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Metabolic Syndrome · Journal article
Journal of Diabetes and Metabolic Disorders · July 28, 2026
Well-designed and adequately powered for the question it asks.
This prospective cohort study of 1129 Algerian adults found that triglyceride-glucose-waist circumference index (TYG-WC) outperforms four alternative insulin resistance indices for predicting 49-month metabolic syndrome incidence, with adjusted hazard ratio 1.44 per SD (95% CI 1.24–1.66) and C-index 0.83 indicating excellent discrimination. The findings were robust across gender, age, and metabolic phenotypes, supporting TYG-WC as a practical clinical screening tool.
Prospective cohort study. 1129 Algerian adults free of metabolic syndrome at baseline. Intervention: Five insulin resistance indices: triglyceride-glucose index (TYG), TYG-BMI, TYG-WC, and estimated glucose disposal rate (eGDR) using BMI or WC. Compared with: Comparative performance across five IR indices; NCEP-ATPIII-defined metabolic syndrome incidence as outcome. n = 1,129. Algeria (single centre inferred; geography not explicitly stated in abstract).
TYG-WC aHR = 1.44 per standard deviation (95% CI [1.24–1.66]) for MS incidence Values above 775.9 associated with 2.65-fold increased risk at 49-month follow-up TYG-WC C-index of 0.83 and mean AUC of 0.828 with quasi-perfect calibration (slope = 0.984)
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Clinicians may use TYG-WC as a simple, non-laboratory alternative to traditional IR indices for identifying asymptomatic individuals at elevated metabolic syndrome risk, particularly given its excellent discriminatory performance (C-index 0.83) and robustness across demographic subgroups. However, generalizability to non-North African populations requires validation.
Prospective cohort with robust methodology (Cox models, time-dependent ROC, C-index, NRI/IDI) demonstrates TYG-WC as superior predictor of metabolic syndrome incidence with clinically meaningful effect size and excellent discrimination (C-index 0.83) across stratified subgroups.
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Clinicians may use TYG-WC as a simple, non-laboratory alternative to traditional IR indices for identifying asymptomatic individuals at elevated metabolic syndrome risk, particularly given its excellent discriminatory performance (C-index 0.83) and robustness across demographic subgroups. However, generalizability to non-North African populations requires validation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Objective. To compare the predictive performance of five insulin resistance (IR) indices for the risk of metabolic syndrome (MS) incidence.Methods. This is a cohort study including 1129 Algerian adults free of MS at baseline, followed for up to 49 months (median follow-up: 45 months; IQR, 22-49 months). Incident MS was defined according to the NCEP-ATPIII criteria. Five IR indices: triglyceride-glucose index (TYG), TYG-body mass index (TYG-BMI), TYG-waist circumference (TYG-WC), and estimated glucose disposal rate (eGDR), using BMI or WC, were evaluated using Cox models, adjusted for cardio-metabolic confounding factors. Their performance was evaluated using time-dependent ROC curves, Harrell's C-index, Kaplan-Meier curves, and incremental predictive improvement (net reclassification improvement (NRI) and integrated discrimination improvement (IDI)). Sensitivity analyses were performed using stratification based on gender, age, and baseline metabolic phenotypes.Results. During follow-up, 291 participants developed MS (25.8%). TYG-WC demonstrated the highest predictive performance among the evaluated indices within the NCEP-ATPIII framework: aHR = 1.44 per standard deviation (95% CI [1.24-1.66]). Values above 775.9 were associated with a 2.65-fold increased risk at the 49-month horizon, with a C-index of 0.83, mAUC of model curves of 0.828, and quasi-perfect calibration (slope = 0.984). It also provided the best incremental improvement (NRI = 0.076, IDI = 0.041). Indices incorporating waist circumference consistently demonstrated modestly better predictive performance than their BMI-based counterparts and showed significant improvement in risk reclassification (NRI), whereas BMI-based indices did not. The associations remained robust across gender, age, and obesity status.Conclusion. Within the NCEP-ATPIII framework, TYG-WC demonstrated the highest predictive performance among the evaluated indices and may represent a simple and clinically useful tool for metabolic risk stratification and early identification of individuals at increased risk of MS.Supplementary information. The online version contains supplementary material available at 10.1007/s40200-026-02021-3.
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