Journal of Obesity & Metabolic Syndrome

Search

Article

March, 2024 | Vol.33 No.1

J Obes Metab Syndr 2023; 32(2): 179-180

Published online June 30, 2023 https://doi.org/10.7570/jomes23017

Copyright © Korean Society for the Study of Obesity.

Letter: Triglyceride-Glucose Index Predicts Cardiovascular Outcome in Metabolically Unhealthy Obese Population: A Nationwide Population-Based Cohort Study (J Obes Metab Syndr 2022;31:178-86)

Gwanpyo Koh *

Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea

Correspondence to:
Gwanpyo Koh
https://orcid.org/0000-0002-6020-2777
Department of Internal Medicine, Jeju National University College of Medicine, 15 Aran 13-gil, Jeju 63241, Korea
Tel: +82-64-754-8163
Fax: +82-64-717-1131
E-mail: okdom@jejunu.ac.kr

Received: February 8, 2023; Reviewed : March 30, 2023; Accepted: April 2, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cardiovascular diseases (CVDs) are the most common cause of physical disability and mortality globally1 and the second leading cause of death in Korea.2 Hence, determining predictors of CVD is crucial to promoting human health. Currently, traditional cardiovascular (CV) risk factors are used in CVD prediction models.3 In addition to diabetes mellitus (DM), insulin resistance is the fundamental etiology of atherosclerotic CVD and is used to predict CVD in both people with and without DM.4 The gold standard for diagnosis of insulin resistance is the euglycemic insulin clamp technique; however, this method is complex, invasive, and costly.5 The homeostasis model assessment-estimated insulin resistance index is widely used owing to its convenience; only one blood sample is required. However, it has the following drawbacks: (1) blood insulin concentration must be measured; (2) it cannot be used for individuals receiving insulin therapy; and (3) it is inaccurate in patients with DM with diminished beta-cell function.6 The triglyceride-glucose (TyG) index overcomes these drawbacks. It is calculated using fasting glucose and triglyceride levels and can be used to indicate insulin resistance in people with and without DM.7

Cho et al.8 classified 292,206 participants of the Korean National Health Insurance Service National Health Screening Cohort into four groups (metabolically healthy non-obese, metabolically unhealthy non-obese, metabolically healthy obese [MHO], and metabolically unhealthy obese [MUO]) that were followed from 2009 to 2015. The baseline TyG index was found to be correlated with CV events and CV mortality in the MUO group. However, this study analyzed the correlation between baseline TyG index and the incidence of CVD over 6 years of follow-up. Changes in the TyG index during the follow-up period may have influenced the gradual onset of CVD. Therefore, predicting CVD based on TyG index taken at one time point may be inaccurate and vulnerable to regression dilution biases.9 Furthermore, Cho et al.8 divided the participants into groups based on obesity and metabolic health at baseline to investigate CV events and mortality throughout the follow-up period. Obesity and metabolic health also change over time. Soriguer et al.10 reported that many study participants progressed from MHO to MUO during a 6- or 11-year of follow-up. Furthermore, the incidence of type 2 DM decreased among individuals who lost weight during the follow-up period. Thus, obesity and metabolic health are dynamic and change over time, and ultimately, the incidence of obesity-related outcomes such as type 2 DM and CVD may also differ accordingly.

Additional analysis considering changes in TyG index, obesity, and metabolic health during follow-up would enhance the predictive value of TyG index for CV outcomes.

The authors declare no conflict of interest.

  1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol 2020;76:2982-3021.
    Pubmed KoreaMed CrossRef
  2. Kim KJ, Kwon TY, Yu S, Seo JA, Kim NH, Choi KM, et al. Ten-year mortality trends for adults with and without diabetes mellitus in South Korea, 2003 to 2013. Diabetes Metab J 2018;42:394-401.
    Pubmed KoreaMed CrossRef
  3. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation 2019;140:e596-646.
    CrossRef
  4. Mancusi C, de Simone G, Best LG, Wang W, Zhang Y, Roman MJ, et al. Myocardial mechano-energetic efficiency and insulin resistance in non-diabetic members of the Strong Heart Study cohort. Cardiovasc Diabetol 2019;18:56.
    Pubmed KoreaMed CrossRef
  5. Cersosimo E, Solis-Herrera C, Trautmann ME, Malloy J, Triplitt CL. Assessment of pancreatic β-cell function: review of methods and clinical applications. Curr Diabetes Rev 2014;10:2-42.
    Pubmed KoreaMed CrossRef
  6. Minh HV, Tien HA, Sinh CT, Thang DC, Chen CH, Tay JC, et al. Assessment of preferred methods to measure insulin resistance in Asian patients with hypertension. J Clin Hypertens (Greenwich) 2021;23:529-37.
    Pubmed KoreaMed CrossRef
  7. Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord 2008;6:299-304.
    Pubmed CrossRef
  8. Cho YK, Kim HS, Park JY, Lee WJ, Kim YJ, Jung CH. Triglyceride-glucose index predicts cardiovascular outcome in metabolically unhealthy obese population: a nationwide population-based cohort study. J Obes Metab Syndr 2022;31:178-86.
    Pubmed KoreaMed CrossRef
  9. Tai S, Fu L, Zhang N, Yang R, Zhou Y, Xing Z, et al. Association of the cumulative triglyceride-glucose index with major adverse cardiovascular events in patients with type 2 diabetes. Cardiovasc Diabetol 2022;21:161.
    Pubmed KoreaMed CrossRef
  10. Soriguer F, Gutiérrez-Repiso C, Rubio-Martín E, García-Fuentes E, Almaraz MC, Colomo N, et al. Metabolically healthy but obese, a matter of time?: findings from the prospective Pizarra study. J Clin Endocrinol Metab 2013;98:2318-25.
    Pubmed CrossRef