Associations between C-reactive protein-triglyceride glucose index and Endometriosis: the NHANES 1999-2006

Associations between C-reactive protein-triglyceride glucose index and Endometriosis: the NHANES 1999-2006 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Associations between C-reactive protein-triglyceride glucose index and Endometriosis: the NHANES 1999-2006 Yanan Ren, Ren Xu, Junqin Zhang, Ying Jin, Di Zhang, Yazhuo Wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5181764/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jan, 2025 Read the published version in BMC Women's Health → Version 1 posted 18 You are reading this latest preprint version Abstract Background: The C-reactive protein-triglyceride glucose index (CTI), a promising new marker, could evaluate the extent of inflammation. Endometriosis is a prevalent chronic inflammatory condition that is influenced by estrogen and primarily impacts individuals of reproductive age. However, no investigated have shown association of the CTI with endometriosis. Methods: In total, 2235 women in National Health and Nutrition Examination Survey from the 1999-2006 were included. The CTI was defined as 0.412 × ln (CRP) + ln [T.G. (mg/dL) × FPG (mg/dL)/2]. Multivariate logistic regression, restricted cubic splines, and subgroup analyses were employed to examine the association of CTI with endometriosis. Results： Totally 2235 women were included, of whom 175 (7.82%) had endometriosis and 2060(92.18%) did not have endometriosis (named control). In comparison to the control group, patients exhibited a tendency toward higher CTI levels ( P =0.005). CTI levels were positive associated with the prevalence of endometriosis ( P =0.011). In Model 1, 1 mg/dL increment in CTI was associated with a 56% higher prevalence of endometriosis (OR: 1.563, 95% CI: 1.295–1.885, P < 0.001). This association in Model 2 (OR: 1.609, 95% CI: 1.334-1.941, P ＜ 0.001) and Model 3 (OR: 1.565, 95% CI: 1.246–1.966, P < 0.001) remained significant. Notably, individuals in the uppermost RC tertial exhibited a notably greater prevalence of endometriosis than those in the lowest tertial (OR = 3.029, P for trend = 0.051). The results from the restricted cubic splines indicated a nonlinear positive association between CTI and the prevalence of endometriosis. In addition, the higher endometriosis prevalence with CTI in >40 years (OR = 1.57, 95% CI:1.16 , 2.13), BMI ≥25 kg/m 2 (OR =1.38, 95% CI: 1.06,1.80), smoking ≥ 100 cigarettes (OR =1.43, 95% CI: 1.06, 1.96), married or living with partner (OR =1.41, 95% CI: 1.09, 1.85) and taking oral contraceptives (OR =1.35, 95% CI: 1.07, 1.69) was observed. Conclusions: CTI is positively associated with endometriosis in US women. Therefore, the use of CTI as a new indicator of inflammation may help provide new insights into the prevention and management of endometriosis. C-reactive protein-triglyceride glucose index endometriosis inflammation NHANES Figures Figure 1 Figure 2 Figure 3 1. Background Endometriosis is a common, chronic, inflammatory, benign gynecological disorder characterized by the growth of endometrioid tissue outside the uterine cavity, with a prevalence of about 10 per cent in people of childbearing age. ( 1 )( 2 , 3 ). The standard method for diagnosing endometriosis is laparoscopically guided biopsy( 4 , 5 ), which often leads to significant delays in diagnosis, typically ranging from 6–11 years.( 6 ).The development of innovative diagnostic methods and predictive biomarkers is essential for improving diagnostic accuracy and sensitivity, ultimately enhancing patients' quality of life. The C-reactive protein-triglyceride glucose index (CTI) is gaining recognition as a new metric for thoroughly evaluating the severity of inflammation and insulin resistance (IR). The CTI is calculated via the following formula: 0.412 × ln(CRP) + ln[T.G. (mg/dL) × FPG (mg/dL)/2]. A novel metric termed the "CTI" provide a comprehensive assessment of both inflammatory status and IR( 7 ).CTI is the sole metric that combines the intensity of inflammation and IR, and it has been recognized as valuable for predicting survival rates in a Chinese cancer population( 7 ).Additionally, CTI is a straightforward and quick indicator that incurs no extra costs beyond standard laboratory tests. As a result, in the general population without imposing any further financial burden on patients or the healthcare system. Elevated CRP levels demonstrate a systemic inflammatory response( 8 ).Endometriosis is a complex chronic inflammatory disease( 9 ). IR is a pathological condition that impairs glucose metabolism in tissue cells, and can lead to metabolic complications such as hyperglycemia, hyperlipidemia, and obesity.( 10 , 11 ). Recent studies indicated that insulin sensitivity is diminished in endometriosis cells, leading to the upregulation of the glycolytic pathway and increased lactate levels in follicular fluid. This mechanism contributes to inflammation, angiogenesis, and cell proliferation( 12 ).Considering these viewpoints, it is important to investigate the potential link between CTI and the risk of developing endometriosis. Thus, our aim was to explore the relationship between CTI and endometriosis by analyzing a substantial study from the 1999–2006 National Health and Nutrition Examination Survey (NHANES), with the intention of offering compelling evidence for this association. 2. Materials and methods Study population The NHANES, a nationally representative study, which procedures were approved by the Research Ethics Review Board of the National Center for Health Statistics (NCHS), were conducted by the Centers for Disease Control and Prevention. The consent were written by all participants provided at the time of enrollment. A total number of 41474 individuals from four consecutive 2-year NHANES cycles (1999–2000, 2001–2002, 2003–2004, 2005–2006) were included in this study. We included 2235 female participants aged 20–50 years and excluded participants with missing data on endometriosis, CTI, and other covariates. Ultimately, participants who satisfied these criteria were assigned to the endometriosis or control group according to their diagnosis. Endometriosis A questionnaire-based survey asking“Has a doctor or other health professional ever told you that you had endometriosis (age at interview 20–54 years)?”were collected to diagnose endometriosis. Participants who responded affirmatively were classified as endometriosis group, otherwise they were in the control group. Measurement of the CTI The CTI( 7 ) was calculated as following: CTI = 0.412 × Ln (CRP) + TyG (TyG = Ln [fasting triglyceride (TG) (mg/dL) × fasting glucose (FPG) (mg/dL)/2])( 13 ). Blood samples were collected in the morning after an 8.5-hour fast and processed in NCHS-certified laboratories. Serum triglyceride levels were assessed via Roche Modular P and Roche Cobas 6000 chemistry analyzers, while FPG was assessed via the oxygen rate method on a Beckman DxC800( 14 , 15 ). CRP concentrations were determined via latex-enhanced nephelometry by Behring Nephelometer( 16 ). Additional details about the laboratory procedures are available on the official NHANES website. Usually, an elevated CTI suggests a more severe level of inflammation and insulin resistance (IR). ( 13 ). Covariables Covariates included age, age at menarche (years), income-to-poverty ratio (PIR),and body mass index (BMI), Smoked ≥ 100 cigarettes, race/ethnicity, marital status, education level, hypertension, diabetes, alcohol intake, oral contraceptives, CRP (mg/dL), fasting triglyceride (mg/dL), fasting glucose, mg/dl, triglyceride glucose index (TyG), total cholesterol (mg/dL), CTI. Age was categorized into two groups according to clinical relevance (≤ 40years and > 40 years). BMI was classified as normal (< 25 kg/m 2 ) or overweight (≥ 25 kg/m 2 ) on the basis of clinical significance. Smoking status was categorized based on having smoked at least 100 cigarettes in their lifetime (yes, no as the referent). There were 3 levels for the poverty income ratio (PIR): less than 1.3, between 1.5 and 3.0, and 3.0 or greater. Statistical analysis To assess the differences between the two groups under consideration, Student's t test was used for continuous variables. This test helps determine if there are statistically significant differences in means between the two groups. For categorical variables, the Chi-square test was employed, which evaluates whether there was a significant association between the categorical outcomes across the groups. By selecting these appropriate statistical methods, the analysis ensured robust evaluation of the data. To assess the relationships of the CTI with endometriosis logistic regression models were constructed. Three models were constructed: ( 1 ) Model 1 (unadjusted model) and ( 2 ) Model 2 (adjusted for age, ethnicity) and ( 3 ) Model 3 (additionally adjusted for PIR, BMI, education level, marital status, smoking habits, hypertension, diabetes, drinking status, age at menarche, total cholesterol, and the use of contraceptive pills). The relationship between an increase of 1 mg/dL in the CTI and endometriosis. In addition, stratified analyses were conducted according to the participants' age, BMI, age at menarche, smoking status, drinking, marital status, and use of oral contraceptives. The prevalence was calculated as odds ratios (ORs) along with their 95% confidence intervals (CIs). To flexibly model the association between the CTI and the prevalence of incidence endometriosis, restricted cubic splines with three knots were applied. R statistical software (version 4.2) and EmpowerStats (version 5.0) ( http://www.empowerstats.net ) were used to analyze. A P value of less than 0.05 was deemed statistically significant for all analyses. 3. Results Baseline characteristics Between 1999 and 2006, the NHANES study included 6,508 participants. Among them, 951 participants were excluded due to endometriosis, 3,050 due to CTI, and 272 due to incomplete covariate information. Ultimately, 2,235 participants were included in the final analysis.Ultimately, based on diagnosis of the endometriosis,175 participants in endometriosis group and 2060 in the control group were included on the basis of the diagnosis of endometriosis(Fig. 1 ). Table 1 provides an overview of the descriptive characteristics of the participants included in the study. A total of 175 individuals, accounting for 7.83%, reported having endometriosis, whereas 2060 (92.17%) did not. Participants with endometriosis were more likely to have used oral contraceptives for birth control and were more often non-Hispanic white women, compared to those without the condition. Moreover, endometriosis sufferers have higher rates of smoking and marriage, and are more likely to be obese. It is worth noting that their CRP, TyG, fasting triglyceride, total cholesterol, and CTI levels are also higher than those in patients without endometriosis.(Table 1). Associations between the CTI and endometriosis Table 2 illustrates the association between the CTI and endometriosis, analyzed through three different models. In all the models, a continuous increase in the CTI was significantly associated with an elevated prevalence rate of endometriosis. Specifically, in the unadjusted model (Model 1), OR for continuous CTI was 1.563 (95% CI: 1.295–1.885, P < 0.001), whereas in the model adjusted for age and ethnicity (Model 2), the OR slightly increased to 1.609 (95% CI: 1.334–1.941, P < 0.001). After further adjustment for various factors including BMI, PIR, education level, and lifestyle habits (Model 3), the OR remained significant at 1.565 (95% CI: 1.246–1.966, P < 0.001), indicating a consistent relationship between higher CTI and the risk of endometriosis. When stratified by quartiles, the highest quartile of CTI (Q4) was associated with significantly increased odds of endometriosis across all the models, with ORs of 3.430 (95% CI: 1.589–7.402, P = 0.002) in Model 1, 3.615 (95% CI: 1.667–7.839, P = 0.002) in Model 2, and 3.029 (95% CI: 1.306–7.025, P = 0.011) in Model 3. These results suggest that an elevated CTI is strongly associated with an increased risk of endometriosis, even after controlling for multiple demographic and clinical factors. In Fig. 2 , the relationship of the predicted values was visualized by plotting the restricted cubic splines. A nonlinear positive relationship between CTI and prevalence of endometriosis was observed (nonlinearity P = 0.603), with a breakpoint identified at 8.053. Subgroup analyses The results of the stratified assessment by age, age at menarche, BMI, smoking, drinking, marital status, and use of oral contraceptives are shown in Fig. 3 . Those > 40 years old, with a BMI ≥ 25 kg/m 2 , who smoke smoking ≥ 100 cigarettes, who are married or living with a partner, and who consume oral contraceptives are intake showed more vulnerable. Following the stratification of analyses on the basis of drinking habits, comparable results were found regarding the positive associations between the CTI and the prevalence of endometriosis Furthermore, a higher endometriosis prevalence with CTI in > 40 years old (OR = 1.57, 95% CI: 1.16, 2.13), BMI ≥ 25 kg/m 2 (OR = 1.38, 95% CI: 1.06,1.80), smoking ≥ 100 cigarettes (OR = 1.43, 95% CI: 1.06, 1.96), being married or living with a partner (OR = 1.41, 95% CI: 1.09, 1.85) and taking oral contraceptives intaking (OR = 1.35, 95% CI: 1.07, 1.69) was observed. 4. Discussion In this cross-sectional study that involving 2235 representative participants, we found positive associations between CTI and endometriosis with a threshold concentration of approximately 8.053 mg/dL. Our conclusions indicate that individuals with endometriosis are generally older and chiefly non-Hispanic white. The diagnosis of endometriosis is frequently delayed, typically occurring 6–11 years after the initial symptoms appear, which likely accounts for the older age of these patients( 6 ).The increased incidence among white individuals may be associated with a greater racial susceptibility. Additionally, we Recorded that individuals who are obese or have a history of smoking are more prone to developing endometriosis. This may be because of the inflammatory response triggered by smoking( 17 , 18 ), while higher estrogen levels in obese patients could also promote the development of endometriosis( 19 ). Endometriosis is a prevalent chronic condition among women of reproductive age, impacting approximately 10% of this population( 2 , 3 , 20 ).There are several theories regarding the pathogenesis of endometriosis, with the leading theories being that ectopic endometrial-like glands and stroma may arise from the metaplasia of local tissue or from the transplanted ectopic endometrium( 21 , 22 ). This implies that normal endometrial cells may undergo changes in other parts of the body, resulting in the formation of new pathological tissue. Furthermore, elevated levels of local estrogen are believed to play a crucial role in this process, as they not only aid in the survival and implantation of ectopic endometriotic lesions but also promote their proliferation( 3 , 19 ). Nevertheless, the precise physiopathology remains unclear. Recent research has highlighted the potential contributions of inflammation and oxidative stress in this context( 23 – 26 ). A cohort study conducted in Japan also suggested that consuming a diverse range of anti-inflammatory foods, such as vegetables, may ultimately impact perinatal mortality and morbidity in patients with endometriosis( 27 , 28 ).A recent cross-sectional analysis revealed that the dietary inflammatory index was positively associated with the prevalence of endometriosis( 27 , 29 ).The inflammatory nature of endometriosis has been well established over the years( 30 , 31 ).Considering the central role of inflammation in the pathogenesis of endometriosis, addressing inflammatory dysfunctions has emerged as a promising strategy for developing new treatments( 32 , 33 ). This approach provides avenues for exploring innovative options for both the prevention and management of this disease. The results of our study are consistent with earlier research regarding the significant association between inflammation and endometriosis( 34 ). Similarly, several studies have shown that chronic inflammation plays a crucial role in the pathogenesis of endometriosis( 28 , 33 ). For example, research utilizing the dietary inflammatory index (DII) revealed a positive association between pro-inflammatory diets and the prevalence of endometriosis( 35 , 36 ). Similar to our findings, higher inflammatory indicators, such as CRP and TyG indices,are significantly associated with endometriosis ( 37 – 40 ).This similarity emphasizes the role of systemic inflammation in the progression of endometriosis and supports the hypothesis that inflammatory processes are central to disease development( 38 , 41 ). Furthermore, the role of demographic and lifestyle considerations, including smoking and BMI( 42 , 43 ), was more prominently analyzed in our study, revealing that these factors might modulate the relationship between inflammation and endometriosis. This provides a more nuanced understanding of how lifestyle and metabolic factors interact with inflammatory processes to influence the risk of endometriosis. A key strength of this study lies in its foundation of a weighted and representative population with a substantial sample size. It should be emphasized that we also Implemented the restricted cubic splines analysis. Nevertheless, this study has a number of limitations. First, owing to the cross-sectional design, it is hard to determine the causation between CTI and endometriosis. Second, because participants younger than 20 years were excluded, this findings may not be relevant to younger patients. Third, since most of the data were gathered through self-report questionnaires or interviews, the control group may unintentionally include individuals with undiagnosed endometriosis, potentially resulting in recall and reporting bias. Lastly, because of the limitations of the database, we could not incorporate data on all covariates related to endometriosis and inflammation levels to ensure a sufficiently large sample size. Therefore, future research should involve a more diverse population and take into account additional potential covariates to clarify the causal association between the CTI and endometriosis. 5. Conclusion This research revealed a strong positive association of the CTI with endometriosis. Therefore, actively managing blood glucose levels and minimizing inflammatory responses may aid in decreasing the prevalence of endometriosis.However, additional foundational research is necessary to investigate the possible relationships among them. Abbreviations C-reactive protein-triglyceride glucose (CTI) Endometriosis (EM) National Health and Nutrition Examination Survey (NHANES) Family income-to-poverty ratio (PIR) National Center for Health Statistics (NCHS) Body mass index (BMI) Triglyceride Glucose Index(TyG) insulin resistance (IR) Declarations Acknowledgments We would like to thank all participants in this study. Author contributions: RY, XR, and SL designed the research. RY, ZJ, and JY collected and analyzed the data and drafted the manuscript. SL and WY revised the manuscript. All the authors contributed to the article and approved the submitted version. Funding This work did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector. Consent for publication Not applicable Competing interests All the authors declare that they have no competing financial interests. Ethical statement The portions of this study involving human participants, human materials, or human data were conducted in accordance with the Declaration of Helsinki and were approved by the NCHS Ethics Review Board. The patients/participants provided written informed consent to participate in this study. Data availability The survey data are publicly available on the internet for data users and researchers throughout the world (www.cdc.gov/nchs/nhanes/). References Huang Y, Yan S, Dong X, Jiao X, Wang S, Li D, et al. Deficiency of MST1 in endometriosis related peritoneal macrophages promoted the autophagy of ectopic endometrial stromal cells by IL-10. Front Immunol. 2022;13:993788. Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, et al. Endometriosis. Endocr Rev. 2019;40(4):1048-79. França PRC, Lontra ACP, Fernandes PD. Endometriosis: A Disease with Few Direct Treatment Options. Molecules. 2022;27(13). Cui X, Zhou S, Lin Y. 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Tables Characteristics Overall (N=2235) Non-endometriosis (N=2060) Endometriosis (N=175) P value Age (years) 0.095 ≤40 1455 (58.2%) 1368 (59.0%) 87 (51.3%) >40 780 (41.8%) 692 (41.0%) 88 (48.7%) Age at menarche (years) 0.387 <12 509 (21.3%) 464 (20.8%) 45 (25.0%) 12-13 1187 (54.6%) 1089 (54.7%) 98 (53.9%) ≥14 539 (24.2%) 507 (24.5%) 32 (21.1%) PIR 0.419 3.0 805 (43.9%) 725 (43.2%) 80 (50.1%) BMI (kg/m 2 ) 0.149 <25 776 (42.0%) 720 (42.6%) 56 (36.5%) ≥25 1459 (58.0%) 1340 (57.4%) 119 (63.5%) Smoked ≥ 100cigarettes 0.002 YES 858 (43.1%) 768 (41.4%) 90 (57.6%) NO 1377 (56.9%) 1292 (58.6%) 85 (42.4%) Race/ethnicity 0.001 Mexican American 497 (7.4%) 488 (8.0%) 9 (1.4%) Other Hispanic 96 (5.7%) 91 (6.1%) 5 (2.0%) Non-Hispanic White 1088 (70.6%) 965 (69.0%) 123 (84.8%) Non-Hispanic Black 457 (11.6%) 425 (12.1%) 32 (7.9%) Other 97 (4.7%) 91 (4.8%) 6 (3.9%) Marital status 0.010 Married/Living with partner 1499 (68.3%) 1380 (67.3%) 119 (77.3%) Never married 414 (14.6%) 391 (18.2%) 23 (7.3%) Widowed/Divorced/Separated 322 (17.0%) 289 (14.5%) 33 (15.4%) Education level 0.112 High school and below 507 (15.8%) 486 (16.2%) 21 (11.5%) Above high school 1728 (84.2%) 1574 (83.8%) 154 (88.5%) Hypertension 0.287 YES 406 (18.9%) 358 (18.5%) 48 (21.9%) NO 1829 (81.1%) 1702 (81.5%) 127 (78.1%) Diabetes 0.436 YES 97 (3.4%) 90 (3.5%) 7 (2.6%) NO 2138 (96.6%) 1970 (96.5%) 168 (97.4%) Alcohol intake 0.850 YES 1376 (68.2%) 1257 (68.1%) 119 (69.1%) NO 859 (31.8%) 803 (31.9%) 56 (30.9%) Oral contraceptive 0.020 YES 1742 (80.8%) 1586 (79.9%) 156 (89.3%) NO 493 (19.2%) 474 (20.1%) 19 (10.7%) CRP (mg/dL) 0.47 (0.73) 0.46 (0.74) 0.57 (0.67) 0.041 Fasting triglyceride (mg/dL) 121.62 (99.40) 117.20 (81.42) 160.52 (192.34) 0.007 Fasting glucose, mg/dl 94.32 (20.48) 94.29 (20.45) 94.56 (20.84) 0.857 TyG 8.48 (0.58) 8.45 (0.56) 8.68 (0.68) <0.001 Total cholesterol (mg/dL) 195.51 (40.22) 194.35 (39.89) 205.78 (41.79) 0.001 CTI 7.83 (0.95) 7.79 (0.94) 8.20 (0.98) <0.001 Values are mean±SD or number (%). P < 0.05 was deemed significant. BMI body mass index, CRP C-reactive protein, TyG triglyceride glucose index, CTI C-reactive protein-triglyceride glucose index, PIR poverty income ratio. Table 2 Association between CTI and endometriosis Exposures OR (95% CI) P Model 1 Model 2 Model 3 CTI (continuous) 1.563 (1.295-1.885) <0.001 1.609 (1.334-1.941) <0.001 1.565 (1.246-1.966) <0.001 CTI (Quartiles) Q1 Reference Reference Reference Q2 2.105 (0.965-4.593) 0.061 2.153 (0.976-4.747) 0.057 2.000 (0.901-4.442) 0.087 Q3 1.838 (0.850-3.976) 0.120 1.976 (0.895-4.363) 0.090 1.695 (0.777-3.698) 0.179 Q4 3.430 (1.589-7.402) 0.002 3.615 (1.667-7.839) 0.002 3.029 (1.306-7.025) 0.011 P for trend 0.005 0.003 0.051 Model 1: unadjusted model. Model 2: adjusted for age, ethnicity. Model 3: further adjusted for PIR, BMI, education level, marital status, smoking habits, hypertension, diabetes, drinking status, age at menarche, total cholesterol, and the use of contraceptive pills. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Jan, 2025 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Revision requested 03 Dec, 2024 Reviews received at journal 02 Dec, 2024 Reviews received at journal 27 Nov, 2024 Reviewers agreed at journal 27 Nov, 2024 Reviews received at journal 24 Nov, 2024 Reviewers agreed at journal 21 Nov, 2024 Reviewers agreed at journal 21 Nov, 2024 Reviews received at journal 21 Nov, 2024 Reviewers agreed at journal 20 Nov, 2024 Reviewers agreed at journal 20 Nov, 2024 Reviewers agreed at journal 19 Nov, 2024 Reviewers agreed at journal 19 Nov, 2024 Reviewers agreed at journal 19 Nov, 2024 Reviewers invited by journal 09 Oct, 2024 Editor invited by journal 09 Oct, 2024 Editor assigned by journal 01 Oct, 2024 Submission checks completed at journal 01 Oct, 2024 First submitted to journal 30 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5181764","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":385494608,"identity":"d650e126-c445-4ab2-babc-df7d717f884e","order_by":0,"name":"Yanan Ren","email":"","orcid":"","institution":"Hebei General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yanan","middleName":"","lastName":"Ren","suffix":""},{"id":385494609,"identity":"8a17a3b1-66da-43ee-8191-a0c373c3254f","order_by":1,"name":"Ren Xu","email":"","orcid":"","institution":"Hebei General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ren","middleName":"","lastName":"Xu","suffix":""},{"id":385494610,"identity":"21cb90eb-4cee-4b76-a044-6094581f2596","order_by":2,"name":"Junqin Zhang","email":"","orcid":"","institution":"Hebei General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Junqin","middleName":"","lastName":"Zhang","suffix":""},{"id":385494611,"identity":"bcbac3a3-ce6a-4d88-997d-f2a595c9b077","order_by":3,"name":"Ying Jin","email":"","orcid":"","institution":"Hebei General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Jin","suffix":""},{"id":385494612,"identity":"42054f93-16b2-40e9-945e-0a1b4accc3f0","order_by":4,"name":"Di Zhang","email":"","orcid":"","institution":"Hebei General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Di","middleName":"","lastName":"Zhang","suffix":""},{"id":385494613,"identity":"485bead7-694a-491e-ba72-a38a8d6c8a94","order_by":5,"name":"Yazhuo Wang","email":"","orcid":"","institution":"Hebei General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yazhuo","middleName":"","lastName":"Wang","suffix":""},{"id":385494614,"identity":"3d1efad8-9a0b-44f8-bb60-e152767b5ab9","order_by":6,"name":"Luyang Su","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYBACPhiDjb35wIEPBjZ2BLWwwfXyHEt8OKMgLZl4LXISOcbGPB8OMTYQ1CKRY/i54FddYptEjpm0jcEBZgb2w0c3ENBiLD2z73BiG8+zMukcgzt8DDxpaTcIaDGQ5u05kNjGnrwNqOUZM4MEjxkhLca/eXuADmNIMJO2MDjM2ECEFjNpnh/MiW0cKcbGDERpAXrBmrfhsHEbKJB7DNKS2Qj5hZ89efNtnj91svPbgVH544+NHT/74WN4tTAwcBgwMLYh24tfOQiwP2Bg+ENY2SgYBaNgFIxgAAD1kkgPi6kIbgAAAABJRU5ErkJggg==","orcid":"","institution":"Hebei General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Luyang","middleName":"","lastName":"Su","suffix":""}],"badges":[],"createdAt":"2024-09-30 14:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5181764/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5181764/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-024-03541-x","type":"published","date":"2025-01-09T15:58:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71477886,"identity":"1f09baad-b738-4374-9f8a-fa089f98aaf2","added_by":"auto","created_at":"2024-12-16 05:27:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":70475,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of eligible participants selection\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5181764/v1/ee73ed76fec74b0ad0a8ee51.png"},{"id":71477875,"identity":"7b8f56f7-2466-43d7-a0bf-f88558a87c64","added_by":"auto","created_at":"2024-12-16 05:27:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35066,"visible":true,"origin":"","legend":"\u003cp\u003eRestricted cubic splines for associations between CTI and endometriosis.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5181764/v1/7f978ae94c78ebead47cc218.png"},{"id":71477879,"identity":"f8818642-4c17-483a-8c8e-dea2d15af581","added_by":"auto","created_at":"2024-12-16 05:27:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":112472,"visible":true,"origin":"","legend":"\u003cp\u003eSubgroup analysis of the association between the remnant CTI and endometriosis.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5181764/v1/f8d326f3a203bd3084f4f7c4.png"},{"id":73694089,"identity":"c90f0a4d-bffb-4f04-9899-b9e025bfcbda","added_by":"auto","created_at":"2025-01-13 16:10:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":954900,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5181764/v1/df73d4ee-6c8b-49cb-bf0a-28dd4943683e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Associations between C-reactive protein-triglyceride glucose index and Endometriosis: the NHANES 1999-2006","fulltext":[{"header":"1. Background","content":"\u003cp\u003eEndometriosis is a common, chronic, inflammatory, benign gynecological disorder characterized by the growth of endometrioid tissue outside the uterine cavity, with a prevalence of about 10 per cent in people of childbearing age. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The standard method for diagnosing endometriosis is laparoscopically guided biopsy(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), which often leads to significant delays in diagnosis, typically ranging from 6\u0026ndash;11 years.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).The development of innovative diagnostic methods and predictive biomarkers is essential for improving diagnostic accuracy and sensitivity, ultimately enhancing patients' quality of life.\u003c/p\u003e \u003cp\u003eThe C-reactive protein-triglyceride glucose index (CTI) is gaining recognition as a new metric for thoroughly evaluating the severity of inflammation and insulin resistance (IR). The CTI is calculated via the following formula: 0.412 \u0026times; ln(CRP)\u0026thinsp;+\u0026thinsp;ln[T.G. (mg/dL) \u0026times; FPG (mg/dL)/2]. A novel metric termed the \"CTI\" provide a comprehensive assessment of both inflammatory status and IR(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).CTI is the sole metric that combines the intensity of inflammation and IR, and it has been recognized as valuable for predicting survival rates in a Chinese cancer population(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).Additionally, CTI is a straightforward and quick indicator that incurs no extra costs beyond standard laboratory tests. As a result, in the general population without imposing any further financial burden on patients or the healthcare system. Elevated CRP levels demonstrate a systemic inflammatory response(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).Endometriosis is a complex chronic inflammatory disease(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). IR is a pathological condition that impairs glucose metabolism in tissue cells, and can lead to metabolic complications such as hyperglycemia, hyperlipidemia, and obesity.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Recent studies indicated that insulin sensitivity is diminished in endometriosis cells, leading to the upregulation of the glycolytic pathway and increased lactate levels in follicular fluid. This mechanism contributes to inflammation, angiogenesis, and cell proliferation(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).Considering these viewpoints, it is important to investigate the potential link between CTI and the risk of developing endometriosis. Thus, our aim was to explore the relationship between CTI and endometriosis by analyzing a substantial study from the 1999\u0026ndash;2006 National Health and Nutrition Examination Survey (NHANES), with the intention of offering compelling evidence for this association.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003e \u003cb\u003eStudy population\u003c/b\u003e \u003c/p\u003e \u003cp\u003e The NHANES, a nationally representative study, which procedures were approved by the Research Ethics Review Board of the National Center for Health Statistics (NCHS), were conducted by the Centers for Disease Control and Prevention. The consent were written by all participants provided at the time of enrollment.\u003c/p\u003e \u003cp\u003eA total number of 41474 individuals from four consecutive 2-year NHANES cycles (1999\u0026ndash;2000, 2001\u0026ndash;2002, 2003\u0026ndash;2004, 2005\u0026ndash;2006) were included in this study. We included 2235 female participants aged 20\u0026ndash;50 years and excluded participants with missing data on endometriosis, CTI, and other covariates. Ultimately, participants who satisfied these criteria were assigned to the endometriosis or control group according to their diagnosis.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEndometriosis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA questionnaire-based survey asking\u0026ldquo;Has a doctor or other health professional ever told you that you had endometriosis (age at interview 20\u0026ndash;54 years)?\u0026rdquo;were collected to diagnose endometriosis. Participants who responded affirmatively were classified as endometriosis group, otherwise they were in the control group.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMeasurement of the CTI\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe CTI(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) was calculated as following: CTI\u0026thinsp;=\u0026thinsp;0.412 \u0026times; Ln (CRP)\u0026thinsp;+\u0026thinsp;TyG (TyG\u0026thinsp;=\u0026thinsp;Ln [fasting triglyceride (TG) (mg/dL) \u0026times; fasting glucose (FPG) (mg/dL)/2])(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Blood samples were collected in the morning after an 8.5-hour fast and processed in NCHS-certified laboratories. Serum triglyceride levels were assessed via Roche Modular P and Roche Cobas 6000 chemistry analyzers, while FPG was assessed via the oxygen rate method on a Beckman DxC800(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). CRP concentrations were determined via latex-enhanced nephelometry by Behring Nephelometer(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Additional details about the laboratory procedures are available on the official NHANES website. Usually, an elevated CTI suggests a more severe level of inflammation and insulin resistance (IR). (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eCovariables\u003c/b\u003e \u003c/p\u003e \u003cp\u003eCovariates included age, age at menarche (years), income-to-poverty ratio (PIR),and body mass index (BMI), Smoked\u0026thinsp;\u0026ge;\u0026thinsp;100 cigarettes, race/ethnicity, marital status, education level, hypertension, diabetes, alcohol intake, oral contraceptives, CRP (mg/dL), fasting triglyceride (mg/dL), fasting glucose, mg/dl, triglyceride glucose index (TyG), total cholesterol (mg/dL), CTI. Age was categorized into two groups according to clinical relevance (\u0026le;\u0026thinsp;40years and \u0026gt;\u0026thinsp;40 years). BMI was classified as normal (\u0026lt;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e) or overweight (\u0026ge;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e) on the basis of clinical significance. Smoking status was categorized based on having smoked at least 100 cigarettes in their lifetime (yes, no as the referent). There were 3 levels for the poverty income ratio (PIR): less than 1.3, between 1.5 and 3.0, and 3.0 or greater.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTo assess the differences between the two groups under consideration, Student's t test was used for continuous variables. This test helps determine if there are statistically significant differences in means between the two groups. For categorical variables, the Chi-square test was employed, which evaluates whether there was a significant association between the categorical outcomes across the groups. By selecting these appropriate statistical methods, the analysis ensured robust evaluation of the data.\u003c/p\u003e \u003cp\u003eTo assess the relationships of the CTI with endometriosis logistic regression models were constructed. Three models were constructed: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Model 1 (unadjusted model) and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Model 2 (adjusted for age, ethnicity) and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Model 3 (additionally adjusted for PIR, BMI, education level, marital status, smoking habits, hypertension, diabetes, drinking status, age at menarche, total cholesterol, and the use of contraceptive pills). The relationship between an increase of 1 mg/dL in the CTI and endometriosis. In addition, stratified analyses were conducted according to the participants' age, BMI, age at menarche, smoking status, drinking, marital status, and use of oral contraceptives. The prevalence was calculated as odds ratios (ORs) along with their 95% confidence intervals (CIs).\u003c/p\u003e \u003cp\u003eTo flexibly model the association between the CTI and the prevalence of incidence endometriosis, restricted cubic splines with three knots were applied.\u003c/p\u003e \u003cp\u003eR statistical software (version 4.2) and EmpowerStats (version 5.0) (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.empowerstats.net\u003c/span\u003e\u003cspan address=\"http://www.empowerstats.net\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) were used to analyze. A \u003cem\u003eP\u003c/em\u003e value of less than 0.05 was deemed statistically significant for all analyses.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetween 1999 and 2006, the NHANES study included 6,508 participants. Among them, 951 participants were excluded due to endometriosis, 3,050 due to CTI, and 272 due to incomplete covariate information. Ultimately, 2,235 participants were included in the final analysis.Ultimately, based on diagnosis of the endometriosis,175 participants in endometriosis group and 2060 in the control group were included on the basis of the diagnosis of endometriosis(Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1 provides an overview of the descriptive characteristics of the participants included in the study. A total of 175 individuals, accounting for 7.83%, reported having endometriosis, whereas 2060 (92.17%) did not. Participants with endometriosis were more likely to have used oral contraceptives for birth control and were more often non-Hispanic white women, compared to those without the condition. Moreover, endometriosis sufferers have higher rates of smoking and marriage, and are more likely to be obese. It is worth noting that their CRP, TyG, fasting triglyceride, total cholesterol, and CTI levels are also higher than those in patients without endometriosis.(Table\u0026nbsp;1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociations between the CTI and endometriosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the association between the CTI and endometriosis, analyzed through three different models. In all the models, a continuous increase in the CTI was significantly associated with an elevated prevalence rate of endometriosis. Specifically, in the unadjusted model (Model 1), OR for continuous CTI was 1.563 (95% CI: 1.295\u0026ndash;1.885, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas in the model adjusted for age and ethnicity (Model 2), the OR slightly increased to 1.609 (95% CI: 1.334\u0026ndash;1.941, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). After further adjustment for various factors including BMI, PIR, education level, and lifestyle habits (Model 3), the OR remained significant at 1.565 (95% CI: 1.246\u0026ndash;1.966, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating a consistent relationship between higher CTI and the risk of endometriosis. When stratified by quartiles, the highest quartile of CTI (Q4) was associated with significantly increased odds of endometriosis across all the models, with ORs of 3.430 (95% CI: 1.589\u0026ndash;7.402, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) in Model 1, 3.615 (95% CI: 1.667\u0026ndash;7.839, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) in Model 2, and 3.029 (95% CI: 1.306\u0026ndash;7.025, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011) in Model 3. These results suggest that an elevated CTI is strongly associated with an increased risk of endometriosis, even after controlling for multiple demographic and clinical factors.\u003c/p\u003e\n\u003cp\u003eIn Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, the relationship of the predicted values was visualized by plotting the restricted cubic splines. A nonlinear positive relationship between CTI and prevalence of endometriosis was observed (nonlinearity \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.603), with a breakpoint identified at 8.053.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubgroup analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the stratified assessment by age, age at menarche, BMI, smoking, drinking, marital status, and use of oral contraceptives are shown in Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. Those\u0026thinsp;\u0026gt;\u0026thinsp;40 years old, with a BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e, who smoke smoking\u0026thinsp;\u0026ge;\u0026thinsp;100 cigarettes, who are married or living with a partner, and who consume oral contraceptives are intake showed more vulnerable. Following the stratification of analyses on the basis of drinking habits, comparable results were found regarding the positive associations between the CTI and the prevalence of endometriosis\u003c/p\u003e\n\u003cp\u003eFurthermore, a higher endometriosis prevalence with CTI in \u0026gt;\u0026thinsp;40 years old (OR\u0026thinsp;=\u0026thinsp;1.57, 95% CI: 1.16, 2.13), BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e (OR\u0026thinsp;=\u0026thinsp;1.38, 95% CI: 1.06,1.80), smoking\u0026thinsp;\u0026ge;\u0026thinsp;100 cigarettes (OR\u0026thinsp;=\u0026thinsp;1.43, 95% CI: 1.06, 1.96), being married or living with a partner (OR\u0026thinsp;=\u0026thinsp;1.41, 95% CI: 1.09, 1.85) and taking oral contraceptives intaking (OR\u0026thinsp;=\u0026thinsp;1.35, 95% CI: 1.07, 1.69) was observed.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this cross-sectional study that involving 2235 representative participants, we found positive associations between CTI and endometriosis with a threshold concentration of approximately 8.053 mg/dL. Our conclusions indicate that individuals with endometriosis are generally older and chiefly non-Hispanic white. The diagnosis of endometriosis is frequently delayed, typically occurring 6\u0026ndash;11 years after the initial symptoms appear, which likely accounts for the older age of these patients(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).The increased incidence among white individuals may be associated with a greater racial susceptibility. Additionally, we Recorded that individuals who are obese or have a history of smoking are more prone to developing endometriosis. This may be because of the inflammatory response triggered by smoking(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), while higher estrogen levels in obese patients could also promote the development of endometriosis(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEndometriosis is a prevalent chronic condition among women of reproductive age, impacting approximately 10% of this population(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).There are several theories regarding the pathogenesis of endometriosis, with the leading theories being that ectopic endometrial-like glands and stroma may arise from the metaplasia of local tissue or from the transplanted ectopic endometrium(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This implies that normal endometrial cells may undergo changes in other parts of the body, resulting in the formation of new pathological tissue. Furthermore, elevated levels of local estrogen are believed to play a crucial role in this process, as they not only aid in the survival and implantation of ectopic endometriotic lesions but also promote their proliferation(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Nevertheless, the precise physiopathology remains unclear. Recent research has highlighted the potential contributions of inflammation and oxidative stress in this context(\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). A cohort study conducted in Japan also suggested that consuming a diverse range of anti-inflammatory foods, such as vegetables, may ultimately impact perinatal mortality and morbidity in patients with endometriosis(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).A recent cross-sectional analysis revealed that the dietary inflammatory index was positively associated with the prevalence of endometriosis(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).The inflammatory nature of endometriosis has been well established over the years(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).Considering the central role of inflammation in the pathogenesis of endometriosis, addressing inflammatory dysfunctions has emerged as a promising strategy for developing new treatments(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). This approach provides avenues for exploring innovative options for both the prevention and management of this disease.\u003c/p\u003e \u003cp\u003eThe results of our study are consistent with earlier research regarding the significant association between inflammation and endometriosis(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Similarly, several studies have shown that chronic inflammation plays a crucial role in the pathogenesis of endometriosis(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). For example, research utilizing the dietary inflammatory index (DII) revealed a positive association between pro-inflammatory diets and the prevalence of endometriosis(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Similar to our findings, higher inflammatory indicators, such as CRP and TyG indices,are significantly associated with endometriosis (\u003cspan additionalcitationids=\"CR38 CR39\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).This similarity emphasizes the role of systemic inflammation in the progression of endometriosis and supports the hypothesis that inflammatory processes are central to disease development(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, the role of demographic and lifestyle considerations, including smoking and BMI(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e), was more prominently analyzed in our study, revealing that these factors might modulate the relationship between inflammation and endometriosis. This provides a more nuanced understanding of how lifestyle and metabolic factors interact with inflammatory processes to influence the risk of endometriosis.\u003c/p\u003e \u003cp\u003eA key strength of this study lies in its foundation of a weighted and representative population with a substantial sample size. It should be emphasized that we also Implemented the restricted cubic splines analysis. Nevertheless, this study has a number of limitations. First, owing to the cross-sectional design, it is hard to determine the causation between CTI and endometriosis. Second, because participants younger than 20 years were excluded, this findings may not be relevant to younger patients. Third, since most of the data were gathered through self-report questionnaires or interviews, the control group may unintentionally include individuals with undiagnosed endometriosis, potentially resulting in recall and reporting bias. Lastly, because of the limitations of the database, we could not incorporate data on all covariates related to endometriosis and inflammation levels to ensure a sufficiently large sample size. Therefore, future research should involve a more diverse population and take into account additional potential covariates to clarify the causal association between the CTI and endometriosis.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis research revealed a strong positive association of the CTI with endometriosis. Therefore, actively managing blood glucose levels and minimizing inflammatory responses may aid in decreasing the prevalence of endometriosis.However, additional foundational research is necessary to investigate the possible relationships among them.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eC-reactive protein-triglyceride glucose (CTI)\u003c/p\u003e\n\u003cp\u003eEndometriosis (EM)\u003c/p\u003e\n\u003cp\u003eNational Health and Nutrition Examination Survey (NHANES)\u003c/p\u003e\n\u003cp\u003eFamily income-to-poverty ratio (PIR)\u003c/p\u003e\n\u003cp\u003eNational Center for Health Statistics (NCHS)\u003c/p\u003e\n\u003cp\u003eBody mass index (BMI)\u003c/p\u003e\n\u003cp\u003eTriglyceride Glucose Index(TyG)\u003c/p\u003e\n\u003cp\u003einsulin \u0026nbsp;resistance (IR)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all participants in this study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRY, XR, and SL designed the research. RY, ZJ, and JY collected and analyzed the data and drafted the manuscript. SL and WY revised the manuscript. All the authors contributed to the article and approved the submitted version.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors declare that they have no competing financial interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe portions of this study involving human participants, human materials, or human data were conducted in accordance with the Declaration of Helsinki and were approved by the NCHS Ethics Review Board. The patients/participants provided written informed consent to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe survey data are publicly available on the internet for data users and researchers throughout the world (www.cdc.gov/nchs/nhanes/).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHuang Y, Yan S, Dong X, Jiao X, Wang S, Li D, et al. Deficiency of MST1 in endometriosis related peritoneal macrophages promoted the autophagy of ectopic endometrial stromal cells by IL-10. Front Immunol. 2022;13:993788.\u003c/li\u003e\n\u003cli\u003eBulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, et al. Endometriosis. Endocr Rev. 2019;40(4):1048-79.\u003c/li\u003e\n\u003cli\u003eFran\u0026ccedil;a PRC, Lontra ACP, Fernandes PD. Endometriosis: A Disease with Few Direct Treatment Options. Molecules. 2022;27(13).\u003c/li\u003e\n\u003cli\u003eCui X, Zhou S, Lin Y. 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C-reactive protein promotes platelet adhesion to endothelial cells: a potential pathway in atherothrombosis. Br J Haematol. 2006;134(4):426-31.\u003c/li\u003e\n\u003cli\u003eRiccio LGC, Baracat EC, Chapron C, Batteux F, Abr\u0026atilde;o MS. The role of the B lymphocytes in endometriosis: A systematic review. J Reprod Immunol. 2017;123:29-34.\u003c/li\u003e\n\u003cli\u003eVercellini P, Salmeri N, Somigliana E, Piccini M, Caprara F, Vigan\u0026ograve; P, et al. M\u0026uuml;llerian anomalies and endometriosis as potential explanatory models for the retrograde menstruation/implantation and the embryonic remnants/celomic metaplasia pathogenic theories: a systematic review and meta-analysis. Hum Reprod. 2024.\u003c/li\u003e\n\u003cli\u003eSchink M, Konturek PC, Herbert SL, Renner SP, Burghaus S, Blum S, et al. Different nutrient intake and prevalence of gastrointestinal comorbidities in women with endometriosis. J Physiol Pharmacol. 2019;70(2).\u003c/li\u003e\n\u003cli\u003eDang K, Wang X, Hu J, Zhang Y, Cheng L, Qi X, et al. The association between triglyceride-glucose index and its combination with obesity indicators and cardiovascular disease: NHANES 2003-2018. Cardiovasc Diabetol. 2024;23(1):8.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cimg 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\" width=\"250\" height=\"21\"\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"126%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=2235)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-endometriosis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=2060)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEndometriosis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=175)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026le;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1455 (58.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1368 (59.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e87 (51.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026gt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e780 (41.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e692 (41.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e88 (48.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eAge at menarche (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026lt;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e509 (21.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e464 (20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e45 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e12-13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1187 (54.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1089 (54.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e98 (53.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026ge;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e539 (24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e507 (24.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e32 (21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003ePIR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026lt;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e623 (21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e584 (21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e39 (21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e1.3-3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e807 (34.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e751 (35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e56 (28.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026gt;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e805 (43.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e725 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e80 (50.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026lt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e776 (42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e720 (42.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e56 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026ge;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1459 (58.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1340 (57.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e119 (63.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eSmoked\u0026nbsp;\u0026ge;\u0026nbsp;100cigarettes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e858 (43.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e768 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e90 (57.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1377 (56.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1292 (58.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e85 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eRace/ethnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eMexican American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e497 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e488 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e9 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eOther Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e96 (5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e91 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e5 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eNon-Hispanic White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1088 (70.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e965 (69.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e123 (84.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eNon-Hispanic Black\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e457 (11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e425 (12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e32 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e97 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e91 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e6 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eMarried/Living with partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1499 (68.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1380 (67.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e119 (77.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eNever married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e414 (14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e391 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e23 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eWidowed/Divorced/Separated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e322 (17.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e289 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e33 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eHigh school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e507 (15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e486 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e21 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eAbove high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1728 (84.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1574 (83.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e154 (88.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e406 (18.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e358 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e48 (21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1829 (81.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1702 (81.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e127 (78.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.436\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e97 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e90 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e7 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2138 (96.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1970 (96.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e168 (97.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eAlcohol intake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.850\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1376 (68.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1257 (68.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e119 (69.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e859 (31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e803 (31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e56 (30.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eOral contraceptive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1742 (80.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1586 (79.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e156 (89.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e493 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e474 (20.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e19 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eCRP (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.47 (0.73)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.46 (0.74)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.57 (0.67)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eFasting triglyceride (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e121.62 (99.40)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e117.20 (81.42)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e160.52 (192.34)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eFasting glucose, mg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e94.32 (20.48)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e94.29 (20.45)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e94.56 (20.84)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eTyG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8.48 (0.58)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8.45 (0.56)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e8.68 (0.68)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eTotal cholesterol (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e195.51 (40.22)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e194.35 (39.89)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e205.78 (41.79)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eCTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7.83 (0.95)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7.79 (0.94)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e8.20 (0.98)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eValues are mean\u0026plusmn;SD or number (%). P \u0026lt; 0.05 was deemed significant. BMI body mass index, CRP C-reactive protein, TyG triglyceride glucose index, CTI C-reactive protein-triglyceride glucose index, PIR poverty income ratio.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eAssociation between CTI and endometriosis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"779\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 646px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;CTI (continuous)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003e1.563 (1.295-1.885) \u0026nbsp; \u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e1.609 (1.334-1.941) \u0026nbsp; \u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e1.565 (1.246-1.966) \u0026nbsp; \u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;CTI (Quartiles)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eQ1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eQ2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003e2.105 (0.965-4.593) \u0026nbsp; 0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e2.153 (0.976-4.747) \u0026nbsp; \u0026nbsp;0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e2.000 (0.901-4.442) \u0026nbsp; 0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eQ3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003e1.838 (0.850-3.976) \u0026nbsp; 0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e1.976 (0.895-4.363) \u0026nbsp; \u0026nbsp;0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e1.695 (0.777-3.698) \u0026nbsp; 0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eQ4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003e3.430 (1.589-7.402) \u0026nbsp; 0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e3.615 (1.667-7.839) \u0026nbsp; \u0026nbsp;0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e3.029 (1.306-7.025) \u0026nbsp; 0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e for trend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 779px;\"\u003e\n \u003cp\u003eModel 1: unadjusted model.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 779px;\"\u003e\n \u003cp\u003eModel 2: adjusted for age, ethnicity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 779px;\"\u003e\n \u003cp\u003eModel 3: further adjusted for PIR, BMI, education level, marital status, smoking habits, hypertension, diabetes, drinking status, age at menarche, total cholesterol, and the use of contraceptive pills.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"C-reactive protein-triglyceride glucose index, endometriosis, inflammation, NHANES","lastPublishedDoi":"10.21203/rs.3.rs-5181764/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5181764/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The C-reactive protein-triglyceride glucose index (CTI), a promising new marker, could evaluate the extent of inflammation. Endometriosis is a prevalent chronic inflammatory condition that is influenced by estrogen and primarily impacts individuals of reproductive age. However, no investigated have shown association of the CTI with endometriosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In total, 2235 women in National Health and Nutrition Examination Survey from the 1999-2006 were included. The CTI was defined as 0.412 × ln (CRP) + ln [T.G. (mg/dL) × FPG (mg/dL)/2]. Multivariate logistic regression, restricted cubic splines, and subgroup analyses were employed to examine the association of CTI with endometriosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults：\u003c/strong\u003eTotally 2235 women were included, of whom 175 (7.82%) had endometriosis and 2060(92.18%) did not have endometriosis (named control). In comparison to the control group, patients exhibited a tendency toward higher CTI levels (\u003cem\u003eP\u003c/em\u003e =0.005). CTI levels were positive associated with the prevalence of endometriosis (\u003cem\u003eP\u003c/em\u003e =0.011). In Model 1, 1 mg/dL increment in CTI was associated with a 56% higher prevalence of endometriosis (OR: 1.563, 95% CI: 1.295–1.885, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). This association in Model 2 (OR: 1.609, 95% CI: 1.334-1.941, \u003cem\u003eP\u003c/em\u003e ＜ 0.001) and Model 3 (OR: 1.565, 95% CI: 1.246–1.966, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) remained significant. Notably, individuals in the uppermost RC tertial exhibited a notably greater prevalence of endometriosis than those in the lowest tertial (OR = 3.029, \u003cem\u003eP\u003c/em\u003e for trend = 0.051). The results from the restricted cubic splines indicated a nonlinear positive association between CTI and the prevalence of endometriosis. In addition, the higher endometriosis prevalence with CTI in \u0026gt;40 years (OR = 1.57, 95% CI:1.16 , 2.13), BMI ≥25 kg/m\u003csup\u003e2\u003c/sup\u003e (OR =1.38, 95% CI: 1.06,1.80), smoking ≥ 100 cigarettes (OR =1.43, 95% CI: 1.06, 1.96), married or living with partner (OR =1.41, 95% CI: 1.09, 1.85) and taking oral contraceptives\u0026nbsp; (OR =1.35, 95% CI: 1.07, 1.69) was observed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e CTI is positively associated with endometriosis in US women. Therefore, the use of CTI as a new indicator of inflammation may help provide new insights into the prevention and management of endometriosis.\u003c/p\u003e","manuscriptTitle":"Associations between C-reactive protein-triglyceride glucose index and Endometriosis: the NHANES 1999-2006","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-16 05:26:31","doi":"10.21203/rs.3.rs-5181764/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-03T05:54:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-02T09:03:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-27T08:57:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64372609661619753103503394166272917847","date":"2024-11-27T08:49:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-24T09:02:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159155295360409453904679821726569131755","date":"2024-11-21T18:50:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206095337263842528581199570560498959169","date":"2024-11-21T16:56:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-21T07:28:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122024202513089537808638696925932041400","date":"2024-11-20T12:28:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33441669088447208846211689912767276143","date":"2024-11-20T10:12:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53855120706946625642250881959095016721","date":"2024-11-19T18:46:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121205940694860184057029973753495512062","date":"2024-11-19T17:18:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221123807710001571692866529118400436288","date":"2024-11-19T17:11:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-09T09:10:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-10-09T06:45:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-01T08:56:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-01T06:39:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2024-09-30T14:41:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"76f1a52b-b272-4573-963c-35d6754ec650","owner":[],"postedDate":"December 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T16:04:58+00:00","versionOfRecord":{"articleIdentity":"rs-5181764","link":"https://doi.org/10.1186/s12905-024-03541-x","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2025-01-09 15:58:01","publishedOnDateReadable":"January 9th, 2025"},"versionCreatedAt":"2024-12-16 05:26:31","video":"","vorDoi":"10.1186/s12905-024-03541-x","vorDoiUrl":"https://doi.org/10.1186/s12905-024-03541-x","workflowStages":[]},"version":"v1","identity":"rs-5181764","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5181764","identity":"rs-5181764","version":["v1"]},"buildId":"M1DPXKE8UapkOyQliHcFZ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}