ArticleMedicine and pharmacy reports2026
Assessment of triglyceride glucose index and triglyceride to HDL cholesterol ratio as markers of insulin resistance defined by the Homeostatic Model Assessment 2 in Middle Eastern adults with excess adiposity.
Article in Medicine and pharmacy reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Insulin resistance (IR) drives early cardiometabolic risk in populations with high adiposity. Simple fasting markers, such as the triglyceride-glucose (TyG) index and the triglyceride-to-HDL cholesterol ratio (TG/HDL-C), may be helpful. Still, their performance against the updated, non-linear Homeostatic Model Assessment 2 (HOMA2) model in Middle Eastern adults remains unclear. Objectives: Compare TyG versus TG/HDL-C for HOMA2-defined IR; test modification by Body Mass Index (BMI) (overweight vs. obesity); and evaluate discrimination, calibration, and clinical utility. Methods: Cross-sectional study of 140 adults without diabetes with overweight/obesity. Fasting triglycerides, HDL-C, glucose, and insulin were assayed under quality control; HOMA2-IR, %S, and %B were derived. Multivariable linear models (per-SD predictors) adjusted for age, sex, and BMI; multiplicative interactions probed effect modification. Higher IR was defined as the sex-specific top quartile of HOMA2-IR. Discrimination (Area Under the Curve AUC; DeLong test), calibration (intercept, slope, Brier), decision-curve analysis (DCA), multiple imputation (20 datasets), and prespecified sensitivity checks were performed. Results: TyG independently tracked higher HOMA2-IR (β=0.127 per SD; 95% CI 0.033-0.220; p=0.0078), whereas TG/HDL-C was null. TyG×BMI interaction was significant (p=0.0011): negligible in overweight (β≈0.01; p=0.85) but strong in obesity (β=0.29; p<0.001). Discrimination was similar (AUC TyG 0.714 vs TG/HDL-C 0.707; ΔAUC=0.007; p=0.801). DCA showed a higher net benefit for TyG, especially TyG+BMI, across thresholds of 0.20-0.60. Calibration was acceptable; bootstrap-validated metrics and extensive sensitivity analyses were consistent. Conclusions: In adults without diabetes with excess adiposity, TyG captures HOMA2-defined IR more consistently than TG/HDL-C, with the greatest incremental value in obesity. As a low-cost fasting metric, TyG, particularly when combined with BMI, may refine triage for further evaluation; external validation in regional cohorts is warranted.
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