Association of metabolic score for insulin resistance with incident metabolic syndrome: a cohort study in middle-aged and elderly Chinese population

Qiuling Zhang ^1* Yushuang Wei ^2,3 Shengzhu Huang ³ Yemei Mo ^1* Boteng Yan ^3,4 Xihui Jin ^3,4 Mingjie Xu ^3,4 Xiaoyou Mai ^2,3* Chaoyan Tang ^1* Haiyun Lan ^1* Rongrong Liu ^1* Mingli Li ^3* Zengnan Mo ^3* Wenchao Xie ^1*

• ¹ The First People’s Hospital of Yulin, Yulin, Shaanxi Province, China
• ² School of Public Health, Guangxi Medical University, Nanning, Guangx, China
• ³ Guangxi Key Laboratory of Genomics and Personalized Medicine Research, Guangxi Medical University, Nanning, Guangxi Zhuang Region, China
• ⁴ Department of Nephrology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Region, China

Background: Recent studies suggest that the metabolic score for insulin resistance (MetS-IR) is an effective indicator of metabolic disorders. However, evidence on the relationship between MetS-IR and metabolic syndrome (MetS) among the Chinese middle-aged and elderly population is limited.Objective: This cohort study aims to assess the associations of MetS-IR levels with MetS risk and its components. Methods: Data used in this study from the National Basic Public Health Service Project Management System (2020-2023). Multivariable Cox proportional hazards model and restricted cubic spline (RCS) were employed to evaluate the associations of baseline MetS-IR levels with MetS risk and its components, receiver operating characteristic (ROC) curves were further utilized to assess the efficacy of MetS-IR in predicting the risk of MetS and its component. Results: Of 1498 subjects without MetS at baseline, 392 incident MetS cases were observed during a median of 27.70 months of follow-up. The adjusted multivariable Cox regression analysis indicated an elevated 15% risk of developing MetS for 1-SD increment of MetS-IR [hazard ratios (HRs) and 95% confidence intervals: 1.16 (1.13-1.18)]. Compared to the first tertile of MetS-IR,the HRs of the third tertile and second tertile were 6.31 (95% CI 4.55-8.76) and 2.72 (95% CI 1.92-3.85), respectively. Consistent findings were further detected across subgroups. Moreover, nonlinear associations were observed between MetS-IR and the risk of MetS, abdominal obesity, and reduced high-density lipoprotein concentration (HDL-C) (Pnonlinear < 0.01), with the cutoff of MetS-IR was 32.89. The area under the curve for MetS-IR in predicting MetS was 0.740 (95% CI 0.713-0.768), which was better than those of other indicators.Our cohort study indicates a positive nonlinear association between MetS-IR with incident MetS, abdominal obesity, and reduced HDL-C, but positive linear associations of MetS-IR and elevated blood pressure(BP), elevated fasting blood glucose(FBG), elevated triglycerides(TG) in middle-aged and elderly people, more studies are warranted to verify our findings.