{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T07:03:55Z","timestamp":1782889435789,"version":"3.54.5"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The single-point insulin sensitivity estimator (SPISE), derived from triglycerides, high-density lipoprotein cholesterol, and body mass index, has emerged as an easily calculated marker of insulin sensitivity. Its association with atrial fibrillation (AF) has not been well defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cross-sectional study included 1,122 hospitalized participants, including 309 without AF, 409 with paroxysmal AF, and 404 with persistent AF. The association between SPISE and AF was examined with logistic regression by modeling SPISE continuously, per standard deviation (SD), and by quartiles. Restricted cubic splines were used to assess the shape of the association. Candidate variables were reduced by LASSO and then entered into univariable and multivariable logistic regression to construct the AF classification model. Model performance was evaluated with discrimination, calibration, decision-curve analysis, repeated 10-fold cross-validation, and bootstrap optimism correction. The incremental discriminative value of SPISE was assessed by changes in area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Lower SPISE was associated with AF after multivariable adjustment. In the fully adjusted model, the corresponding odds ratios were 0.68 (0.61\u20130.76) per unit increase and 0.56 (0.47\u20130.66) per SD increase. Compared with the lowest quartile, the highest quartile showed lower odds of AF, with an odds ratio of 0.36 (0.23\u20130.58). The relationship was predominantly linear. The AF classification model achieved an AUC of 0.859 (0.836\u20130.882), and the mean cross-validated C-statistic was 0.855. Adding SPISE increased AUC from 0.843 to 0.862 and significantly improved both NRI and IDI; however, the absolute AUC gain was small, although NRI and IDI improved statistically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lower SPISE was associated with AF after multivariable adjustment and added discriminative information beyond conventional clinical variables in this hospital-based sample. Given the small absolute improvement in AUC, SPISE should be interpreted as an adjunctive marker of AF-related metabolic phenotype rather than a stand-alone component of routine AF assessment. Prospective studies are needed to determine whether SPISE is related to incident AF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1862319","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:27:43Z","timestamp":1782883663000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Single-point insulin sensitivity estimator and atrial fibrillation: association and incremental discriminative value in a hospital-based population"],"prefix":"10.3389","volume":"17","author":[{"given":"Yuzhou","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xijia","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongrui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 esc guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"euaf027","DOI":"10.1093\/europace\/euaf027","article-title":"Global, regional, and national burden of atrial fibrillation and atrial flutter from 1990 to 2021: sex differences and global burden projections to 2046-a systematic analysis of the Global Burden of Disease Study 2021","volume":"27","author":"Tan","year":"2025","journal-title":"Europace"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjco.2024.11.017","article-title":"Trends in global burden and socioeconomic profiles of atrial fibrillation and atrial flutter: insights from the Global Burden of Disease Study 2021","volume":"7","author":"Tan","year":"2025","journal-title":"CJC Open"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(11)61514-6","article-title":"Atrial fibrillation","volume":"407","author":"Lane","year":"2026","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2023.12.011","article-title":"Impact of atrial fibrillation burden on health care costs and utilization","volume":"10","author":"Peigh","year":"2024","journal-title":"JACC Clin Electrophysiol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.116.023163","article-title":"Modifiable risk factors and atrial fibrillation","volume":"136","author":"Lau","year":"2017","journal-title":"Circulation"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.2174\/157340312803760749","article-title":"Obesity, diabetes and atrial fibrillation; epidemiology, mechanisms and interventions","volume":"8","author":"Asghar","year":"2012","journal-title":"Curr Cardiol Rev"},{"key":"B8","doi-asserted-by":"publisher","first-page":"02968-6","DOI":"10.1016\/j.hrthm.2025.10.015","article-title":"Insulin sensitivity, genetic predisposition, and risk of atrial fibrillation: a prospective cohort study","author":"Wang","year":"2025","journal-title":"Heart Rhythm"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2019.00135","article-title":"The association between diabetes mellitus and atrial fibrillation: clinical and mechanistic insights","volume":"10","author":"Bohne","year":"2019","journal-title":"Front Physiol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2024.116137","article-title":"Exerkine \u03b2-aminoisobutyric acid protects against atrial structural remodeling and atrial fibrillation in obesity via activating AMPK signaling and improving insulin sensitivity","volume":"171","author":"Qin","year":"2024","journal-title":"BioMed Pharmacother"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1177\/2047487320908706","article-title":"Association between insulin resistance and risk of atrial fibrillation in non-diabetics","volume":"27","author":"Lee","year":"2020","journal-title":"Eur J Prev Cardiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"6191","DOI":"10.1038\/s41598-023-46983-3","article-title":"Mendelian randomization study on insulin resistance and risk of hypertension and cardiovascular disease","volume":"14","author":"Zhang","year":"2024","journal-title":"Sci Rep"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v13.i29.108380","article-title":"Mini-review on insulin resistance assessment: advances in surrogate indices and clinical applications","volume":"13","author":"Moriyama","year":"2025","journal-title":"World J Clin cases"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-2339","article-title":"Defining insulin resistance from hyperinsulinemic-euglycemic clamps","volume":"35","author":"Tam","year":"2012","journal-title":"Diabetes Care"},{"key":"B15","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1038\/s41421-018-0016-3","article-title":"Evaluation of insulin sensitivity by hyperinsulinemic-euglycemic clamps using stable isotope-labeled glucose","volume":"4","author":"Zhang","year":"2018","journal-title":"Cell Discov"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2004.08.014","article-title":"Limitation of the validity of the homeostasis model assessment as an index of insulin resistance in Korea","volume":"54","author":"Kang","year":"2005","journal-title":"Metabolism"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1439901","article-title":"SPISE INDEX (Single point insulin sensitivity estimator): indicator of insulin resistance in children and adolescents with overweight and obesity","volume":"15","author":"Tantari","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.exger.2024.112578","article-title":"Association between single-point insulin sensitivity estimator and heart failure in older adults: a cross-sectional study","volume":"196","author":"Zhu","year":"2024","journal-title":"Exp Gerontol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.orcp.2024.08.002","article-title":"Single point insulin sensitivity estimator index for identifying metabolic syndrome in US adults: NHANES 2017-march 2020","volume":"18","author":"Cho","year":"2024","journal-title":"Obes Res Clin Pract"},{"key":"B20","doi-asserted-by":"publisher","first-page":"100","DOI":"10.3390\/metabo13010100","article-title":"Single point insulin sensitivity estimator (SPISE) as a prognostic marker for emerging dysglycemia in children with overweight or obesity","volume":"13","author":"Stein","year":"2023","journal-title":"Metabolites"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0338958","article-title":"Association of atherogenic index of plasma and triglyceride-glucose index with atrial fibrillation: a retrospective study","volume":"21","author":"Li","year":"2026","journal-title":"PloS One"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1111\/jch.13062","article-title":"The association between insulin resistance and atrial fibrillation: a cross-sectional analysis from SPRINT (Systolic Blood Pressure Intervention Trial)","volume":"19","author":"Cho","year":"2017","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"B23","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.amjcard.2011.08.008","article-title":"Insulin resistance and atrial fibrillation (from the Framingham Heart Study)","volume":"109","author":"Fontes","year":"2012","journal-title":"Am J Cardiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/s12933-024-02158-6","article-title":"Non-insulin-based insulin resistance indexes in predicting atrial fibrillation recurrence following ablation: a retrospective study","volume":"23","author":"Wang","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2348","DOI":"10.3390\/biomedicines13102348","article-title":"The triglyceride-glucose index: a clinical tool to quantify insulin resistance as a metabolic myocardial remodeling bridge in atrial fibrillation","volume":"13","author":"Luo","year":"2025","journal-title":"Biomedicines"},{"key":"B26","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1186\/s12933-024-02388-8","article-title":"The effect of non-insulin-based insulin resistance indices on the prediction of recurrence in patients with atrial fibrillation undergoing radiofrequency catheter ablation","volume":"23","author":"Luo","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1186\/s12933-025-02809-2","article-title":"The triglyceride-glucose index, a marker of insulin resistance, as a predictor of thrombotic risk in atrial fibrillation","volume":"24","author":"Rivera-Caravaca","year":"2025","journal-title":"Cardiovasc Diabetol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00645.2007","article-title":"Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage","volume":"294","author":"Muniyappa","year":"2008","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"B29","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s12933-019-0928-8","article-title":"Atrial fibrillation and its arrhythmogenesis associated with insulin resistance","volume":"18","author":"Chan","year":"2019","journal-title":"Cardiovasc Diabetol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.metabol.2018.10.011","article-title":"Obesity and cardiovascular disease: revisiting an old relationship","volume":"92","author":"Koliaki","year":"2019","journal-title":"Metabolism"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1111\/jpi.12851","article-title":"Melatonin increases susceptibility to atrial fibrillation in obesity via Akt signaling impairment in response to lipid overload","volume":"74","author":"Qin","year":"2023","journal-title":"J Pineal Res"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.771940","article-title":"Enhancing fatty acids oxidation via L-carnitine attenuates obesity-related atrial fibrillation and structural remodeling by activating AMPK signaling and alleviating cardiac lipotoxicity","volume":"12","author":"Zhang","year":"2021","journal-title":"Front Pharmacol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbadis.2023.166638","article-title":"Intermittent fasting attenuates obesity-related atrial fibrillation via SIRT3-mediated insulin resistance mitigation","volume":"1869","author":"Zhang","year":"2023","journal-title":"Biochim Biophys Acta Mol Basis Dis"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbadis.2017.12.038","article-title":"Dysregulation of insulin-sensitive glucose transporters during insulin resistance-induced atrial fibrillation","volume":"1864","author":"Maria","year":"2018","journal-title":"Biochim Biophys Acta Mol Basis Dis"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1862319\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:27:44Z","timestamp":1782883664000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1862319\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":34,"alternative-id":["10.3389\/fendo.2026.1862319"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1862319","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"article-number":"1862319"}}