Elevated TyG index a red flag for adverse metabolic trajectories, pregnancy outcomes in PCOS

Among patients with polycystic ovary syndrome (PCOS), a high triglyceride-glucose (TyG) index appears to be associated with adverse metabolic trajectories and pregnancy outcomes, according to a study.

Researchers conducted a secondary analysis of the Acupuncture and Clomiphene for Chinese Women with Polycystic Ovary Syndrome trial (PCOSAct). PCOSAct included 956 participants who were grouped according to TyG quartiles. TyG was calculated using fasting triglyceride and glucose levels.

Of the participants, 231 were in TyG quartile 1 (≤8.15), 241 were in quartile 2 (8.16–8.55), 251 were in quartile 3 (8.56–9.01), and 233 were in quartile 4 (≥9.02).

Linear trends showed that the TyG was positively associated with age, BMI, waist circumference, hip circumference, waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, FPG, fasting insulin, the homeostatic model assessment for insulin resistance (HOMA-IR), total cholesterol, triglycerides, low-density lipoprotein, apolipoprotein B, free androgen index, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and the prevalence of insulin resistance (IR), metabolic syndrome (MS), and nonalcoholic fatty liver disease (NAFLD).

Conversely, TyG had a negative association with the quantitative insulin sensitivity check index, high-density lipoprotein, apolipoprotein A1, sex hormone-binding globulin, and the prevalence of ovulation per cycle, conception, pregnancy, and live birth. Multivariable logistic regression showed a significant linear relationship between TyG and components of MS, IR markers, and ALT.

Receiver operating characteristic (ROC) curve analysis indicated that TyG at a cutoff value of 8.745 predicted MS (according to the International Diabetes Federation criteria) with an area under the curve (AUC) of 0.871 (95 percent confidence interval [CI], 0.846–0.896), sensitivity of 81.4 percent, and specificity of 81.2 percent.

TyG at a cutoff value of 8.585 predicted IR based on HOMA-IR with an AUC of 0.782 (95 percent CI, 0.753–0.811), sensitivity of 71.9 percent, and specificity of 70.3 percent. TyG at a cutoff value of 8.665 predicted NAFLD with an AUC of 0.705 (95 percent CI, 0.644–0.766), sensitivity of 76.8 percent, and specificity of 59.3 percent.

Compared with those in the lowest TyG quartile, participants in the fourth quartile had significantly increased odds of MS (odds ratio [OR], 38.36, 95 percent CI, 20.03–73.46; p<0.001) and IR (OR, 12.49, 95 percent CI, 7.3–21.35; p<0.001). Elevated TyG had a marginal association with NAFLD (OR, 2.56, 95 percent CI, 1.00–6.55; p=0.069).

On the other hand, participants in the lowest vs highest TyG quartile had higher odds of conception (OR, 1.56, 95 percent CI, 1.04–2.35; p<0.05), pregnancy (OR, 2.35, 95 percent CI, 1.46–3.79; p<0.01), and live birth (OR, 2.32, 95 percent CI, 1.42–3.78; p<0.01).

The findings point to the potential of TyG as a biomarker for identifying metabolic dysfunction, suggesting clinical potential for risk stratification in PCOS management.