Non-linear associations of HOMA2-IR with all-cause mortality in general populations: insights from NHANES 1999-2006

• Главные авторы: Aikai Zhang (Автор), Lingchen Huang (Автор), Min Tang (Автор)
• Формат: ‌
• Опубликовано: BMC, 2024-02-01T00:00:00Z.
• Предметы: article
• Online-ссылка: Connect to this object online.
• Notes: 10.1186/s12889-024-18026-7; 1471-2458
• Keywords: Homeostatic model assessment; Insulin resistance; Obesity; NHANES; Public aspects of medicine; RA1-1270
• Source: BMC Public Health, Vol 24, Iss 1, Pp 1-9 (2024)

Abstract Background The association between homeostatic model assessment (HOMA2-IR) and mortality in obese and non-obese populations has not been clearly explained. Methods A total of 7,085 individuals aged ≥ 20 years from the 1999-2006 National Health and Nutrition Examination Survey were included in the study. Study endpoints were all-cause and cardiovascular mortality. Multivariate Cox proportional hazards regression models with restricted cubic spline analysis were used for analysis. Results In the study populations, a total of 1666 all-cause deaths and 555 cardiovascular (CV) deaths were recorded during a mean follow-up of 195.53 months. Notably, a significant difference in obesity was observed in the association between HOMA2-IR and mortality. After adjustment for multiple variables, HOMA2-IR was positively associated with all-cause mortality in all participants, in those with normal BMI, and in those with obesity. Conversely, tertile 2 of HOMA2-IR was associated with a lower risk of all-cause mortality in participants with obesity compared with tertile 1 (adjusted hazard ratio, 0.68; 95% confidence interval, 0.52-0.89; P = 0.005). Results from restricted cubic spline analysis showed a J-shaped association between HOMA2-IR and all-cause and CV mortality. In addition, a nonlinear U-shaped correlation with all-cause (P for nonlinear < 0.001) and CV (P for nonlinear = 0.002) mortality was observed in the population with obesity, with inflection points of HOMA2-IR identified at 1.85 and 1.75. Below the inflection point of 1.85, a negative relationship between HOMA2-IR and all-cause mortality was observed. Conclusions Elevated HOMA2-IR showed a notable correlation with increased risk of all-cause mortality. It was noteworthy that excessively reduced levels of insulin resistance showed a distinct association with increased mortality in individuals with obesity.