Triglyceride-glucose index is associated with metabolic syndrome in women with polycystic ovary syndrome

Figures & data

Figure 1. Flow chart of the study design.

Table 1. Baseline characteristics in PCOS and non-PCOS women.

Variables	PCOS	non-PCOS	P value
	819	3122
Age (year)	29.56 ± 3.77	29.66 ± 2.95	0.58
BMI (kg/m^2)	23.73 ± 3.64	21.70 ± 3.09	<0.001
WC (cm)	80.02 ± 9.96	74.11 ± 8.51	<0.001
SBP (mmHg)	113.13 ± 12.67	109.14 ± 11.35	<0.001
DBP (mmHg)	75.36 ± 9.25	72.68 ± 8.00	<0.001
Basal LH (IU/L)	6.78 (4.58–10.09)	4.41 (3.23–5.97)	<0.001
Basal FSH (IU/L)	6.88 ± 2.14	7.76 ± 2.12	<0.001
LH/FSH ratio	1.02 (0.70–1.50)	0.58 (0.43–0.78)	<0.001
Basal E2 (pmol/L)	169.00 (120.50–221.00)	168.10 (122.00–229.00)	0.31
Basal T (nmol/L)	2.00 (1.50–2.55)	1.48 (1.09–1.90)	<0.001
AMH (ng/mL)	8.18 (6.11–11.10)	3.37 (2.20–4.89)	<0.001
TSH (mU/L)	2.06 (1.39–2.83)	1.86 (1.33–2.57)	0.55
TyG index	8.60 ± 0.60	8.37 ± 0.55	<0.001
FBG (mmol/L)	5.29 ± 0.99	5.19 ± 0.57	0.01
FINS (mIU/L)	11.69 (7.58–16.81)	8.09 (5.71–11.82)	<0.001
HOMA-IR	2.63 (1.74–3.97)	1.86 (1.27–2.83)	<0.001
HOMA-β	134.62 (93.78–200.76)	100.56 (70.77–144.89)	<0.001
TC (mmol/L)	4.98 ± 0.94	4.66 ± 0.86	<0.001
TG (mmol/L)	1.27 (0.90–1.88)	0.99 (0.74–1.41)	<0.001
HDL (mmol/L)	1.33 ± 0.32	1.39 ± 0.30	<0.001
LDL (mmol/L)	2.80 (2.35–3.35)	2.53 (2.14–2.99)	<0.001
MetS (n, %)	266 (32.5)	287 (9.2)	<0.001
Hypertension (n, %)	61 (7.4)	62 (2.0)	<0.001
Obesity (n, %)	277 (33.8)	395 (12.7)	<0.001
Central obesity (n, %)	401 (49.0)	729 (23.4)	<0.001
Hyperglycemia (n, %)	171 (20.9)	319 (10.2)	<0.001
Dyslipidemia (n, %)	271 (33.1)	451 (14.4)	<0.001

Abbreviations: BMI, body mass index; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; LH, luteinizing hormone; FSH, follicle stimulating hormone; E2, estradiol; T, testosterone; AMH, anti-Mullerian hormone; TSH, thyroid stimulating hormone; TyG index, triglyceride-glucose index; FBG, fasting blood glucose; FINS, fasting insulin; HOMA-IR, homeostasis model assessment of insulin resistance; HOMA-β, homeostasis model assessment of β cell function; TC, total cholesterol; TG, triglycerides; HDL, high-density lipoprotein; LDL, low-density lipoprotein; MetS, metabolic syndrome.

Table 2. Prevalence ratios for MetS according to the tertiles of TyG index.

	Tertiles of TyG index
	T1	T2	T3	P for trend
MetS in PCOS
Model 1	1.00 (Reference)	3.02 (1.93–4.73)	9.45 (6.11–14.61)	<0.001
Model 2	1.00 (Reference)	2.79 (1.40–5.55)	7.97 (4.00–15.85)	<0.001
Model 3	1.00 (Reference)	1.55 (0.60–4.01)	3.66 (1.28–10.49)	<0.001
MetS in non-PCOS
Model 1	1.00 (Reference)	1.34 (0.99–1.82)	1.43 (1.05–1.93)	0.02
Model 2	1.00 (Reference)	1.39 (0.98–1.96)	1.81 (1.29–2.54)	0.02
Model 3	1.00 (Reference)	1.53 (0.81–2.89)	1.49 (0.67–3.28)	0.06

Note: Model 1: unadjusted. Model 2: adjusted for age and BMI. Model 3: model 2 + SBP, WC, LH/FSH ratio (log-transformed), T (log-transformed), FINS (log-transformed), TC, HDL and LDL (log-transformed).

Abbreviations: MetS, metabolic syndrome; TyG index, triglyceride-glucose index; BMI, body mass index; SBP, systolic blood pressure; WC, waist circumference; T, testosterone; FINS, fasting insulin; TC, total cholesterol; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Table 3. Odds ratios for metabolic risk factors based on tertiles of TyG index in PCOS and non-PCOS.

	Tertiles of TyG index in PCOS
	T1	T2	T3	P for trend
Hypertension
OR (95%)^a	1.00 (Reference)	2.61 (1.06–6.43)	3.14 (1.14–8.62)	<0.001
Obesity
OR (95%)^b	1.00 (Reference)	3.84 (1.39–10.64)	12.52 (4.55–34.43)	<0.001
Central obesity
OR (95%)^c	1.00 (Reference)	1.97 (1.22–3.18)	3.90 (2.17–7.00)	<0.001
Hyperglycemia
OR (95%)^d	1.00 (Reference)	3.79 (2.13–6.74)	7.51 (3.87–14.61)	<0.001
Dyslipidemia
OR (95%)^e	1.00 (Reference)	1.99 (1.20–3.29)	2.48 (1.69–3.65)	<0.001
	Tertiles of TyG index in non-PCOS
	T1	T2	T3	P for trend
Hypertension
OR (95%)^a	1.00 (Reference)	0.94 (0.53–1.68)	0.61 (0.31–1.20)	0.10
Obesity
OR (95%)^b	1.00 (Reference)	1.44 (1.04–2.00)	1.94 (1.39–2.70)	0.02
Central obesity
OR (95%)^c	1.00 (Reference)	1.32 (1.02–1.70)	1.45 (1.13–1.87)	0.20
Hyperglycemia
OR (95%)^d	1.00 (Reference)	1.33 (0.99–1.79)	1.39 (1.04–1.87)	0.04
Dyslipidemia
OR (95%)^e	1.00 (Reference)	1.13 (0.88–1.46)	1.14 (0.89–1.48)	0.35

Note: ^a, Data were adjusted for obesity, central obesity, hyperglycemia and dyslipidemia; ^b, Data were adjusted for hypertension, central obesity, hyperglycemia and dyslipidemia; ^c, Data were adjusted for hypertension, obesity, hyperglycemia, and dyslipidemia; ^d, Data were adjusted for hypertension, obesity, central obesity, and dyslipidemia; ^e, Data were adjusted for hypertension, obesity, central obesity, and hyperglycemia.

Abbreviations: OR = odds ratio.

Figure 2. Receiver operating characteristic curves for the detection of MetS using various metabolic parameters.

Abbreviations: TyG index, triglyceride-glucose index; FBG, fasting blood glucose; TG, triglycerides; HDL, high-density lipoprotein; LDL, low-density lipoprotein; HOMA-IR, homeostasis model assessment of insulin resistance

Table 4. AUC, Cutoff points, sensitivities, specificities, positive and negative predictive values of various biomarkers for MetS.

Variables	AUC	Cutoff values	Youden Index	SE (95% CI)	SP (95% CI)	PPV (%)	NPV (%)
PCOS
TyG index	0.88	8.65	0.65	83.52 (77.20–88.70)	81.36 (77.50–84.80)	68.33	91.11
FBG (mmol/L)	0.68*	5.50	0.33	43.50 (36.10–51.10)	89.47 (86.30–92.10)	66.54	76.68
TG (mmol/L)	0.85	1.66	0.63	77.84 (71.00–83.70)	85.53 (82.00–88.60)	72.15	88.91
HDL (mmol/L)	0.83	1.28	0.55	89.20 (83.70–93.40)	66.23 (61.70–70.60)	55.98	92.72
LDL (mmol/L)	0.62*	3.18	0.20	44.89 (37.40–52.60)	74.78 (70.50–78.70)	46.15	73.81
HOMA-IR	0.78*	2.72	0.46	80.13 (72.90–86.20)	66.23 (61.20–71.00)	53.32	87.38
Non-PCOS
TyG index	0.57	8.94	0.11	22.93 (17.40–29.30)	88.10 (86.60–89.50)	16.33	91.86
FBG (mmol/L)	0.52	4.80	0.04	80.98 (74.90–86.10)	23.44 (21.60–25.40)	9.68	92.40
TG (mmol/L)	0.57	1.69	0.10	24.88 (19.10–31.40)	85.26 (83.60–86.80)	14.60	91.80
HDL (mmol/L)	0.56	1.23	0.11	41.46 (34.60–48.50)	69.65 (67.60–71.70)	12.16	92.15
LDL (mmol/L)	0.51	2.46	0.06	59.51 (52.50–66.30)	46.57 (44.30–48.80)	10.14	91.90
HOMA-IR	0.54	2.48	0.13	44.19 (33.50–55.30)	68.90 (65.70–72.00)	12.59	92.42

Note: * compared with the AUC of TyG index, p < 0.001.

Abbreviations: TyG index, triglyceride-glucose index; FBG, fasting blood glucose; TG, triglycerides; HDL, high-density lipoprotein; LDL, low-density lipoprotein; HOMA-IR, homeostasis model assessment of insulin resistance.

Data availability statement

Some or all datasets generated during and/or analyzed during current study are not publicly available but are available from the corresponding author on reasonable request