BACKGROUND: The triglyceride glucose-body mass index (TyG-BMI index) has been considered a reliable surrogate measure of insulin resistance; however, its ability to predict the incidence of cardiovasc

The gap

Consensus across the literature

Supporting evidence — 5 representative gaps

• Association between triglyceride glucose-body mass index and cardiovascular outcomes in patients undergoing percutaneous coronary intervention: a retrospective study (2023) · doi

  BACKGROUND: The triglyceride glucose-body mass index (TyG-BMI index) has been considered a reliable surrogate measure of insulin resistance; however, its ability to predict the incidence of cardiovascular disease in individuals with coronary artery disease (CAD) remains uncertain.

  Keywords: index disease background triglyceride glucose body mass considered reliable surrogate measure insulin resistance ability predict
• Triglyceride-glucose index as a marker of metabolic and inflammatory risk across different thyroid function states (2026) · doi

  Several limitations should be considered when interpreting the findings of this study. First, the cross-sectional design precludes causal inference regarding the relationship between thyroid function and the TyG index. Second, direct measures of insulin resistance, such as HOMA-IR or hyperinsulinemic– euglycemic clamp techniques, were not available. As a result, the TyG index was used both as a surrogate indicator of insulin resistance–related metabolic risk and as the primary outcome variable in association and ROC analyses, which limits the diagnostic and clinical interpretability of the findings. Accordingly, TyG-derived cut-off values should be interpreted as markers of increased metabolic risk rather than as validated diagnostic thresholds for insulin resistance. ARTICLE IN PRESSARTICLE IN PRESS ACCEPTED MANUSCRIPT In addition, a pooled multivariable regression model including thyroid function group as an independent predictor of the TyG index was not performed; instead, regression analyses were conducted separately within each thyroid function category. While this approach allowed identification of group-specific determinants of the TyG index, it may limit direct between-group comparisons. Furthermore, although the overall sample size was adequate for the primary analyses, subgroup analyses may have been underpowered for more detailed stratification by sex or body mass index. Behavioral factors such as dietary intake, physical activity, and alcohol consumption could not be systematically assessed due to the retrospective nature of data collection. Thyroid disease duration and medication status were also not fully captured, and undiagnosed dysglycemia could not be entirely excluded despite the exclusion of individuals with known diabetes. Finally, systemic inflammation was assessed using the CRP/albumin ratio; additional inflammatory biomarkers, such as interleukin-6 or tumor necrosis factor-α, were not measured and may have provided a more comprehensive characterization of inflammatory status. Future studies incorporating longitudinal designs, direct measures of insulin sensitivity, and broader panels of metabolic and inflammatory biomarkers are warranted to validate and extend these findings and to clarify the clinical utility of the TyG index across different thyroid function states.

  Keywords: index thyroid function insulin analyses direct resistance metabolic group inflammatory measures risk primary diagnostic clinical
• Association between different atherogenic and insulin resistance indices and infertility in polycystic ovary syndrome patients (2026) · doi

  This study has several notable strengths. First, it is among the few to comprehensively assess multiple atherogenic and insulin resistance indices—including AIP, TyG, TyG-BMI, TG-HDL, and METS-IR—in relation to infertility specifically within a PCOS population, rather than the general population. Given the metabolic vulnerability of women with PCOS, this targeted approach enhances the clinical relevance of our findings. Second, the use of a relatively large and well-defined sample (n = 669) from a tertiary care center adds strength and improves the precision of our estimates. Moreover, we assessed predictive performance using ROC curve analysis, offering insight into the clinical utility of these indices. However, our study also has limitations. Its cross-sectional design precludes causal inference between metabolic indices and infertility. Although infertility status was clinically documented, a detailed etiologic workup was not uniformly PLOS One | https://doi.org/10.1371/journal.pone.0343783 May 22, 2026 9 / 13 Table 3. Findings of studies for the association between different atherogenic and insulin resistance indices and female infertility. Author (year)

  Keywords: indices infertility atherogenic insulin resistance pcos population metabolic clinical several notable strengths first among comprehensively
• Homeostasis Model Assessment Is More Reliable Than the Fasting Glucose/Insulin Ratio and Quantitative Insulin Sensitivity Check Index for Assessing Insulin Resistance Among Obese Children and Adolescents (2005) · doi

  OBJECTIVE: Simple fasting methods to measure insulin resistance, such as the homeostasis model assessment (HOMA), fasting glucose/insulin ratio (FGIR), and quantitative insulin sensitivity check index (QUICKI) methods, have been widely promoted for adult studies but have not been evaluated formally among children and adolescents.

  Keywords: insulin fasting objective simple measure resistance homeostasis model assessment homa glucose ratio fgir quantitative sensitivity
• Comparison of the homeostasis model assessment of insulin resistance (HOMA-IR) and the triglyceride-glucose index (TyG index) in non-diabetic young adults with obesity (2026) · doi

  There are, however, several limitations of this study. First, defining insulin resistance using a sam- ple-specific HOMA-IR threshold (upper tertile) as the reference standard for ROC evaluation introduces potential circularity, which may inflate the perfor- mance estimates of the TyG index. Consequently, the reported results should be interpreted as internal concordance within this specific cohort rather than a universal diagnostic capability. Second, the study population was limited to general practitioners at a single medical center, which restricts the external va- lidity and generalizability of the findings to the broader young adult population. Third, the reported correlations between adiposity markers and insulin resistance indices were not adjusted for potential confounders, such as age, sex, and lifestyle factors, which are known to influence metabolic profiles. Al- though sex-specific descriptive data were provided, the lack of sex-stratified or sex-adjusted analyses re- mains a limitation, particularly given the significant influence of sex on fat distribution and triglyceride metabolism. COnCLuSIOn In this study of non-diabetic young adults with obesity, the TyG index demonstrated a high concord- ance with HOMA-IR, showing 96.9% sensitivity at an optimal cut-off of 4.33. While both were significantly associated with markers of central adiposity (BMI and WC), the TyG index was uniquely characterized by a lack of significant correlation with BF%. These findings suggest that the TyG index is a reliable and accessible surrogate for HOMA-IR in identifying insu- lin resistance within this specific demographic. How- ever, as a cross-sectional study conducted at a single center, these results represent metabolic associations and should be validated in larger, more diverse pop- ulations. Author’s contributions: Conceptualization, Awaluddin RB, Aman AM; methodology, Awaluddin RB, Aman AM; software, Romanian medical JouRnal – Volume 73, no. 1, 202654 Romanian medical JouRnal – Volume 73, no. 1, 2026 Zainuddin AA; validation, Awaluddin RB, Aman AM; data curation, Awaluddin RB; writing—original draft preparation, Awaluddin RB; writing—review and ed- iting, Awaluddin RB, Aman AM, Rasyid H., Bakri S., Harjianti T., and Sanusi H.; supervision, Aman AM, Rasyid H., Bakri S., Harjianti T., and Sanusi H.; fund- ing acquisition, Awaluddin RB. All authors have read and agreed to the published version of the manu- script. Conflict of interest: The authors declare no conflicts of interest. Financial support: none declared. Acknowledgements: The authors thank all study members, staff, and participants involved in the study. REFEREnCES 1. Sugondo S. Obesity [Obesitas]. In: Setiati S, Alwi I, Sudoyo WA, Simadibrata M, Setiyohadi B, Syam AF, eds. Textbook of internal medicine [Bu

  Keywords: awaluddin aman specific index resistance homa medical authors insulin potential reported internal within population single