Diagnostic value of insulin resistance indices for colorectal cancer: a study using the data from NHANES 2009-2018

Colorectal cancer (CRC) is a major global health burden, and its increasing incidence in younger adults underscores the need for simple, noninvasive biomarkers to aid in risk stratification. Metabolic dysfunction and insulin resistance play central roles in CRC pathogenesis. This study evaluated the associations of the uric acid to HDL cholesterol ratio (UHR), estimated glucose disposal rate (eGDR), homeostatic model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI) with CRC risk.

Data from 3656 participants (1074 CRC cases, 2582 non-CRC controls) were extracted from the NHANES 2009-2018 cycles. Insulin resistance indices were calculated using standard formulas. Logistic regression models assessed associations between indices and CRC risk, adjusting for demographic and metabolic covariates. Receiver operating characteristic (ROC) analysis was performed for significant predictors.

Patients with CRC were older, more frequently female, and had a higher prevalence of low HDL-C, obesity, elevated fasting blood glucose, elevated uric acid, and hypertension than controls (all P < 0.001). In the multivariable analysis, higher eGDR was independently associated with lower odds of CRC (adjusted OR = 0.42, 95% CI: 0.35-0.52), whereas higher QUICKI was independently associated with CRC (adjusted OR = 12.77, 95% CI: 9.19-17.74; both P < 0.001). ROC analysis identified optimal cut-off values of 11.19 for eGDR (AUC = 0.319) and 0.30 for QUICKI (AUC = 0.762; both P < 0.001).

Both eGDR and QUICKI were independently associated with CRC. While QUICKI demonstrated moderate discriminatory performance, eGDR showed poor diagnostic accuracy despite its significant association with CRC. Further prospective studies are warranted to validate these findings and clarify the role of metabolic indices in CRC screening and prevention strategies.