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Objective <p>To compare the predictive performance of five insulin resistance (IR) indices for the risk of metabolic syndrome (MS) incidence.</p> Methods <p>This is a cohort study including 1129 Algerian adults free of MS at baseline, followed for up to 49 months (median follow-up: 45 months; IQR, 22–49 months). Incident MS was defined according to the NCEP-ATPIII criteria. Five IR indices: triglyceride-glucose index (TYG), TYG-body mass index (TYG-BMI), TYG-waist circumference (TYG-WC), and estimated glucose disposal rate (eGDR), using BMI or WC, were evaluated using Cox models, adjusted for cardio-metabolic confounding factors. Their performance was evaluated using time-dependent ROC curves, Harrell’s C-index, Kaplan-Meier curves, and incremental predictive improvement (net reclassification improvement (NRI) and integrated discrimination improvement (IDI)). Sensitivity analyses were performed using stratification based on gender, age, and baseline metabolic phenotypes.</p> Results <p>During follow-up, 291 participants developed MS (25.8%). TYG-WC demonstrated the highest predictive performance among the evaluated indices within the NCEP-ATPIII framework: aHR = 1.44 per standard deviation (95% CI [1.24–1.66]). Values above 775.9 were associated with a 2.65-fold increased risk at the 49-month horizon, with a C-index of 0.83, mAUC of model curves of 0.828, and quasi-perfect calibration (slope = 0.984). It also provided the best incremental improvement (NRI = 0.076, IDI = 0.041). Indices incorporating waist circumference consistently demonstrated modestly better predictive performance than their BMI-based counterparts and showed significant improvement in risk reclassification (NRI), whereas BMI-based indices did not. The associations remained robust across gender, age, and obesity status.</p> Conclusion <p>Within the NCEP-ATPIII framework, TYG-WC demonstrated the highest predictive performance among the evaluated indices and may represent a simple and clinically useful tool for metabolic risk stratification and early identification of individuals at increased risk of MS.</p>

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Longitudinal comparative performance of triglyceride-glucose-related indices and estimated glucose disposal rate for predicting metabolic syndrome risk

  • 期刊论文

  • 发表日期：

    2026年7月28日

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  • Salam Bennouar,
  • Abdelghani Bachir Cherif,
  • Mahrez Fissah,
  • Samia Abdi

摘要

Objective

To compare the predictive performance of five insulin resistance (IR) indices for the risk of metabolic syndrome (MS) incidence.

Methods

This is a cohort study including 1129 Algerian adults free of MS at baseline, followed for up to 49 months (median follow-up: 45 months; IQR, 22–49 months). Incident MS was defined according to the NCEP-ATPIII criteria. Five IR indices: triglyceride-glucose index (TYG), TYG-body mass index (TYG-BMI), TYG-waist circumference (TYG-WC), and estimated glucose disposal rate (eGDR), using BMI or WC, were evaluated using Cox models, adjusted for cardio-metabolic confounding factors. Their performance was evaluated using time-dependent ROC curves, Harrell’s C-index, Kaplan-Meier curves, and incremental predictive improvement (net reclassification improvement (NRI) and integrated discrimination improvement (IDI)). Sensitivity analyses were performed using stratification based on gender, age, and baseline metabolic phenotypes.

Results

During follow-up, 291 participants developed MS (25.8%). TYG-WC demonstrated the highest predictive performance among the evaluated indices within the NCEP-ATPIII framework: aHR = 1.44 per standard deviation (95% CI [1.24–1.66]). Values above 775.9 were associated with a 2.65-fold increased risk at the 49-month horizon, with a C-index of 0.83, mAUC of model curves of 0.828, and quasi-perfect calibration (slope = 0.984). It also provided the best incremental improvement (NRI = 0.076, IDI = 0.041). Indices incorporating waist circumference consistently demonstrated modestly better predictive performance than their BMI-based counterparts and showed significant improvement in risk reclassification (NRI), whereas BMI-based indices did not. The associations remained robust across gender, age, and obesity status.

Conclusion

Within the NCEP-ATPIII framework, TYG-WC demonstrated the highest predictive performance among the evaluated indices and may represent a simple and clinically useful tool for metabolic risk stratification and early identification of individuals at increased risk of MS.