|
|
|
|
|
≤ 18.4
|
679(51.4)
|
642(48.6)
|
0.96(0.86–1.07)
|
0.43
|
163(51.1)
|
156(48.9)
|
1.15(0.92–1.44)
|
0.21
|
516(51.5)
|
486(48.5)
|
0.84(0.73–0.95)
|
< 0.01
|
18.5–23.9
|
9854(50.3)
|
9749(49.7)
|
1.0(ref)
|
1.00
|
4555(54.7)
|
3778(45.3)
|
1.0(ref)
|
1.00
|
5299(47.0)
|
5971(53.0)
|
1.0(ref)
|
1.00
|
24.0-27.9
|
6497(48.4)
|
6921(51.6)
|
1.08(1.03–1.13)
|
< 0.01
|
4873(52.6)
|
4397(47.4)
|
1.09(1.03–1.15)
|
< 0.01
|
1624(39.2)
|
2524(60.8)
|
1.38(1.28–1.48)
|
< 0.01
|
≥ 28.0
|
1626(49.1)
|
1687(50.9)
|
1.05(0.97–1.13)
|
0.21
|
1311(54.2)
|
1107(45.8)
|
1.02(0.93–1.12)
|
0.70
|
315(35.2)
|
580(64.8)
|
1.63(1.42–1.88)
|
< 0.01
|
Central obesity(cm)
|
|
|
|
|
|
|
|
|
|
|
|
|
No
|
13896(50.6)
|
13592(49.4)
|
1.0(ref)
|
1.00
|
7144(54.8)
|
5881(45.2)
|
1.0(ref)
|
1.00
|
6752(46.7)
|
7711(53.5)
|
1.0(ref)
|
1.00
|
Yes
|
4743(46.8)
|
5390(53.2)
|
1.16(1.11–1.22)
|
< 0.01
|
3756(51.4)
|
3550(48.6)
|
1.15(1.08–1.22)
|
< 0.01
|
987(34.9)
|
1840(65.1)
|
1.63(1.50–1.78)
|
< 0.01
|
Hypertension
|
|
|
|
|
|
|
|
|
|
|
|
|
No
|
14096(52.3)
|
12858(47.7)
|
1.0(ref)
|
1.00
|
7591(56.6)
|
5815(43.4)
|
1.0(ref)
|
1.00
|
6505(48.0)
|
7043(52.0)
|
1.0(ref)
|
1.00
|
Yes
|
4626(42.7)
|
6203(57.3)
|
1.47(1.41–1.54)
|
< 0.01
|
3339(47.8)
|
3646(52.2)
|
1.43(1.35–1.51)
|
< 0.01
|
1287(33.5)
|
2557(66.5)
|
1.84(1.70–1.98)
|
< 0.01
|
DM
|
|
|
|
|
|
|
|
|
|
|
|
|
Normal
|
17704(51.0)
|
16996(49.0)
|
1.0(ref)
|
1.00
|
9614(55.5)
|
7714(44.5)
|
1.0(ref)
|
1.00
|
8090(46.6)
|
9289(53.4)
|
1.0(ref)
|
1.00
|
IGR
|
1049(45.1)
|
1275(54.9)
|
1.27(1.16–1.38)
|
< 0.01
|
799(50.2)
|
792(49.8)
|
1.24(1.11–1.37)
|
< 0.01
|
250(34.1)
|
483(65.9)
|
1.68(1.44–1.97)
|
< 0.01
|
DM
|
1392(40.4)
|
2054(59.6)
|
1.54(1.43–1.65)
|
< 0.01
|
1109(43.9)
|
1420(56.1)
|
1.60(1.47–1.74)
|
< 0.01
|
283(30.9)
|
634(69.1)
|
1.95(1.69–2.25)
|
< 0.01
|
TC(mmol/L)
|
|
|
|
|
|
|
|
|
|
|
|
|
≤ 5.2
|
12825(51.0)
|
12337(49.0)
|
1.0(ref)
|
1.00
|
7099(53.4)
|
6185(46.6)
|
1.0(ref)
|
1.00
|
5726(48.2)
|
6152(51.8)
|
1.0(ref)
|
1.00
|
> 5.2
|
7385(47.8)
|
8079(52.2)
|
1.14(1.09–1.18)
|
< 0.01
|
4452(54.1)
|
3781(45.9)
|
0.97(0.92–1.03)
|
0.36
|
2933(40.6)
|
4298(59.4)
|
1.36(1.29–1.45)
|
< 0.01
|
TG(mmol/L)
|
|
|
|
|
|
|
|
|
|
|
|
|
≤ 1.7
|
13697(49.7)
|
13889(50.3)
|
1.0(ref)
|
1.00
|
6488(52.7)
|
5819(47.3)
|
1.0(ref)
|
1.00
|
7209(47.2)
|
8070(52.8)
|
1.0(ref)
|
1.00
|
> 1.7
|
6513(49.9)
|
6527(50.1)
|
0.99(0.95–1.03)
|
0.58
|
5063(55.0)
|
4147(45.0)
|
0.91(0.87–0.96)
|
< 0.01
|
1450(37.9)
|
2380(62.1)
|
1.47(1.36–1.58)
|
< 0.01
|
HDL-C(mmol/L)
|
|
|
|
|
|
|
|
|
|
|
|
|
≥ 0.9
|
19207(49.6)
|
19547(50.4)
|
|
1.00
|
10733(53.6)
|
9292(46.4)
|
|
1.00
|
8474(45.2)
|
10255(54.8)
|
|
1.00
|
< 0.9
|
884(53.1)
|
780(46.9)
|
0.87(0.79–0.96)
|
< 0.01
|
777(54.5)
|
649(45.5)
|
0.96(0.87–1.07)
|
0.51
|
107(45.0)
|
131(55.0)
|
1.01(0.78–1.31)
|
0.93
|
LDL-C(mmol/L)
|
|
|
|
|
|
|
|
|
|
|
|
|
≤ 3.1
|
11667(50.6)
|
11410(49.4)
|
1.0(ref)
|
1.00
|
6008(52.8)
|
5372(47.2)
|
1.0(ref)
|
1.00
|
5659(48.4)
|
6038(51.6)
|
1.0(ref)
|
1.00
|
> 3.1
|
8424(48.6)
|
8917(51.4)
|
1.08(1.04–1.13)
|
< 0.01
|
5502(54.6)
|
4569(45.4)
|
0.93(0.88–0.98)
|
0.01
|
2922(40.2)
|
4348(59.8)
|
1.39(1.31–1.48)
|
< 0.01
|
HUA(µmol/L)
|
|
|
|
|
|
|
|
|
|
|
|
|
No
|
15802(49.4)
|
16176(50.6)
|
1.0(ref)
|
1.00
|
8059(53.1)
|
7106(46.9)
|
1.0(ref)
|
1.00
|
7743(46.1)
|
9070(53.9)
|
1.0(ref)
|
1.00
|
Yes
|
4415(51.1)
|
4217(48.9)
|
0.93(0.89–0.98)
|
< 0.01
|
3495(55.0)
|
2859(45.0)
|
0.93(0.87–0.98)
|
0.01
|
920(40.4)
|
1358(59.6)
|
1.26(1.15–1.38)
|
< 0.01
|
Fatty Liver
|
|
|
|
|
|
|
|
|
|
|
|
|
No
|
13884(50.1)
|
13812(49.9)
|
1.0(ref)
|
1.00
|
6696(53.4)
|
5837(46.6)
|
1.0(ref)
|
1.00
|
7188(47.4)
|
7975(52.6)
|
1.0(ref)
|
1.00
|
Yes
|
6101(49.0)
|
6341(51.0)
|
1.04(1.00-1.09)
|
0.04
|
4785(53.9)
|
4094(46.1)
|
0.98(0.93–1.04)
|
0.50
|
1316(36.9)
|
2247(63.1)
|
1.54(1.43–1.66)
|
< 0.01
|
STNs: single thyroid nodules; MTNs: multiple thyroid nodules; BMI: body mass index; TC: total cholesterol; TG: triglyceride; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; DM: diabetes mellitus; IGR: sugar adjustment; HUA: hyperuricemia |
Multivariable binary logistic regression analysis showed that in the general population, female gender, advanced age, central obesity, hypertension, and diabetes were independently associated with the risk of MTNs(Tables 7). After stratified by the sex of the participants, these factors were also associated with the MTNs risk in men, while for female, only advanced age and hypertension were associated with MTNs risk. (Tables 8–9)
Table 7
Association between metabolic factors and multiple thyroid nodules in the general population analyzed by multivariate binary logistic regression(vs. single thyroid nodules,N = 41,547).
Factors
|
β
|
SE
|
|
Walds
|
P value
|
OR
|
95% CI
|
Female
|
0.44
|
0.02
|
|
342.46
|
< 0.01
|
1.55
|
1.48–1.63
|
Age
|
|
|
|
|
|
|
|
≤ 30
|
|
|
|
|
1.00
|
1.0(ref)
|
|
31–40
|
-0.23
|
0.04
|
|
32.65
|
< 0.01
|
0.79
|
0.73–0.86
|
41–50
|
0.03
|
0.04
|
|
0.50
|
0.48
|
1.03
|
0.95–1.11
|
51–60
|
0.40
|
0.04
|
|
93.41
|
< 0.01
|
1.49
|
1.37–1.61
|
≥ 61
|
0.84
|
0.04
|
|
362.48
|
< 0.01
|
2.31
|
2.12–2.51
|
BMI
|
|
|
|
|
|
|
|
≤ 18.4
|
0.01
|
0.06
|
|
0.07
|
0.94
|
1.01
|
0.89–1.13
|
18.5–23.9
|
|
|
|
|
1.00
|
1.0(ref)
|
|
24.0-27.9
|
0.03
|
0.03
|
|
0.74
|
0.39
|
1.02
|
0.97–1.08
|
≥ 28.0
|
-0.01
|
0.05
|
|
0.02
|
0.89
|
1.00
|
0.90–1.10
|
Central obesity
|
0.09
|
0.03
|
|
7.58
|
< 0.01
|
1.09
|
1.03–1.17
|
Hypertension
|
0.11
|
0.03
|
|
16.76
|
< 0.01
|
1.12
|
1.06–1.18
|
Normal
|
|
|
|
|
1.00
|
1.0(ref)
|
|
IGR
|
0.04
|
0.05
|
|
0.52
|
0.47
|
1.04
|
0.94–1.14
|
DM
|
0.17
|
0.04
|
|
17.27
|
< 0.01
|
1.19
|
1.10–1.29
|
High TC
|
0.00
|
0.03
|
|
0.01
|
0.93
|
1.00
|
0.94–1.06
|
Low HDL-C
|
-0.04
|
0.06
|
|
0.55
|
0.46
|
0.96
|
0.86–1.07
|
High LDL-C
|
-0.01
|
0.03
|
|
0.14
|
0.71
|
0.99
|
0.93–1.05
|
HUA
|
0.02
|
0.03
|
|
0.69
|
0.41
|
1.02
|
0.97–1.08
|
Fatty Liver
|
0.00
|
0.03
|
|
0.00
|
0.96
|
1.00
|
0.95–1.06
|
BMI: body mass index; TC: total cholesterol; TG: triglyceride; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; DM: diabetes mellitus; IGR: sugar adjustment; HUA: hyperuricemia |
Table 8
Association between metabolic factors and multiple thyroid nodules in the male population analyzed by multivariate binary logistic regression(vs. single thyroid nodules,N = 21,813 ).
Factors
|
β
|
SE
|
Walds
|
P value
|
OR
|
95% CI
|
Age
|
|
|
|
|
|
|
≤ 30
|
|
|
|
1.00
|
1.0(ref)
|
|
31–40
|
-0.29
|
0.06
|
27.06
|
< 0.01
|
0.75
|
0.67–0.84
|
41–50
|
-0.14
|
0.05
|
6.47
|
0.01
|
0.87
|
0.79–0.97
|
51–60
|
0.24
|
0.05
|
20.09
|
< 0.01
|
1.28
|
1.15–1.42
|
≥ 61
|
0.68
|
0.06
|
142.54
|
< 0.01
|
1.97
|
1.76–2.20
|
BMI
|
|
|
|
|
|
|
≤ 18.4
|
0.16
|
0.12
|
1.71
|
0.19
|
1.17
|
0.93–1.47
|
18.5–23.9
|
|
|
|
1.00
|
1.0(ref)
|
|
24.0-27.9
|
0.03
|
0.04
|
0.69
|
0.41
|
1.03
|
0.96–1.10
|
≥ 28.0
|
-0.05
|
0.06
|
0.84
|
0.36
|
0.95
|
0.84–1.06
|
Central obesity
|
0.11
|
0.04
|
7.47
|
< 0.01
|
1.11
|
1.03–1.20
|
Hypertension
|
0.11
|
0.03
|
11.68
|
< 0.01
|
1.12
|
1.05–1.20
|
Normal
|
|
|
|
1.00
|
1.0(ref)
|
|
IGR
|
0.03
|
0.06
|
0.28
|
0.60
|
1.03
|
0.92–1.15
|
DM
|
0.20
|
0.05
|
17.68
|
< 0.01
|
1.22
|
1.11–1.34
|
High TG
|
-0.04
|
0.03
|
1.54
|
0.21
|
0.96
|
0.90–1.02
|
High LDL-C
|
-0.06
|
0.03
|
3.33
|
0.07
|
1.06
|
1.00-1.12
|
HUA
|
-0.01
|
0.03
|
0.02
|
0.89
|
1.00
|
0.93–1.06
|
BMI: body mass index; TC: total cholesterol; TG: triglyceride; HDL-C:high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; DM: diabetes mellitus; IGR: sugar adjustment; HUA: hyperuricemia |
Table 9
Association between metabolic factors and multiple thyroid nodules in female population analyzed by multivariate binary logistic regression(vs. single thyroid nodules,N = 19,734 ).
Factors
|
β
|
SE
|
Walds
|
P value
|
OR
|
95% CI
|
Age
|
|
|
|
|
|
|
≤ 30
|
|
|
|
1.00
|
1.0(ref)
|
|
31–40
|
-0.15
|
0.06
|
6.41
|
0.01
|
0.86
|
0.77–0.97
|
41–50
|
0.23
|
0.06
|
15.39
|
< 0.01
|
1.26
|
1.12–1.41
|
51–60
|
0.56
|
0.06
|
79.44
|
< 0.01
|
1.75
|
1.55–1.98
|
≥ 61
|
0.99
|
0.07
|
198.06
|
< 0.01
|
2.68
|
2.34–3.08
|
BMI
|
|
|
|
|
|
|
≤ 18.4
|
0.02
|
0.07
|
0.06
|
0.81
|
1.02
|
0.88–1.17
|
18.5–23.9
|
|
|
|
1.00
|
1.0(ref)
|
|
24.0-27.9
|
0.01
|
0.05
|
0.02
|
0.89
|
1.01
|
0.92–1.10
|
≥ 28.0
|
0.08
|
0.09
|
0.80
|
0.37
|
1.08
|
0.91–1.30
|
Central obesity
|
0.07
|
0.06
|
1.55
|
0.21
|
1.08
|
0.96–1.21
|
Hypertension
|
0.10
|
0.05
|
4.48
|
0.03
|
1.10
|
1.01–1.21
|
Normal
|
|
|
|
1.00
|
1.0(ref)
|
|
IGR
|
0.11
|
0.09
|
1.37
|
0.24
|
1.11
|
0.93–1.33
|
DM
|
0.12
|
0.09
|
1.83
|
0.18
|
1.12
|
0.95–1.33
|
High TC
|
-0.02
|
0.05
|
0.11
|
0.74
|
0.98
|
0.89–1.09
|
High TG
|
0.06
|
0.05
|
1.65
|
0.20
|
1.06
|
0.97–1.16
|
High LDL-C
|
0.04
|
0.05
|
0.46
|
0.50
|
1.04
|
0.93–1.15
|
HUA
|
0.05
|
0.05
|
0.99
|
0.32
|
1.06
|
0.95–1.17
|
Fatty Liver
|
0.05
|
0.05
|
0.78
|
0.38
|
1.05
|
0.95–1.16
|
BMI: body mass index; TC: total cholesterol; TG: triglyceride; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; DM: diabetes mellitus; IGR: sugar adjustment; HUA: hyperuricemia |