Estimation of fatty liver disease clinical role on glucose metabolic remodelling phenotypes and T2DM onset.

INTRODUCTION: Metabolic syndrome (MetS), prediabetes (PreDM) and Fatty Liver Disease (FLD) share pathophysiological pathways concerning type 2 diabetes mellitus (T2DM) onset. The non-invasive assessment of fatty liver combined with PreDM and MetS features screening might provide further accuracy in predicting hyperglycemic status in the clinical setting with the putative description of singular phenotypes. The objective of the study is to evaluate and describe the links of a widely available FLD surrogate -the non-invasive serological biomarker Hepatic Steatosis Index (HSI)- with previously described T2DM risk predictors, such as preDM and MetS in forecasting T2DM onset. PATIENTS AND METHODS: A retrospective ancillary cohort study was performed on 2799 patients recruited in the Vascular-Metabolic CUN cohort. The main outcome was the incidence of T2DM according to ADA criteria. MetS and PreDM were defined according to ATP III and ADA criteria, respectively. Hepatic steatosis index (HSI) with standardized thresholds was used to discriminate patients with FLD, which was referred as estimated FLD (eFLD). RESULTS: MetS and PreDM were more common in patients with eFLD as compared to those with an HSI < 36 points (35% vs 8% and 34% vs. 18%, respectively). Interestingly, eFLD showed clinical effect modification with MetS and PreDM in the prediction of T2DM [eFLD-MetS interaction HR = 4.48 (3.37-5.97) and eFLD-PreDM interaction HR = 6.34 (4.67-8.62)]. These findings supported the description of 5 different liver status-linked phenotypes with increasing risk of T2DM: Control group (1,5% of T2DM incidence), eFLD patients (4,4% of T2DM incidence), eFLD and MetS patients (10,6% of T2DM incidence), PreDM patients (11,1% of T2DM incidence) and eFLD and PreDM patients (28,2% of T2DM incidence). These phenotypes provided independent capacity of prediction of T2DM incidence after adjustment for age, sex, tobacco and alcohol consumption, obesity and number of SMet features with a c-Harrell=0.84. CONCLUSION: Estimated Fatty Liver Disease using HSI criteria (eFLD) interplay with MetS features and PreDM might help to discriminate patient risk of T2DM in the clinical setting through the description of independent metabolic risk phenotypes. [Correction added on 15 June 2023, after first online publication: The abstract section was updated in this current version.].

Interactive Role of Surrogate Liver Fibrosis Assessment and Insulin Resistance on the Incidence of Major Cardiovascular Events.

Introduction: The combination of easy-to-obtain validated biomarkers is interesting in the prognostic evaluation of patients at cardiovascular risk in a precision medicine scenario. The evaluation of the effect modification of insulin resistance and liver fibrosis with the Triglyceride-Glucose index (TyG) and Fibrosis-4 index (FIB4) might provide prognostic information in patients at cardiovascular risk. Patients and methods: A retrospective cohort study was performed with 2055 patients recruited in the Vascular Metabolic CUN cohort. The studied outcome was the incidence rate of major cardiovascular events (MACE). The Systematic Coronary Risk Evaluation (SCORE), FIB4 and TyG indexes were calculated according to validated formulas. Results: FIB4 and TyG showed a synergistic interaction using validated cut-offs for both indexes in the prediction of MACE (Hazard ratio (HR) 1.05 CI95% 1.01-1.08) which remained after adjustment by age, sex, SCORE subgroup, presence of diabetes, or previous MACE using standardized cut-off (HR 2.29 CI95% 1.33-3.94). Finally, a subgroup with significant TyG and FIB4 showed a higher cardiovascular risk in the study population (adjusted HR 3.34 CI 95% 1.94-5.77). Conclusion: The combined interpretation of TyG and FIB4 indexes might have a potential predictive value of major cardiovascular events.

A Multidimensional Item Response Theory Model for Continuous and Graded Responses With Error in Persons and Items.

Item response theory "dual" models (DMs) in which both items and individuals are viewed as sources of differential measurement error so far have been proposed only for unidimensional measures. This article proposes two multidimensional extensions of existing DMs: the M-DTCRM (dual Thurstonian continuous response model), intended for (approximately) continuous responses, and the M-DTGRM (dual Thurstonian graded response model), intended for ordered-categorical responses (including binary). A rationale for the extension to the multiple-content-dimensions case, which is based on the concept of the multidimensional location index, is first proposed and discussed. Then, the models are described using both the factor-analytic and the item response theory parameterizations. Procedures for (a) calibrating the items, (b) scoring individuals, (c) assessing model appropriateness, and (d) assessing measurement precision are finally discussed. The simulation results suggest that the proposal is quite feasible, and an illustrative example based on personality data is also provided. The proposals are submitted to be of particular interest for the case of multidimensional questionnaires in which the number of items per scale would not be enough for arriving at stable estimates if the existing unidimensional DMs were fitted on a separate-scale basis.

Reliability and External Validity of Personality Test Scores: The Role of Person and Item Error.

BACKGROUND: This article explores the suitability of a proposed "Dual" model, in which both people and items are sources of measurement error, by assessing how the test scores are expected to behave in terms of marginal reliability and external validity when the model holds. METHOD: Analytical derivations are produced for predicting: (a) the impact of person and item errors in the amount of marginal reliability and external validity, as well as the occurrence of "ceiling" effects; (b) the changes in test reliability across groups with different average amounts of person error, and (c) the phenomenon of differential predictability. Two empirical studies are also used both as an illustration and as a check of the predicted results. RESULTS: Results show that the model-based predictions agree with existing evidence as well as with basic principles in classical test theory. However, the additional inclusion of individuals as a source of error leads to new explanations and predictions. CONCLUSIONS: The proposal and results provide new sources of information in personality assessment as well as of evidence of model suitability. They also help to explain some disappointing recurrent results.

Reliability and External Validity of Personality Test Scores: The Role of Person and Item Error / Fiabilidad y Validez Externa de las Puntuaciones en los Tests de Personalidad: El Papel del Error en las Personas y en los Ítems

Background: This article explores the suitability of a proposed “Dual” model, in which both people and items are sources of measurement error, by assessing how the test scores are expected to behave in terms of marginal reliability and external validity when the model holds. Method: Analytical derivations are produced for predicting: (a) the impact of person and item errors in the amount of marginal reliability and external validity, as well as the occurrence of “ceiling” effects; (b) the changes in test reliability across groups with different average amounts of person error, and (c) the phenomenon of differential predictability. Two empirical studies are also used both as an illustration and as a check of the predicted results. Results: Results show that the model-based predictions agree with existing evidence as well as with basic principles in classical test theory. However, the additional inclusion of individuals as a source of error leads to new explanations and predictions. Conclusions: The proposal and results provide new sources of information in personality assessment as well as of evidence of model suitability. They also help to explain some disappointing recurrent results. (AU)

Antecedentes: se explora la adecuación de un modelo “Dual” en el que ítems y personas son fuente de error de medida, evaluando como se espera que se comporten las puntuaciones en un test en términos de fiabilidad y validez cuando el modelo se cumple. Método: se derivan analíticamente predicciones respecto a: (a) el impacto del error en personas y en ítems en las estimaciones de fiabilidad y validez externa, así como en efectos techo esperados, (b) cambios en la fiabilidad marginal en grupos con diferente magnitud media de error individual, y (c) el fenómeno de la predictibilidad diferencial. Se incluyen dos estudios empíricos a efectos de ilustración y verificación empírica. Resultados: las predicciones concuerdan con la evidencia acumulada y con los principios de la teoría clásica del test. Sin embargo, la inclusión del parámetro de error individual permite llegar a nuevas explicaciones y predicciones. Conclusiones: la propuesta y resultados proporcionan nuevas fuentes de información en la medida de la personalidad, así como evidencia de la adecuación del modelo. También explican algunos resultados decepcionantes y recurrentes. (AU)

InDisc: An R Package for Assessing Person and Item Discrimination in Typical-Response Measures.

InDisc is an R Package that implements procedures for estimating and fitting unidimensional Item Response Theory (IRT) Dual Models (DMs). DMs are intended for personality and attitude measures and are, essentially, extended standard IRT models with an extra person parameter that models the discriminating power of the individual. The package consists of a main function, which calls subfunctions for fitting binary, graded, and continuous responses. The program, a detailed user's guide, and an empirical example are available at no cost to the interested practitioner.

To reverse or to not reverse likert-type items: that is the question / Invertir o no invertir ítems tipo Likert: esa es la cuestión

BACKGROUND: The suitability of using reversed items in typical response measures has been a matter of controversy for many years. While some authors recommend their use, others reject them due to their undesirable effects on tests' psychometric properties. The present research intends to analyse a third alternative based on the use of reversed items plus a procedure to control response bias effects. METHOD: We analysed two forms of the same test, one with direct and reversed items and another composed only of direct items, and compared them both before and after applying a procedure to control response biases. RESULTS: The factorial structure and factorial reliability of both versions was almost equivalent after controlling response biases. When no effect biases were controlled, the version with both types of items exhibited less acceptable psychometric properties. CONCLUSIONS: The use of reversed items is not advisable without the application of a procedure to control response bias effects. When such effects are mitigated, the results are equivalent to those obtained with only direct items, but with the added value of controlling for acquiescence effects

ANTECEDENTES: la utilización de ítems invertidos en medidas de respuesta típica ha sido durante mucho tiempo una cuestión controvertida. Mientras algunos autores aconsejan su utilización, otros la rechazan debido a sus efectos indeseables en las propiedades psicométricas de las medidas. El presente estudio pretende analizar una tercera vía, basada en el uso de ítems invertidos juntamente con un método para eliminar los efectos de los sesgos de respuesta. MÉTODO: se analizaron dos versiones de una misma prueba, una incorporando ítems directos e invertidos y otra compuesta únicamente de ítems directos. Posteriormente se compararon ambas versiones antes y después de controlar los efectos de los sesgos de respuesta. RESULTADOS: la estructura factorial y la fiabilidad de las puntuaciones factoriales de ambas versiones tras eliminar los efectos de los sesgos de respuesta fue equivalente, mientras que la versión con ambos tipos de ítems sin control de sesgos mostró peores propiedades psicométricas. CONCLUSIONES: la utilización de ítems revertidos sin la aplicación de un método de control de sesgos está claramente desaconsejada. Cuando dichos métodos se utilizan los resultados de ambas versiones son equivalentes con el añadido que en la versión con ítems revertidos se controlan los efectos de aquiescencia

To reverse or to not reverse Likert-type items: That is the question.

BACKGROUND: The suitability of using reversed items in typical response measures has been a matter of controversy for many years. While some authors recommend their use, others reject them due to their undesirable effects on tests' psychometric properties. The present research intends to analyse a third alternative based on the use of reversed items plus a procedure to control response bias effects. METHOD: We analysed two forms of the same test, one with direct and reversed items and another composed only of direct items, and compared them both before and after applying a procedure to control response biases. RESULTS: The factorial structure and factorial reliability of both versions was almost equivalent after controlling response biases. When no effect biases were controlled, the version with both types of items exhibited less acceptable psychometric properties. CONCLUSIONS: The use of reversed items is not advisable without the application of a procedure to control response bias effects. When such effects are mitigated, the results are equivalent to those obtained with only direct items, but with the added value of controlling for acquiescence effects.

Multidimensional or essentially unidimensional? a multi-faceted factor-analytic approach for assessing the dimensionality of tests and items / ¿Multidimensional o esencialmente unidimensional? Una propuesta multifacética basada en el análisis factorial para evaluar la dimensionalidad de ítems y tests

BACKGROUND: Factor-analysis based dimensional assessment of psychometric measures is a key step in the development of tests. However, current practices for deciding between a multiple-correlated or essentially unidimensional solution are clearly improvable. METHOD: A series of recent studies are reviewed, and an approach is proposed that combines multiple sources of information, which is expected to be used to make an informed judgement about the most appropriate dimensionality for the measure being studied. It uses both internal and external sources of information, and focuses on the properties of the scores derived from each of the solutions compared. RESULTS: The proposal is applied to a re-analysis of a measure of symptoms of psychological distress. The results show that a clear and informed judgement about the most appropriate dimensionality of the measure in the target population can be obtained. Discussion: The proposal is useful and can be put into practice by using user-friendly, non-commercial software. We hope that this availability will result in good practice in the future

ANTECEDENTES: la evaluación de la dimensionalidad de las medidas psicométricas mediante análisis factorial es un aspecto básico en la construcción y desarrollo de tests. Sin embargo, las prácticas utilizadas habitualmente para decidir entre soluciones múltiples o esencialmente unidimensionales son bastante mejorables. Método: se revisan una serie de trabajos recientes y se propone una aproximación basada en múltiples fuentes de información, que permite tomar decisiones informadas acerca de la dimensionalidad más apropiada para la medida que se evalúa. La propuesta utiliza tanto fuentes internas como externas y se basa sobre todo en las propiedades de las puntuaciones que se derivan de cada una de las soluciones a comparar. RESULTADOS: la propuesta se aplica como ejemplo ilustrativo en un re-análisis de una medida de síntomas referidos al malestar psicológico. Los resultados muestran que es posible tomar una decisión clara acerca de la dimensionalidad más apropiada de la medida en la población de referencia. CONCLUSIÓN: la propuesta se considera útil y además puede llevarse a cabo mediante el uso de programas no comerciales. Se espera que esta disponibilidad pueda llevar al uso de mejores prácticas en el futuro

Multidimensional or essentially unidimensional? A multi-faceted factor-analytic approach for assessing the dimensionality of tests and items.

BACKGROUND: Factor-analysis based dimensional assessment of psychometric measures is a key step in the development of tests. However, current practices for deciding between a multiple-correlated or essentially unidimensional solution are clearly improvable. METHOD: A series of recent studies are reviewed, and an approach is proposed that combines multiple sources of information, which is expected to be used to make an informed judgement about the most appropriate dimensionality for the measure being studied. It uses both internal and external sources of information, and focuses on the properties of the scores derived from each of the solutions compared. RESULTS: The proposal is applied to a re-analysis of a measure of symptoms of psychological distress. The results show that a clear and informed judgement about the most appropriate dimensionality of the measure in the target population can be obtained. DISCUSSION: The proposal is useful and can be put into practice by using user-friendly, non-commercial software. We hope that this availability will result in good practice in the future.

Risk of incident ischemic stroke according to the metabolic health and obesity states in the Vascular-Metabolic CUN cohort.

Background Whether obesity is a major risk factor for cardiovascular disease in the absence of metabolic comorbidities remains under debate. Indeed, some obese individuals may be at low risk of metabolic-related complications, while normal-weight individuals may not be "healthy." Aims To assess the incidence of ischemic stroke according to the metabolic health and obesity states of 5171 participants from the Vascular-Metabolic CUN cohort. Methods A Cox proportional-hazard analysis was conducted to estimate the hazard ratio and their 95% confidence interval of stroke according to the metabolic health and obesity states based on TyG index and Adult Treatment Panel-III criteria, during 9.1 years of follow-up. Results After 50,056.2 person-years of follow-up, 162 subjects developed an ischemic stroke (incidence rate 3.23 per 1000 person-years). Metabolically healthy obese subjects did not show greater risk of stroke, while metabolically unhealthy participants, obese and non-obese, had an increased risk of stroke, compared with healthy non-obese. The hazard ratios for the multivariable adjusted model were 1.55 (95% CI: 1.36-1.77) and 1.86 (95% CI: 1.57-2.21), respectively. Conclusions Metabolically unhealthy individuals exhibited a greater risk of ischemic stroke than metabolically healthy obese individuals.

The Psychometric Toolbox: an Excel package for use in measurement and psychometrics courses / Psychometric Toolbox: un paquete Excel diseñado para cursos en medida y psicometría

The Psychometric Toolbox (PT) is a user-friendly, non-commercial package mainly intended to be used for instructional purposes in introductory courses of educational and psychological measurement, psychometrics and statistics. The PT package is organized in six separate modules or sub-programs: Data preprocessor (descriptive analyses and data transformations); Guttman scaling (item analysis and individual scoring based on Guttman's model); Classical Item Analysis (CTT-based item analysis and reliability estimation); Item Factor Analysis (FA-Based Item Analysis and omega reliability estimation); Scoring and Norming (linear and nonlinear score transformations and normative tables); and Item Response Theory-Basic analysis (item calibration and test scoring based on the one and two parameter logistic models). Because they have been designed for instructional use, these modules are intended to (a) be very easy to use, (b) provide clear and well explained results, and (c) make use of graphical displays whenever possible (AU)

El «Psychometric Toolbox» (PT) es un paquete no comercial de fácil utilización, diseñado principalmente para ser utilizado con fines educativos en cursos introductorios de medición educativa y psicológica, psicometría y estadística. El paquete PT está organizado en seis módulos o subprogramas separados: Data preprocessor (análisis descriptivos y transformaciones de datos); Guttman scaling (análisis de ítems y puntuación individual basada en el modelo de Guttman); Classical Item Analysis (análisis de ítems basados en la TCT y estimación de la fiabilidad); Item Factor Analysis (Análisis factorial de ítems y estimación del coeficiente de fiabilidad omega); Scoring and Norming (transformaciones lineales y no lineales y elaboración de tablas normativas); y Item Response Theory-Basic analysis (calibración de ítems y puntaciones basadas en los modelos logísticos de uno y dos parámetros). Debido a que han sido diseñados para uso educativo, estos módulos han sido desarrollados para (a) ser muy fáciles de usar, (b) proporcionar resultados claros y bien explicados, y (c) hacer uso de presentaciones gráficas siempre que sea posible (AU)

Planteamiento diagnóstico y terapéutico de los paragangliomas cervicales en geriatría / Diagnostic and therapeutic approach to cervical paragangliomas in geriatrics

No disponible

Are all metabolically healthy individuals with obesity at the same risk of diabetes onset?

OBJECTIVE: To examine the risk of diabetes and the development of an unhealthy status according to metabolic health. To assess the effect of changes in metabolic health among participants with metabolically healthy obesity (MHO) on the risk of diabetes. METHODS: A total of 4,340 subjects were included. Unhealthy metabolic status was defined as having three or more risk factors of the Adult Treatment Panel-III criteria. A Cox proportional-hazard analysis was conducted to estimate the hazard ratio (HR) of developing diabetes across the change in the metabolic status of subjects with MHO. RESULTS: After 40,622 person-years of follow-up, the risk of becoming unhealthy was 1.53 times higher for participants with MHO, compared with lean or overweight healthy subjects. A greater risk of diabetes was found in MHO, but it was attributable to those who progressed to an unhealthier status over time: HR of 4.78 (95% CI: 3.38-6.78). The combination of being metabolically unhealthy and obesity heightened the risk of diabetes: HR of 10.09 (95% CI: 4.82-21.55). CONCLUSIONS: The increased risk of diabetes in MHO is attributed to the progression to an unhealthier state. "Healthy obesity" is not a permanent situation but a transitory state.

How response bias affects the factorial structure of personality self-reports / Efectos de los sesgos de respuesta en la estructura factorial de los autoinformes de personalidad

BACKGROUND: Various studies have shown that acquiescence can distort the factor structure of personality questionnaires based on the five-factor model. In the present study, we analysed how acquiescence and social desirability affect the factor structure of a measure based on this personality model and a measure of aggression. METHOD: We analysed the factor structures of both tests before and after removing both biases in a sample of 532 adolescents aged between 11 and 18 (M= 14.75, SD= 2.1). RESULTS: The factor structure of both tests presented a worse fit to the expected model when response bias was not controlled, and the congruence indexes for the personality and aggression measures showed a moderate (from C= .948 to C= .872) or great (from C= .931 to C= .475) decrease, respectively. Furthermore, acquiescence was largely responsible for these effects, and social desirability effects were only shown on the aggression measure. CONCLUSIONS: Response bias, and especially acquiescence, should be controlled during the development of personality measures to avoid distorting them, especially with samples of people with a high level of acquiescence (for example, those with little education, the young or the elderly). Furthermore, the use of response bias loadings as a criterion for choosing the items minimizes those distortions

ANTECEDENTES: diversos estudios han mostrado que la aquiescencia genera distorsiones en la estructura factorial de los cuestionarios de personalidad. En este estudio analizamos los efectos tanto de la aquiescencia como de la deseabilidad social en la estructura factorial de dos cuestionarios. MÉTODO: se analizó la estructura factorial de ambos con y sin sesgos de respuesta en una muestra de 532 adolescentes con edades entre los 11 y los 18 años (M= 14.75 SD= 2.1). RESULTADOS: cuando no se eliminó el efecto de los sesgos de respuesta, el ajuste de ambos tests en relación al modelo esperado empeoró, disminuyendo la congruencia factorial moderadamente (desde C= .948 hasta C= .872) o notablemente (desde C= .931 a C= .475) para las medidas de personalidad y agresividad, respectivamente. Además, la aquiescencia fue la principal responsable de estos efectos, mientras que la deseabilidad social tan solo afectó la medida de agresividad. CONCLUSIONES: es necesario controlar los sesgos de respuesta para evitar estructuras factoriales distorsionadas, especialmente en muestras con elevados niveles de aquiescencia, como poblaciones con bajo nivel educativo, adolescentes o en la tercera edad. Además, la minimización de los sesgos de respuesta durante el proceso de elección de ítems parece reducir dichas distorsiones

How response bias affects the factorial structure of personality self-reports.

BACKGROUND: Various studies have shown that acquiescence can distort the factor structure of personality questionnaires based on the five-factor model.  In the present study, we analysed how acquiescence and social desirability affect the factor structure of a measure based on this personality model and a measure of aggression. METHOD: We analysed the factor structures of both tests before and after removing both biases in a sample of 532 adolescents aged between 11 and 18 (M= 14.75, SD= 2.1). RESULTS: The factor structure of both tests presented a worse fit to the expected model when response bias was not controlled, and the congruence indexes for the personality and aggression measures showed a moderate (from C= .948 to C= .872) or great (from C= .931 to C= .475) decrease, respectively. Furthermore, acquiescence was largely responsible for these effects, and social desirability effects were only shown on the aggression measure. CONCLUSIONS:   Response bias, and especially acquiescence, should be controlled during the development of personality measures to avoid distorting them, especially with samples of people with a high level of acquiescence (for example, those with little education, the young or the elderly). Furthermore, the use of response bias loadings as a criterion for choosing the items minimizes those distortions.

Association of triglycerides and new lipid markers with the incidence of hypertension in a Spanish cohort.

OBJECTIVE: Triglycerides and high-density lipoprotein cholesterol (HDL-C) are known to be risk factors for cardiovascular disease. However, there has been limited knowledge on the relationship between triglycerides and incident hypertension. The associations of incident hypertension with triglycerides and triglycerides-related indices such as triglycerides to HDL-C ratio (TG/HDL-C) and triglyceride-glucose index (TyG) were evaluated. METHODS: Data from 3637 participants from the Vascular Metabolic Clinica Universidad Navarra cohort were followed-up during a mean of 8.49 years. A Cox proportional hazard ratio with repeated measures analyses was performed to assess the risk of developing hypertension across the quintiles of triglycerides, TG/HDL-C ratio, and TyG index. RESULTS: The risk of developing hypertension was 47% and 73% greater for those in the fourth and fifth quintiles of triglycerides, after adjusting for age, sex, BMI, cigarette smoking, daily alcohol intake, lifestyle pattern, type 2 diabetes, antiaggregation therapy, low-density lipoprotein cholesterol, SBP, and DBP. In men, those in the top quintile of triglycerides, TG/HDL-C ratio or TyG index were two times more likely to develop hypertension than those in the bottom quintile. In women, the effect was attenuated although the risk of hypertension rose with increasing quintiles (P for trend <0.05). The results were consistent when analyses were restricted to those participants without diabetes and obesity at baseline. CONCLUSIONS: Our results evidenced the associations between triglycerides-related variables and incident hypertension independently of adiposity. This association was stronger than those observed for other commonly used lipid parameters or lipid ratios, such as the TC/HDL-C ratio. VIDEO ABSTRACT: : http://links.lww.com/HJH/A620.

TyG Index Change Is More Determinant for Forecasting Type 2 Diabetes Onset Than Weight Gain.

The risk of type 2 diabetes associated with obesity appears to be influenced by other metabolic abnormalities, and there is controversy about the harmless condition of the metabolically healthy obese (MHO) state. The aim of this study is to assess the risk of diabetes and the impact of changes in weight and in triglyceride-glucose index (TyG index), according to the metabolic health and obesity states.We analyzed prospective data of the Vascular Metabolic CUN cohort, a population-based study among a White European population (mean follow-up, 8.9 years). Incident diabetes was assessed in 1923 women and 3016 men with a mean age at baseline of 55.33 ±â€Š13.68 and 53.78 ±â€Š12.98 years old.A Cox proportional-hazard analysis was conducted to estimate the hazard ratio (HR) of diabetes on metabolically healthy nonobese (MHNO), metabolically healthy obese, metabolically unhealthy nonobese (MUNO), and metabolically unhealthy obese (MUO). A continuous standardized variable (z-score) was derived to compute the HR for diabetes per 1-SD increment in the body mass index (BMI) and the TyG index.MHO, MUNO, and MUO status were associated with the development of diabetes, HR of 2.26 (95% CI: 1.25-4.07), 3.04 (95% CI: 1.69-5.47), and 4.04 (95% CI: 2.14-7.63), respectively. MUNO individuals had 1.82 greater risk of diabetes compared to MHO subjects (95% CI: 1.04-3.22). The HRs for incident diabetes per 1-SD increment in BMI and TyG indexes were 1.23 (95% CI: 1.04-1.44) and 1.54 (95% CI: 1.40-1.68). The increase in BMI did not raise the risk of developing diabetes among metabolically unhealthy subjects, whereas increasing the TyG index significantly affect the risk in all metabolic health categories.Metabolic health is more important determinant for diabetes onset than weight gain. The increase in weight does not raise the risk of developing diabetes among metabolically unhealthy subjects.

Triglyceride-glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The Vascular-Metabolic CUN cohort.

AIMS: We evaluated the potential role of the triglyceride-glucose index (TyG index) as a predictor of diabetes in a White European cohort, and compared it to fasting plasma glucose (FPG) and triglycerides. METHODS: 4820 patients of the Vascular-Metabolic CUN cohort (VMCUN cohort) were examined and followed up for 8.84years (±4.39). We performed a Cox proportional hazard ratio with repeated-measures analyses to assess the risk of developing type 2 diabetes across quartiles of FPG, triglycerides and the TyG index (ln[fasting triglycerides (mg/dl)×fasting plasma glucose (mg/dl)/2]), and plotted a receiver operating characteristics (ROC) curve for discrimination. RESULTS: There were 332 incident cases of type 2 diabetes involving 43,197.32person-years of follow-up. We observed a progressively increased risk of diabetes in subjects with TyG index levels of 8.31 or more. Among those with normal fasting glucose at baseline, <100mg/dl, subjects with the TyG index in the fourth quartile were 6.87 times more likely to develop diabetes (95% CI, 2.76-16.85; P for trend<0.001), as compared with the bottom quartile. The areas under the ROC curves (95% CI) were 0.75 (0.70-0.81) for TyG index, 0.66 (0.60-0.72) for FPG and 0.71 (0.65-0.77) for TG, in subjects with normal fasting glucose (p=0.017). CONCLUSIONS: Our data suggest that the TyG index is useful for the early identification of individuals at risk of type 2 diabetes. The TyG index seems to be a better predictor than FPG or triglycerides of the potential development of type 2 diabetes in normoglycemic patients.