Evaluating the role of insulin resistance in chronic intestinal health issues: NHANES study findings.

Abstract

Background: Intestinal health issues affect approximately 20% of the global population, yet the relationship between insulin resistance (IR) and intestinal health remains poorly understood. This study evaluated the discriminative ability of five IR surrogate indices-homeostatic model assessment for insulin resistance (HOMA-IR), triglyceride-glucose index (TyG), TyG adjusted for body mass index (TyG-BMI), triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), and estimated glucose disposal rate (eGDR)-for chronic diarrhea and constipation in adults.

Methods: Using data from the 2005-2010 National Health and Nutrition Examination Survey (NHANES), we analyzed associations between five IR surrogate indices and chronic diarrhea/constipation in adults. Key variables were selected via the Boruta algorithm and incorporated into weighted multivariate logistic regression models. Restricted cubic spline (RCS) analysis, threshold effect analysis, and receiver operating characteristic (ROC) curves were employed to assess these associations.

Results: Among 6,133 participants in this study, 7.5% had chronic diarrhea and 7.4% had chronic constipation. After adjusting for confounders, multivariate logistic regression revealed significant positive associations of HOMA-IR (OR: 1.02, 95% CI: 1.00-1.04), TyG (OR: 1.28, 95% CI: 1.05-1.55), and TyG-BMI (OR: 1.01, 95% CI: 1.00-1.01) with chronic diarrhea, while eGDR showed an inverse association (OR: 0.88, 95% CI: 0.80-0.96). No significant associations were observed between IR surrogate indices and chronic constipation. RCS and threshold effect analyses demonstrated a non-linear relationship between TG/HDL-C and chronic diarrhea: Each 1-unit increase in TG/HDL-C below the threshold of 7.33 elevated diarrhea risk by 11% (95% CI: 1.05-1.17). ROC analysis indicated that TyG-BMI (AUC: 0.656 vs. 0.644) and eGDR (AUC: 0.652 vs. 0.644) significantly improved the discriminative ability of the baseline model for chronic diarrhea, whereas HOMA-IR and TyG showed no statistically meaningful enhancements.

Conclusion: IR surrogate indices were significantly associated with chronic diarrhea but not chronic constipation, highlighting their potential as biomarkers for screening diarrhea in the general population.