Associations of the metabolic score for insulin resistance and uric acid with prevalent thyroid nodules: A cross-sectional study with systolic blood pressure mediation analysis and C-TIRADS category-specific analyses
- 1Nursing College, Shanxi Medical University, Taiyuan, China
- 2Health Management Center, The First Hospital of Shanxi Medical University, Taiyuan, China
Abstract
Objective: To investigate the associations of metabolic score for insulin resistance (METS-IR) and uric acid (UA) with the odds of prevalent thyroid nodules, including nonlinear associations across C-TIRADS categories; to explore SBP-related indirect associations; and to evaluate the joint association and statistical interaction of METS-IR and UA. Methods: Among 12,256 individuals initially screened at the Health Management Center of the First Hospital of Shanxi Medical University between January 2018 and December 2021, 5,232 participants were included in the final complete-case analysis. Data were retrieved from the hospital health examination database on January 25, 2026. METS-IR and UA were categorized into quartiles. Multivariable logistic regression, restricted cubic spline (RCS) regression, exploratory mediation analysis, joint classification analysis, and interaction analyses were performed. Results: Compared with the lowest quartile, the highest quartiles of METS-IR and UA were associated with higher odds of prevalent thyroid nodules in the fully adjusted models (METS-IR: OR=3.928, 95% CI: 3.120 to 4.946; UA: OR=3.627, 95% CI: 2.839 to 4.634; both P < 0.001). RCS analyses showed nonlinear associations of METS-IR and UA with C-TIRADS 2–3 and C-TIRADS 4 thyroid nodules (all P for overall association <0.001; all P for nonlinearity ≤0.049). Exploratory mediation analyses yielded outcome-dependent findings: in the overall analysis, the estimated proportions mediated through SBP were 6.62% for METS-IR and 1.44% for UA; no significant indirect associations were observed for C-TIRADS 2–3 nodules, whereas only the indirect association for METS-IR was significant for C-TIRADS 4 nodules. Participants with concurrently elevated METS-IR and UA had the highest adjusted odds of prevalent thyroid nodules (OR, 4.562; 95% CI, 3.753–5.544; P < 0.001); however, interaction analyses indicated a submultiplicative joint association and no evidence of positive additive interaction. Conclusion: METS-IR and UA were associated with higher odds of prevalent thyroid nodules, with nonlinear associations observed across the exposure distributions. Concurrent elevations in METS-IR and UA identified a subgroup with the highest observed odds of thyroid nodules, although interaction analyses did not support positive synergy. Exploratory mediation analyses provided limited and outcome-dependent evidence of SBP-related indirect associations. The cross-sectional design precludes conclusions regarding temporal ordering or causal mediation.
Related
- Evaluating associations of oxylipin metabolites and fatty acids with incident and prevalent type 2 diabetes in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
- Novel myo -inositol to butyrate fermentation pathway in the prevalent human gut species Dysosmobacter welbionis, a bacterium associated with improved metabolic and liver health
- Framing, Analysis, Interpretation and Two Supplemental Tests for Exploring Serial Mediation Theories with Cross-Sectional Data
- 628 Vascular-metabolic checkpoint derives immunotherapy resistance in solid tumor
- Effectiveness of health mediation to promote organised cancer screening among underserved and under-screened populations in Marseille, France: findings from a repeated cross-sectional survey.
BibTeX
@article{ding2026associations,
title = {{Associations of the metabolic score for insulin resistance and uric acid with prevalent thyroid nodules: A cross-sectional study with systolic blood pressure mediation analysis and C-TIRADS category-specific analyses}},
author = {Jiahui Ding and Xiaojin Hu and Meiling Sun and Shanshan Ge},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358879},
url = {https://doi.org/10.1371/journal.pone.0358879},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Associations of the metabolic score for insulin resistance and uric acid with prevalent thyroid nodules: A cross-sectional study with systolic blood pressure mediation analysis and C-TIRADS category-specific analyses
AU - Jiahui Ding
AU - Xiaojin Hu
AU - Meiling Sun
AU - Shanshan Ge
PY - 2026
DA - 2026/09/21
JO - PLOS One
DO - 10.1371/journal.pone.0358879
UR - https://doi.org/10.1371/journal.pone.0358879
AB - Objective: To investigate the associations of metabolic score for insulin resistance (METS-IR) and uric acid (UA) with the odds of prevalent thyroid nodules, including nonlinear associations across C-TIRADS categories; to explore SBP-related indirect associations; and to evaluate the joint association and statistical interaction of METS-IR and UA. Methods: Among 12,256 individuals initially screened at the Health Management Center of the First Hospital of Shanxi Medical University between January 2018 and December 2021, 5,232 participants were included in the final complete-case analysis. Data were retrieved from the hospital health examination database on January 25, 2026. METS-IR and UA were categorized into quartiles. Multivariable logistic regression, restricted cubic spline (RCS) regression, exploratory mediation analysis, joint classification analysis, and interaction analyses were performed. Results: Compared with the lowest quartile, the highest quartiles of METS-IR and UA were associated with higher odds of prevalent thyroid nodules in the fully adjusted models (METS-IR: OR=3.928, 95% CI: 3.120 to 4.946; UA: OR=3.627, 95% CI: 2.839 to 4.634; both P < 0.001). RCS analyses showed nonlinear associations of METS-IR and UA with C-TIRADS 2–3 and C-TIRADS 4 thyroid nodules (all P for overall association <0.001; all P for nonlinearity ≤0.049). Exploratory mediation analyses yielded outcome-dependent findings: in the overall analysis, the estimated proportions mediated through SBP were 6.62% for METS-IR and 1.44% for UA; no significant indirect associations were observed for C-TIRADS 2–3 nodules, whereas only the indirect association for METS-IR was significant for C-TIRADS 4 nodules. Participants with concurrently elevated METS-IR and UA had the highest adjusted odds of prevalent thyroid nodules (OR, 4.562; 95% CI, 3.753–5.544; P < 0.001); however, interaction analyses indicated a submultiplicative joint association and no evidence of positive additive interaction. Conclusion: METS-IR and UA were associated with higher odds of prevalent thyroid nodules, with nonlinear associations observed across the exposure distributions. Concurrent elevations in METS-IR and UA identified a subgroup with the highest observed odds of thyroid nodules, although interaction analyses did not support positive synergy. Exploratory mediation analyses provided limited and outcome-dependent evidence of SBP-related indirect associations. The cross-sectional design precludes conclusions regarding temporal ordering or causal mediation.
SN - 1932-6203
ER -