Stage-specific associations of nutrition-related surrogate insulin resistance indices across the chronic kidney disease continuum: evidence from a Chinese cohort
- 1Health Management Center, The Second Affiliated Hospital of Dalian Medical University , , ,
Abstract
Introduction: Comparative longitudinal evidence on how different surrogate insulin resistance (IR) indices relate to chronic kidney disease (CKD) onset and subsequent renal deterioration remains limited. This study aimed to evaluate the associations of surrogate IR indices with CKD incidence, progression, and outcomes.
Methods: This retrospective cohort study included participants from the Dalian Health Management Cohort, in which 12 surrogate IR indices were calculated. The primary outcome was incident CKD, while secondary outcomes included rapid kidney function decline (RKFD) and adverse renal outcomes. Kaplan–Meier analysis compared the CKD incidence across quartiles. Associations between surrogate IR indices and renal outcomes were evaluated using Cox proportional hazards and logistic regression models. Dose–response relationships were assessed using restricted cubic splines, and predictive performance was evaluated using time-dependent receiver operating characteristic curves and associated metrics.
Results: Among 48,304 participants, 1,092 incident CKD cases (2.26%) were identified over a median follow-up of 4.74 years. Kaplan–Meier curves showed increasing CKD risk across the IR quartiles. Quartile-based analyses showed progressively higher incident CKD risk with increasing levels of the evaluated surrogate IR indices (all P for trend < 0.001). The triglyceride–glucose index combined with waist circumference (TyG-WC) showed a relatively strong association with incident CKD (Q4 vs. Q1: HR 2.48, 95% CI 1.89–3.26) and exhibited a nonlinear association with an inflection point at 811.58, below which the risk increased more steeply and above which the association tended to plateau. The cholesterol–high-density lipoprotein–glucose index was associated with RKFD (OR per 1-SD increase, 1.56, 95% CI 1.23–1.96), whereas the TyG combined with body mass index was associated with adverse renal outcomes (HR per 1-SD increase, 2.55, 95% CI 1.38–4.71). In predictive analyses, TyG-WC showed the highest discrimination at 1 year (AUC 0.817, 95% CI 0.776–0.851).
Conclusion: Surrogate IR indices were higher in groups with poorer renal outcomes. Indices emphasizing visceral adiposity-related components showed relatively stronger associations with incident CKD, whereas indices incorporating glucose–lipid metabolic and overall adiposity components showed relatively stronger associations with later renal deterioration. TyG-WC may serve as a simple marker for early risk identification and stratification.
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BibTeX
@article{fang2026stagespecific,
title = {{Stage-specific associations of nutrition-related surrogate insulin resistance indices across the chronic kidney disease continuum: evidence from a Chinese cohort}},
author = {Shusheng Fang and Yan Li and Yangxuan He and Jingshan Jiang and Yilin Zhu and Hong Chen and Song Leng},
journal = {Frontiers in nutrition},
year = {2026},
month = oct,
doi = {10.3389/fnut.2026.1943087},
url = {https://europepmc.org/article/PMC/PMC13724407},
note = {CC BY},
}
RIS
TY - JOUR
TI - Stage-specific associations of nutrition-related surrogate insulin resistance indices across the chronic kidney disease continuum: evidence from a Chinese cohort
AU - Shusheng Fang
AU - Yan Li
AU - Yangxuan He
AU - Jingshan Jiang
AU - Yilin Zhu
AU - Hong Chen
AU - Song Leng
PY - 2026
DA - 2026/10/19
JO - Frontiers in nutrition
DO - 10.3389/fnut.2026.1943087
UR - https://europepmc.org/article/PMC/PMC13724407
AB - Introduction: Comparative longitudinal evidence on how different surrogate insulin resistance (IR) indices relate to chronic kidney disease (CKD) onset and subsequent renal deterioration remains limited. This study aimed to evaluate the associations of surrogate IR indices with CKD incidence, progression, and outcomes. Methods: This retrospective cohort study included participants from the Dalian Health Management Cohort, in which 12 surrogate IR indices were calculated. The primary outcome was incident CKD, while secondary outcomes included rapid kidney function decline (RKFD) and adverse renal outcomes. Kaplan–Meier analysis compared the CKD incidence across quartiles. Associations between surrogate IR indices and renal outcomes were evaluated using Cox proportional hazards and logistic regression models. Dose–response relationships were assessed using restricted cubic splines, and predictive performance was evaluated using time-dependent receiver operating characteristic curves and associated metrics. Results: Among 48,304 participants, 1,092 incident CKD cases (2.26%) were identified over a median follow-up of 4.74 years. Kaplan–Meier curves showed increasing CKD risk across the IR quartiles. Quartile-based analyses showed progressively higher incident CKD risk with increasing levels of the evaluated surrogate IR indices (all P for trend < 0.001). The triglyceride–glucose index combined with waist circumference (TyG-WC) showed a relatively strong association with incident CKD (Q4 vs. Q1: HR 2.48, 95% CI 1.89–3.26) and exhibited a nonlinear association with an inflection point at 811.58, below which the risk increased more steeply and above which the association tended to plateau. The cholesterol–high-density lipoprotein–glucose index was associated with RKFD (OR per 1-SD increase, 1.56, 95% CI 1.23–1.96), whereas the TyG combined with body mass index was associated with adverse renal outcomes (HR per 1-SD increase, 2.55, 95% CI 1.38–4.71). In predictive analyses, TyG-WC showed the highest discrimination at 1 year (AUC 0.817, 95% CI 0.776–0.851). Conclusion: Surrogate IR indices were higher in groups with poorer renal outcomes. Indices emphasizing visceral adiposity-related components showed relatively stronger associations with incident CKD, whereas indices incorporating glucose–lipid metabolic and overall adiposity components showed relatively stronger associations with later renal deterioration. TyG-WC may serve as a simple marker for early risk identification and stratification.
SN - 2296-861X
ER -