Diabetes represents a growing global public health burden. Traditional risk assessments based on static metabolic markers may not adequately reflect underlying mechanisms such as insulin resistance. As the primary site of glucose disposal, skeletal muscle may offer additional insight through functional assessments. However, the predictive value of muscle function indicators, including grip strength and the five-times chair stand test (5-CST), remains uncertain. This prospective cohort study comprised 6,604 participants drawn from the China Health and Retirement Longitudinal Study (CHARLS), with follow-up data collected from 2011 to 2020. Muscle strength and physical performance were assessed at baseline using grip strength and 5-CST, respectively. New-onset diabetes was identified through self-report of physician diagnosis. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95

Sarcopenia, characterized by progressive muscle loss, burdens aging populations. While bile acids (BAs) in skeletal muscle mass (SMM) are poorly understood, the role of amino acids (AAs) remains debated. This study investigated the associations between serum BAs, AAs, and low SMM in Chinese adults. Among 2170 initially enrolled participants, 702 were finally analyzed. Participants were classified into low and normal SMM groups. Serum BAs and AAs were quantified by targeted LC-MS/MS. Nonlinear relationships were assessed using restricted cubic spline analysis. Mediation analysis was used to assess the mediating effects of metabolic factors. The prevalence of low SMM was 14.5

Among all the elderly patients with type 2 diabetes mellitus (T2DM) of different body compositions, patients with sarcopenic obesity exhibited the most severe degree of insulin resistance despite possessing a normal body weight. It is well-established that interventions encompassing resistance training alone or in combination with whey protein supplementation, referred to hereafter as muscle-building interventions, are effective for increasing muscle mass and function in the elderly population. However, the impact of these muscle-building interventions on glucose metabolism in elderly T2DM patients with sarcopenic obesity remains unclear. The objective of this study was to elucidate the effect of muscle-building interventions on blood glucose and insulin resistance in elderly T2DM patients with sarcopenic obesity. The muscle-building interventions in this study included resistance training alone and resistance training combined with whey protein supplementation. In this randomized controlled trial, elderly T2DM patients with sarcopenic obesity were divided into three distinct groups: the control group, the resistance training group, and the resistance training combined with whey protein supplement group. The muscle-building interventions were conducted for 12 weeks. Implementing muscle-building interventions showed significant improvements in glycemic indices (HbA1c, OGTT 2-hour plasma glucose) and insulin resistance levels (HOMA-IR, Gutt index) for elderly T2DM patients with sarcopenic obesity. These muscle-building interventions enhanced muscle functional indices (handgrip strength, 5-time chair stand test). The combination of resistance training with whey protein supplementation did not significantly enhance the favorable effects on glucose metabolism compared to resistance exercise alone. Correlation analyses revealed that improvements in muscle strength were significantly associated with enhancements in glucose metabolism. In elderly T2DM patients with sarcopenic obesity, muscle-building interventions (particularly resistance exercise) have been shown to significantly improve blood glucose control and insulin resistance.

BACKGROUND & AIMS:Accumulating evidence reveals that sarcopenia and obesity display a close association with vascular aging. However, comprehensive analysis of the clinical model for estimating the risk of arterial stiffness based on the co-existence of sarcopenia and obesity has not yet been performed. METHODS:Here, we curated anthropometric, serological, clinical and computerized tomography (CT) variables from 1136 patients and applied univariate analysis (to eliminate irrelevant predictors) and logistic regression analysis (p < 0.05) in the development cohort to establish the clinical model. The precision of the model was evaluated through area under the curve (AUC) of receiver operator characteristic (ROC), calibration plot and decision curve analysis (DCA), for its discriminative power, calibration consistency and clinical usefulness. RESULTS:Logistic regression analysis identified that body mass index (BMI), total triglyceride (TG), interleukin-6 (IL-6), previous diabetes and hypertension, skeletal muscle fat index (SMFI) and skeletal muscle index (SMI) served as independent predictors for arterial stiffness and three clinical models based on these variables were constructed. The Model incorporating SMI and SMFI simultaneously (model SMI + SMFI), exhibited superior performance as compared to the models with only SMI (model SMI) or only SMFI (model SMFI), with reference to the discriminative power (ROC SMI + SMFI 0.795), calibrative ability (Eavg SMI + SMFI 0.022, Emax SMI + SMFI 0.041) and clinical utility in the validation cohort. CONCLUSIONS:This research presents a model for the estimation of pulse wave velocity (PWV), which incorporates BMI, TG, IL-6, previous diabetes and hypertension, SMI and SMFI. The model incorporating sarcopenia and obesity simultaneously instead individually, predicts arterial stiffness more accurately. This advancement could enhance our understanding of the role of sarcopenic obesity in vascular dysfunction.

BackgroundSarcopenia, a condition characterized by low muscle mass, plays a critical role in the health of older adults. Early identification of individuals at risk is essential to prevent sarcopenia-related complications. This study aimed to develop a predictive model using readily available clinical nutrition indicators to facilitate early detection.MethodsA total of 1,002 participants were categorized into two groups: 819 with normal skeletal muscle mass (SMM) and 183 with low muscle mass (sarcopenia). A predictive model was developed for sarcopenia risk via multivariate logistic regression, and its performance was assessed using four analyses: receiver operating characteristic (ROC) curve analysis, decision curve analysis (DCA), a nomogram chart, and external validation. These methods were used to evaluate the model’s discriminative ability and clinical applicability.ResultsIn the low-SMM group, more females (55.73% vs. 40.42%) and older individuals (median 61 vs. 55 years) were observed. These patients had lower albumin (41.00 vs. 42.50 g/L) and lymphocyte levels (1.60 vs. 2.02 × 109/L) but higher HDL (1.45 vs. 1.16 mmol/L) and calcium levels (2.24 vs. 2.20 mmol/L) (all p < 0.001). Using LASSO regression, we developed a nutritional AHLC (albumin + HDL cholesterol + lymphocytes + calcium) model for sarcopenia risk prediction. AUROC and DCA analyses, as well as nomogram charts and external validation, confirmed the robustness and clinical relevance of the AHLC model for predicting sarcopenia.ConclusionOur study employs serum nutrition indicators to aid clinicians in promoting healthier aging. The AHLC model stands out for weight-independent evaluations. This novel approach could assess sarcopenia risk in the Chinese population, thereby enhancing aging and quality of life.

Objective: There is no study on the relationship between triglyceride-glucose index (TyG index) and skeletal muscle mass in middle-aged and elderly C population. Therefore, the aim of the study is to investigate the relationship between the TyG index and weight-adjusted relative skeletal muscle index (RSMI) in middle-aged and elderly C population. Methods: We retrospectively studied 947 aged ⩾40 years subjects who got a routine medical examination in the Department of Geriatrics of R Hospital from May 2021 to March 2023. The RSMI was designed to evaluate skeletal muscle mass and calculated based on lean mass of the limbs(kg)/body weight(kg) × 100%. Skeletal muscle mass reduction was defined as a RSMI of 1-2 standard deviations (SD) below of healthy adults aged 30-49 years old. Considering the quartile groups of the TyG index, the subjects were assigned to 4 groups: Q1 (less than or equal to 8.171), Q2 (from 8.172 to 8.569), Q3 (from 8.570 to 8.992), and Q4 (greater than or equal to 8.993). Results: With TyG index increased, RSMI levels significantly reduced( P < .001). Spearman’s correlation analysis showed that the TyG index was negatively correlated with RSMI in males (r = −0.320) and females (r = −0.240). The TyG index was positively correlated with body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) ( P < .05). Besides, binary logistic regression analysis showed that the risk of developing reduced skeletal muscle mass in the group Q4 was 2.131 (95%CI:1.118-4.064) in males; and was 2.472 (95%CI:1.581-3.867) in females compared to the Q1 group. Conclusion: TyG index was negatively correlated with relative skeletal muscle index, and a higher TyG index was associated with the development of reduced skeletal muscle mass independently of other influencing factors. Therefore, the TyG index promises to be a predictor of skeletal muscle mass loss.

Objective: Data are limited regarding how body composition is linked to insulin resistance in elderly patients with type 2 diabetes mellitus (T2DM). We examined the association between body composition and insulin resistance in elderly T2DM patients. Methods: The cross-sectional study included 488 Chinese elderly patients wth T2DM. Subjects were classified into four groups based on body composition: normal body composition (NBC), low muscle mass alone (LMM), high body fat alone (HBF), both low muscle mass and high body fat (LMMHBF). Results: The percentage of subjects with LMMHBF was 14.5% (11.9% in men and 17.7% in women). Homeostasis model assessment of insulin resistance (HOMA2-IR) was higher in the LMMHBF group than in the HBF group (p = 0.045), and was also significantly higher in the LMMHBF or HBF group than in the NBC or LMM group. The HBF group showed the highest body mass index (BMI) of the four groups of different body compositions, and the LMMHBF group showed lower BMI than the HBF group; however, there was no significant difference in BMI or waist to hip ratio (WHR) between the LMMHBF group and the NBC group. The LMMHBF and HBF groups were significantly associated with increased risk of insulin resistance compared to the NBC group, with odds ratios (ORs) of 4.47 [95% confidence interval (CI) 2.06-9.68, p < 0.001] and 1.76 (95% CI 1.02-3.02, p = 0.041) respectively, even after the adjustment for covariates. Conclusion: In China, though elderly T2DM patients with the body composition of sarcopenic obesity (as defined by coexistence of low muscle mass and high body fat) seemed to have normal body size, they exhibited the most severe degree and the highest risk of insulin resistance.

Background:Skeletal muscle mass (SMM) plays an important part in diverse health and disease states. Bioelectrical impedance analysis (BIA) and computed tomography (CT) are available for its assessment. However, muscle mass assessed by BIA may be influenced by multiple factors. The erector spinae muscle area (ESA) on chest CT is recently presumed to be representative of SMM. This study aimed to derive BIA from the ESA and evaluate the magnitude of association (between ESA measured from chest CT) and BIA.Methods:Subjects hospitalized for health checkups between December 2020 and December 2021, having undergone both BIA (50 kHz, 0.8 mA) and chest CT, were included. ESA was quantified at the level of the 12th thoracic vertebra (T12-ESA) by a standardized semi-automated segmentation algorithm. Low SMM was defined using the Asian Working Group for Sarcopenia criteria. The association between T12-ESA and BIA was then evaluated. Stratified analyses by sex and BMI were also performed.Results:Among 606 included subjects (59.7 ± 16.6 years, 63.5% male), 110 (18.2%) had low SMM. BMI in low and normal SMM groups was 20.1 and 24.7 kg/m2, respectively. Current smoking, drinking, chronic obstructive pulmonary disease, and chronic renal dysfunction were more frequently seen in the low SMM group than in the normal SMM group. The final regression model included T12-ESA, weight, BMI, and age, and had an adjusted R2 of 0.806 with BIA. In the validation group, the correlation between T12-ESA-derived BIA and BIA remained high (Pearson correlation = 0.899). Stratified analysis disclosed a stronger correlation between T12-ESA and BIA in male subjects than in female subjects (adjusted R2 = 0.790 vs. adjusted R2 = 0.711, p < 0.05), and a better correlation was observed in obese (BMI ≥ 30 kg/m2) compared with underweight (BMI < 18.5 kg/m2) subjects (adjusted R2 = 0.852 vs. adjusted R2 = 0.723, p < 0.05). Additional analysis revealed a significant correlation between T12-ESA and skeletal muscle cross-sectional area at the 3rd lumbar vertebra (L3-CSA) (adjusted R2 = 0.935, p < 0.001).Conclusions:CT-based assessment of ESA at the T12 level is feasible and correlated well with BIA, especially in male subjects and obese subjects.

Studies have indicated that the skeletal muscle mass and strength was related to serum uric acid (UA), but there is a lack of research on the association of skeletal muscle fat content with UA. The purpose of this cross-sectional study is to investigate the correlation of skeletal muscle fat index (SMFI) and hyperuricemia (HUA) in Chinese adults. 500 subjects (306 men and 194 women) were included in the study. The participants were divided into four groups according to SMFI quartiles. Pearson's correlations between SMFI and metabolic variables were calculated. Logistic regression analysis was used to estimate the association between the quartiles of SMFI and risk of hyperuricemia. UA showed a positive association with SMFI after adjusted for BMI, age and gender. A significant association between the SMFI and risk of HUA was found, the OR for HUA was 2.79 (95% CI 1.18-6.59, p<0.05) in Q2, 2.41(95% CI 1.00-5.81, p<0.05) in Q3, and 2.63 (95% CI 1.03-6.72, p<0.05) in Q4, after adjusted for BMI. In conclusion, the SMFI was significantly associated with the level of serum UA, and the higher SMFI may indicate a higher risk of HUA, independent of BMI.

目的·筛选脂蛋白脂酶(lipoprotein lipase,Lpl)基因杂合敲除(Lpl+/-)小鼠和野生型(wild type,WT)小鼠的胰岛组织中差异表达基因(differentially expressed genes,DEGs)和通路,探讨脂毒性介导2型糖尿病(type 2 diabetes mellitus,T2DM)发病过程中的分子机制.方法· 将Lpl+/-小鼠和WT小鼠的胰岛进行分离纯化.通过基因芯片分析获得DEGs,并对其进行GO(Gene Ontology)功能分析和KEGG(Kyoto Encyclopedia of Genes and Genomes)通路分析.采用实时荧光定量PCR(quantitative real-time PCR,qPCR)对关键基因表达进行验证.结果·共筛选出187个DEGs.GO功能分析和KEGG通路分析显示,DEGs主要富集于免疫细胞增殖分化、炎症信号通路及细胞黏附等生物过程.在Lpl+/-小鼠和WT小鼠的表达差异最为显著的前10个基因中,gremlin 1(Grem1)基因与胰岛β细胞功能密切相关,且经qPCR验证与基因芯片的结果一致.结论·脂毒性介导T2DM的过程涉及多个信号通路的参与,其可能是通过抑制Grem1表达导致胰岛β细胞功能障碍.

Background The benefits of fenofibrate (FB), a peroxisome proliferator-activated receptor-a agonist, against hyperlipidemia have been established. We investigated the effect of fenofibrate on insulin resistance of lipoprotein lipase knockout heterozygous (LPL+/-) mice, which represent inherited hypertriglyceridemia and impaired glucose tolerance. Methods Male LPL+/- mice were treated with FB (50 mg/kg, once daily) via gavage for 8 weeks. Plasma lipid, glucose tolerance test, systemic insulin sensitivity, insulin signaling of tissues, genes and proteins related to endoplasmic reticulum (ER) stress and oxidative stress were analyzed. Results Body weight of 40-week LPL+/- with FB were reduced by 30.3% (P<0.05), while the differences of 16- and 28-week LPL+/- with FB were not significant (P>0.05). FB improved the lipid profile of both 28 and 40-week LPL+/- (P<0.001 for both), while that of 16-week LPL+/- mice with FB was unaltered (P>0.05). Glucose tolerance of 40-week LPL+/- were improved by FB (P<0.05), while that of 16- and 28-week LPL+/- with FB kept unaltered (P>0.05). Fasting insulin of 40-week LPL +/- were improved by FB (P<0.05), thus HOMA-IR of 40-week LPL+/- was declined (P<0.05). HOMA-IR of 16- and 28-week LPL+/- with FB had no change. Insulin-stimulated phosphorylated Akt (Ser473) in liver and skeletal muscle of 28-week LPL+/- was enhanced by FB (P < 0.001 and P<0.05 respectively). ER stress biomarkers were detected decreased in liver of 16- to 40-week LPL+/- with FB whereas that in muscle of LPL+/- with FB unchanged. Reduced reactive oxygen species (ROS) levels and augmented mRNA expression of superoxide dismutase (SOD) and catalase (CAT) in skeletal muscle of 28- and 40-week LPL+/- mice with FB were observed. There was no significance on ROS levels and mRNA of SOD and CAT in liver between LPL+/- mice with and without FB. Conclusions Fenofibrate improved lipid profile, glucose tolerance, systemic and tissue-specific insulin resistance of LPL knockout heterozygous mice. This may be associated with alleviated endoplasmic reticulum stress in liver and reduced oxidative stress in muscle.

Objective To investigate the effect of fenofibrate on glucolipid metabolism and insulin sensitivity in lipoprotein lipase heterozygous knockout ( LPL+/-) mice, and to explore its mechanism. Methods LPL+/- mice and wild type ( WT) C57 mice were selected and divided into 3 groups ( n=6 each group):LPL+/-( FB) group, LPL+/-(W)group,andWTgroup.MiceinLPL+/-(FB)groupweregavagedwithfenofibrate(50mg·kg-1·d-1)for8 weeks. Mice in LPL+/-( W) and WT groups were orally fed with the same volume water as that in LPL+/-( FB) group for 8 weeks. Body weight was observed. Plasma triglyceride ( TG ) and free fatty acid ( FFA ) were measured. Intraperitoneal glucose tolerance test in 3 groups of mice were performed. The glucose area under the curve ( AUCG) and homeostasis model assessment for insulin resistance index ( HOMA-IR) were calculated. Insulin-stimulated Ser473 Akt phosphorylation in liver and skeletal muscle was measured by Western blot. Reactive oxygen species ( ROS) levels in liver and skeletal muscle were determined by dihydroethidium staining method and superoxide dismutase ( SOD) and catalase ( CAT) mRNA expression levels were detected by real-time PCR. Results Compared with LPL+/-( W) mice, body weight of LPL+/-( FB) mice was lowered, plasma TG and FFA levels were decreased by about 46.0％and 76.5％respectively, and fasting insulin level and HOMA-IR were decreased while there were no significant differences in fasting glucose level and AUCG between two groups. Insulin-stimulated Ser473 Akt phosphorylation levels in liver and skeletal muscle of LPL+/-mice were enhanced by fenofibrate. ROS level in skeletal muscle of LPL+/-( FB) mice was lower than that in LPL+/-( W) mice while there was no significant difference in ROS of liver between two groups. Fenofibrate significantly increased SOD and CAT mRNA expressions in skeletal muscle of LPL+/-mice, but not in liver. Conclusion Fenofibrate reduces body weight, ameliorates lipid metabolism, and improves insulin sensitivity in LPL+/- mice, with reduced oxidative stress.

Aims: The present study aimed to explore the mechanism of a potential beneficial effect of pre-existing diabetes in acute hyperglycemia during critical illness. Methods: Pathophysiological changes including blood glucose variability, changes of inflammatory and oxidative stress responses after lipopolysaccharide (LPS)-induced acute infection were compared between type 2 diabetic rat model (GK rats) and normal controls (Wistar rats). Results: After LPS injection, Wistar rats showed serious infective symptoms while GK rats did not. Blood glucose (BG) levels were significantly elevated in both GK and Wistar rats; however, compared to Wistar rats, GK rats had lower BG variability, smaller increases in the serum tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 levels, a larger increase in the serum IL-10 level, and a smaller decrease in the I kappa B-alpha protein level of lung tissue. Serum malondialdehyde (MDA) levels increased and serum total antioxidant capacity (T-AOC) levels decreased for both GK and Wistar rats. Conclusions: We found diabetes was associated with adaptive changes at the cellular level that might actually be protective in acute hyperglycemia-mediated damage during sepsis. Chronic exposure to hyperglycemia potentially reduced the acute deleterious effects of acute hyperglycemia on septic mortality by decreasing BG variability, blunting the pro-inflammatory response and elevating the anti-inflammatory response. (C) 2018 Elsevier B.V. All rights reserved.

Background. Fatty acid-induced lipotoxicity and macrophage migration inhibitory factor (MIF) affect pancreatic beta-cell function, and may promote the development of diabetes mellitus. However, the association of lipotoxicity with MIF and the effect of Fenofibrate on beta-cell function remain unknown. Methods. LPL+/- mice and MIN6 cells stimulated with palmitic acid (PA) were utilized as models of lipid metabolism disorders. Factors associated with insulin secretion and apoptosis were assessed in the presence or absence of Fenofibrate. The possible mechanisms of lipotoxicity-induced beta-cell dysfunction were also explored. Results. Fenofibrate effectively improved lipid accumulation in pancreatic beta-cells, increased glucose-stimulated insulin secretion and beta-cell mass, and significantly downregulated proapoptotic molecules, at the gene and protein levels, both in vivo and in vitro. Additionally, elevated MIF levels in serum from LPL+/- mice and PA-treated MIN6 cells were starkly decreased after Fenofibrate administration. Mechanistic analysis indicated that NF-kappa B signaling was remarkably triggered, which could further activate MIF transcription. Furthermore, Fenofibrate exerted beneficial effects on fatty acid-induced beta-cell dysfunction likely by inhibiting the NF-kappa B/MIF dependent inflammatory response. Conclusions. Fenofibrate ameliorates lipotoxicity-induced beta-cell dysfunction and apoptosis by inhibiting the NF-kappa B/MIF inflammatory pathway. These findings provide novel insights into the treatment of lipotoxicity-induced metabolic disorders. (C) 2017 Elsevier Inc. All rights reserved.

AIMS:To investigate the associations of dyslipidemia with insulin resistance and β cell function in individuals with normal glucose tolerance (NGT) and different categories of impaired glucose regulation (IGR).METHODS:544 subjects (365 with dyslipidemia and/or IGR and 179 with normal lipid and glucose tolerance) were enrolled in the study. All subjects underwent oral glucose tolerance test (OGTT). HOMA-IR was used to evaluate insulin sensitivity. Disposition index (DI) was used to evaluate β cell function. Multiple linear regression analysis was performed to assess correlations among lipid profiles, insulin resistance and β cell function.RESULTS:Among subjects with NGT, those with dyslipidemia had higher level of HOMA-IR but lower level of DI. While among subjects with different categories of IGR, those with dyslipidemia and CGI had significantly decreased DI. No obvious differences of insulin resistance or β cell function were found in IFG or IGT subjects with or without dyslipidemia. TG and HDL-C were correlated with HOMA-IR (β = 0.79, p <0.001; β = -0.38, p = 0.027, respectively, compared with subjects in the low level groups). Moreover, TG and TC were negatively correlated with DI (β = -2.17, p = 0.013; β = -2.01, p = 0.034 respectively, compared with subjects in the low level groups) after adjusting for confounding parameters.CONCLUSIONS:Dyslipidemia induces insulin resistance and impaired β cell response to insulin resistance in individuals with NGT. Furthermore, dyslipidemia diminishes β cell function in subjects with CGI. TG and HDL-C were correlated with insulin resistance, and TG, TC were negatively correlated with β cell response to insulin resistance in non-diabetic individuals.

Background Apolipoprotein B/apolipoprotein A-I (ApoB/ApoA-I) ratio is a useful predictor of cardiovascular risk. However, the association between the ApoB/ApoA-I ratio and the risk of type 2 diabetes mellitus (T2DM) is still obscure. Aims To investigate the associations between the ApoB/ApoA-I ratio and the risk of T2DM and pre-diabetes in a Chinese population, and to assess the role of gender in these associations. Methods A stratified random sampling design was used in this cross-sectional study which included 264 men and 465 women with normal glucose tolerance (NGT), pre-diabetes or T2DM. Serum ApoB, ApoA-I and other lipid and glycaemic traits were measured. Pearson's partial correlation and multivariable logistic analysis were used to evaluate the associations between ApoB/ApoA-I ratio and the risk of T2DM and pre-diabetes. Results The ApoB/ApoA-I ratios were significantly increased across the spectrum of NGT, pre-diabetes and T2DM. Women showed higher levels of ApoB/ApoA-I ratio and ApoB than men in the pre-diabetic and T2DM groups, but not in the NGT group. The ApoB/ApoA-I ratio was closely related with triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and other glycaemic traits. Moreover, in women, the risk of diabetes and pre-diabetes in the top and middle tertiles of the ApoB/ApoA-I ratio were 3.65-fold (95% CI 1.69 to 6.10) and 2.19-fold (95% CI 1.38 to 2.84) higher than in the bottom tertile, respectively, after adjusting for potential confounding factors. However, the associations disappeared in men after adjusting for other factors. Conclusions The ApoB/ApoA-I ratio showed positive associations with the risk of diabetes and pre-diabetes in Chinese women.

To investigate the anti-inflammatory effects of specific small interfering RNA targeting NF-κB on lipopolysaccharide (LPS)-induced acute lung injury (ALI) in rats.

POEMS syndrome is a rare multi-systemic disease characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes. Arterial thrombosis is a distinctively unusual feature in patients with POEMS syndrome. We report a 33-year-old man with intermittent amaurosis of left eye and skin changes as the onset manifestations, who was finally confirmed as having POEMS syndrome. Most notably, this was a young man without high risk factors of arterial thrombosis and no monoclonal protein was detected until the repeated measurement later. This case evokes the need to consider the diagnosis of POEMS syndrome for young patients with symptoms of arterial thrombosis but no high risk factors of thrombosis.

Body mass index (BMI), waist circumference (WC), visceral adiposity index (VAI), triglyceride glucose index (TyG), TyG-BMI, and TyG-WC have been reported as markers of insulin resistance or type 2 diabetes mellitus (T2DM). However, little is known about the associations between the aforementioned markers and the risk of prediabetes and diabetes in first-degree relatives (FDRs) of T2DM patients.

Objectives To explore the association between the triglyceride to HDL-C ratio (TG/HDL-C) and insulin resistance in Chinese patients with newly diagnosed type 2 diabetes mellitus.MethodsPatients with newly diagnosed type 2 diabetes mellitus (272 men and 288 women) were enrolled and divided into three groups according to TG/HDL-C tertiles. Insulin resistance was defined by homeostatic model assessment of insulin resistance (HOMA-IR). Demographic information and clinical characteristics were obtained. Spearman's correlation was used to estimate the association between TG/HDL-C and other variables. Multiple logistic regression analyses were adopted to obtain probabilities of insulin resistance. A receiver operating characteristic analysis was conducted to evaluate the ability of TG/HDL-C to discriminate insulin resistance.ResultsTG/HDL-C was associated with insulin resistance in Chinese patients with newly diagnosed T2DM (Spearman's correlation coefficient = 0.21, P < 0.01). Patients in the higher tertiles of TG/HDL-C had significantly higher HOMA-IR values than patients in the lower tertiles [T1: 2.68(1.74-3.70); T2: 2.96(2.29-4.56); T3: 3.09(2.30-4.99)]. Multiple logistic regression analysis showed that TG/HDL-C was significantly associated with HOMA-IR, and patients in the higher TG/HDL-C tertile had a higher OR than those in the lower TG/HDL-C tertile, after adjusting for multiple covariates including indices for central obesity [T1: 1; T2: 4.02 (1.86-8.71); T3: 4.30(1.99-9.29)]. Following stratification of waist circumference into quartiles, the effect of TG/HDL-C on insulin resistance remained significant irrespective of waist circumference.ConclusionsTG/HDL-C was associated with insulin resistance independent of waist circumference. Whether it could be a surrogate marker for insulin resistance in Chinese patients with newly diagnosed type 2 diabetes mellitus still needs to be confirmed by more researches.