Associations of triglyceride-glucose index and derived indicators with prediabetes and diabetes among adolescents in the United States: a cross-sectional study.
Abstract
Background
The triglyceride-glucose (TyG) index is a surrogate marker of insulin resistance with potential utility for assessing metabolic risk. However, the associations between the TyG index and related indicators and prediabetes/diabetes in U.S. adolescents remain unknown.
Methods
This study included 5206 adolescents (aged 12-18 years) from the National Health and Nutrition Examination Survey (NHANES, 1999-2018). Prediabetes and diabetes were defined according to 2023 American Diabetes Association guidelines. Multivariable weighted logistic regression, restricted cubic spline (RCS) models, subgroup analyses, and receiver operating characteristic (ROC) curves were used to examine the associations and discriminatory performance of the TyG index and its obesity-related composite indicators with prediabetes or diabetes. Model 1 was unadjusted, Model 2 was adjusted for age, sex, and race/ethnicity, and Model 3 additionally included PIR, BMI, HDL, HbA1c, and fasting insulin.
Results
Both before and after adjustment for potential confounders, the TyG index (Model 3, odds ratio [OR] = 1.754 / 1.741) and its derived indicators TyG-ABSI (OR = 2.016 / 2), TyG-WWI (OR = 1.053 / 1.052), TyG-BMI (OR = 1.019 / 1.019), TyG-WC (OR = 1.006 / 1.006), and TyG-WHtR (OR = 2.59 / 2.566) were significantly and positively associated with prediabetes / prediabetes plus diabetes. These associations were generally consistent across subgroups and remained robust after excluding HbA1c and fasting insulin from the adjustment set and participants with FPG ≥7.0 mmol/L or HbA1c ≥6.5%. RCS analyses indicated that TyG, TyG-ABSI, and TyG-WWI were approximately linearly associated with prediabetes or diabetes, whereas TyG-BMI, TyG-WC, and TyG-WHtR showed nonlinear relationships. ROC analyses demonstrated comparable discriminatory performance across all indicators (≈ 0.77).
Conclusion
The TyG index and its derived indicators correlate positively with the prediabetes/diabetes in children. However, no superior diagnostic potential was observed for TyG obesity composite indicators compared to the standalone TyG index.