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Blood Pressure Levels and Triglyceride-Glucose Index: A Cross-Sectional Study from a Nationwide Screening in Mongolia
(2025-09)
Dagvajantsan, Byambasuren
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Enebish, Oyunsuren
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Enkhtugs, Khangai
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Dangaa, Bayarbold
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Gantulga, Munkhtulga
Background: The triglyceride-glucose (TyG) index has emerged as a reliable surrogate marker of insulin resistance. This study aimed to investigate the association between blood pressure (BP) levels and the TyG index and to assess whether even modest elevations in BP were associated with higher TyG index values. Methods: A cross-sectional analysis was conducted using data from 120,264 participants who underwent nationwide health screening in Mongolia between 2023 and 2024. BP was categorized into five stages. The TyG index was calculated based on fasting triglyceride and glucose levels. Results: The mean TyG index increased progressively with advancing hypertension stages (p for trend <0.001). Multivariate analysis showed that even elevated BP was independently associated with a higher TyG index (adjusted OR 1.108, 95% CI 1.039-1.183; p = 0.002), with the association strengthening across hypertension stage 1 (adjusted OR 1.238, 95% CI 1.200-1.277), stage 2 (adjusted OR 1.516, 95% CI 1.463-1.572), and hypertensive crisis (adjusted OR 1.575, 95% CI 1.350-1.836) (all p < 0.001). Central obesity further amplified the association between hypertension stage and TyG index levels. Among participants without central obesity, the TyG index increased from 8.086 (95% CI: 8.079-8.093) in the normal BP group to 8.449 (8.362-8.536) in the hypertensive crisis group. Similarly, among those with central obesity, the TyG index rose from 8.345 (8.336-8.354) in the normal group to 8.732 (8.685-8.778) in the hypertensive crisis group. Conclusions: This study demonstrates that the TyG index rises consistently with increasing BP stages, even at early elevations, suggesting that insulin resistance may begin at modest blood pressure increases.
Scopus© Citations 2
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Examining Age-Adjusted Associations between BMI and Comorbidities in Mongolia: Cross-Sectional Prevalence
(2024-06)
Enkhtugs, Khangai
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Byambasukh, Oyuntugs
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Boldbaatar, Damdindorj
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Tsedev-Ochir, Tumur-Ochir
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Enebish, Oyunsuren
(1) Background: This study investigated the association between body mass index (BMI) categories and comorbidities in the context of a developing country, utilizing data from a nationwide health screening in Mongolia. (2) Methods: The study included 181,080 individuals (mean age 47.0 ± 15.3, 42.0% male) from the population-based general health screening. We counted the number of diseases from participants' medical records based on ICD-10 codes, excluding those categorized under Z00-Z99 and codes indicating acute disorders, as well as individuals classified as underweight. (3) Results: Among study participants, the prevalence of two or more comorbidities was 4.2%. The weight distribution comprised 40.4% normal weight; 37.1% overweight; and 16.9%, 4.4%, and 1.2% in the Class I, II, and III obesity categories, respectively. Comorbidities increased with BMI: normal weight (0.222); overweight (0.255); and Class I (0.290), Class II (0.302), and Class III obesity (0.303), suggesting a dose-dependent likelihood of having multiple diseases. Adjusted linear regression (beta coefficients, 95% CIs) showed increased comorbidity risks in overweight (0.017, 0.013-0.021) and obesity (0.034, 0.030-0.039). Interaction analysis with age revealed a significant effect (p < 0.001). While comorbidities tend to increase with higher BMI categories in all age-tertile groups, this association was notably stronger among younger individuals. (4) Conclusions: Obesity is associated with a twofold increase in the prevalence of multiple comorbidities compared to normal weight. Our findings also highlight the critical role of age in the development of multiple diseases, with BMI remaining a significant factor across various age groups, encompassing both younger and older adults.
Scopus© Citations 9
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Prevalence of Elevated Blood Triglycerides and Associated Risk Factors: Findings from a Nationwide Health Screening in Mongolia
(2024-11)
Enkhtugs, Khangai
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Tsedev-Ochir, Tumur-Ochir
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Yadamsuren, Enkhtur
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Bayartsogt, Batzorig
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Dangaa, Bayarbold
BACKGROUND: This study aims to assess the demographic, lifestyle, and clinical characteristics associated with varying levels of triglycerides (TGs) in a large population sample. METHODS: This cross-sectional study utilized data from a nationwide health screening program in Mongolia. A total of 125,330 participants (mean age: 43.8 ± 15.3 years) were included. TG levels were categorized into normal, borderline high, high, and very high. Due to the small number of participants in the very high TG group, they were combined with the high TG category for analysis. Multivariate logistic regression was performed to identify independent predictors of elevated TG levels. RESULTS: The majority of participants (80.3%) had normal TG levels, while 10.3% had borderline high, 8.7% had high, and 0.7% had very high TG levels. Significant predictors of elevated TG levels included age (OR 1.013, 95% CI 1.012-1.014), male (OR 2.328, 95% CI 2.251-2.408), obesity (OR 1.920, 95% CI 1.855-1.987), central obesity (OR 1.866, 95% CI 1.801-1.933), smoking (OR 1.399, 95% CI 1.347-1.453), alcohol use (OR 1.233, 95% CI 1.176-1.292), and non-regular exercise (OR 1.144, 95% CI 1.118-1.171). Sex-specific analysis revealed that elevated TG levels were more prevalent among males, regardless of other risk factors such as obesity and smoking. CONCLUSIONS: Male sex, obesity, and smoking were the strongest predictors of elevated TG levels.
Scopus© Citations 1
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SARS-CoV-2 seroepidemiology in Mongolia, 2020-2021: a longitudinal national study
(Elsevier BV, 2023-04)
Chimeddorj, Battogtokh
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Bailie, Christopher R
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Mandakh, Undram
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Price, David J
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Bayartsogt, Batzorig
BACKGROUND: The COVID-19 pandemic has global impacts but is relatively understudied in developing countries. Mongolia, a lower-middle-income country, instituted strict control measures in early 2020 and avoided widespread transmission until vaccines became available in February, 2021. Mongolia achieved its 60% vaccination coverage goal by July 2021. We investigated the distribution and determinants of SARS-CoV-2 seroprevalence in Mongolia over 2020 and 2021. METHODS: We performed a longitudinal seroepidemiologic study aligned with WHO's Unity Studies protocols. We collected data from a panel of 5000 individuals in four rounds between October 2020 and December 2021. We selected participants through local health centres across Mongolia by age-stratified multi-stage cluster sampling. We tested serum for the presence of total antibodies against SARS-CoV-2 receptor-binding domain, and levels of anti-SARS-CoV-2 spike IgG and neutralising antibodies. We linked participant data with national mortality, COVID-19 case, and vaccination registries. We estimated population seroprevalence and vaccine uptake, as well as unvaccinated population prior-infection prevalence. FINDINGS: At the final round in late 2021, 82% (n = 4088) of participants completed follow-up. Estimated seroprevalence increased from 1.5% (95% CI: 1.2-2.0), to 82.3% (95% CI: 79.5-84.8) between late-2020 and late-2021. At the final round an estimated 62.4% (95% CI: 60.2-64.5) of the population were vaccinated, and of the unvaccinated population 64.5% (95% CI: 59.7-69.0) had been infected. Cumulative case ascertainment in the unvaccinated was 22.8% (95% CI: 19.1%-26.9%) and the overall infection-fatality ratio was 0.100% (95% CI: 0.088-0.124). Health workers had higher odds for being COVID-19 confirmed cases at all rounds. Males (1.72 (95% CI: 1.33-2.22)) and adults aged 20 and above (12.70 (95% CI: 8.14-20.26)) had higher odds for seroconverting by mid-2021. Among the seropositive, 87.1% (95% CI: 82.3%-90.8%) had SARS-CoV-2 neutralising antibodies by late 2021. INTERPRETATION: Our study enabled tracking of SARS-CoV-2 serological markers in the Mongolian population over one year. We found low SARS-CoV-2 seroprevalence in 2020 and early 2021, with seropositivity increasing over a 3-month interval in 2021 due to vaccine roll out and rapid infection of most of the unvaccinated population. Despite high seroprevalence in Mongolia amongst both vaccinated and unvaccinated individuals by end-2021, the SARS-CoV-2 Omicron immune escape variant caused a substantial epidemic. FUNDING: World Health Organization, WHO UNITY Studies initiative, with funding by the COVID-19 Solidarity Response Fund and the German Federal Ministry of Health (BMG) COVID-19 Research and development. The Ministry of Health, Mongolia partially funded this study.
Scopus© Citations 6
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SARS-CoV-2 seroprevalence in Mongolia: Results from a national population survey
(Elsevier BV, 2021-12)
Chimeddorj, Battogtokh
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Mandakh, Undram
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Le, Linh-Vi
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Bayartsogt, Batzorig
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Deleg, Zolzaya
BACKGROUND: With the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in early 2020, Mongolia implemented rapid emergency measures and did not report local transmission until November 2020. We conducted a national seroprevalence survey to monitor the burden of SARS-CoV-2 in Mongolia in the months surrounding the first local transmission. METHODS: During October-December 2020, participants were randomly selected using age stratification and invited for interviews and blood samples at local primary health centres. We screened for total SARS-CoV-2 antibodies, followed by two-step quantitative SARS-CoV-2 IgG serology tests for positive samples. Weighted and test-adjusted seroprevalences were estimated. We used chi-square, Fisher's exact and other tests to identify variables associated with seropositivity. FINDINGS: A total of 5000 subjects were enrolled. We detected SARS-CoV-2 IgG antibodies in 72 samples. Crude seroprevalence of SARS-CoV-2 antibodies was 1·44% (95%CI,1·21-1·67). Population weighted and test-adjusted seroprevalences were 1·36% (95%CI,1·11-1·63) and 1·45% (95%CI,1·11-1·63), respectively. Age, sex, geographical, and occupational factors were not associated with seropositivity (p>0·05). Symptoms and signs within past 3 months and seropositivity were not associated at the time of the survey (p>0·05). INTERPRETATION: SARS-CoV-2 seroprevalence in Mongolia was low in the first year of the pandemic potentially due to strong public health measures, including border restrictions, educational facilities closure, earlier adoption of mask-wearing and others. Our findings suggest large-scale community transmission could not have occurred up to November 2020 in Mongolia. Additional serosurveys are needed to monitor the local pandemic dynamic and estimate how far from herd immunity Mongolia will be following-up with vaccination programme in 2021 and 2022. FUNDING: World Health Organisation, WHO UNITY Studies initiative, with funding by the COVID-19 Solidarity Response Fund and the German Federal Ministry of Health (BMG) COVID-19 Research and development. TRANSLATION: Cyrillic and Traditional Mongolian translation of abstract is available on appendix section.
Scopus© Citations 14
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Cardiovascular Risk across Glycemic Categories: Insights from a Nationwide Screening in Mongolia, 2022-2023
(MDPI AG, 2024-10)
Batmunkh, Nomuuna
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Enkhtugs, Khangai
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Munkhbat, Khishignemekh
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Davaakhuu, Narantuya
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Enebish, Oyunsuren
(1) Background: Diabetes mellitus is a significant risk factor for cardiovascular disease (CVD), a leading cause of death globally. Recent studies have highlighted the role of pre-diabetes, particularly impaired fasting glucose (IFG), in elevating CVD risk even before the onset of diabetes. The objective of this study was to assess cardiovascular disease (CVD) risk across specific glycemic categories, including normoglycemia, impaired fasting glucose (IFG), newly diagnosed diabetes, and long-standing diabetes, in a large Mongolian population sample. (2) Methods: This cross-sectional study utilized data from a nationwide health screening program in Mongolia between 2022 and 2023, involving 120,266 adults after applying inclusion criteria. The participants were categorized based on fasting plasma glucose levels (NGT): normoglycemia, IFG, newly diagnosed diabetes, and long-standing diabetes. CVD risk was assessed using WHO risk prediction charts, considering factors like age, blood pressure, smoking status, and diabetes status. (3) Results: CVD risk varied significantly with glycemic status. Among those with NGT, 62.9% were at low risk, while 31.2% were at moderate risk. In contrast, the IFG participants had 49.5% at low risk and 39.9% at moderate risk. Newly diagnosed diabetes showed 38.1% at low risk and 43.3% at moderate risk, while long-standing diabetes had 33.7% at low risk and 45.9% at moderate risk. Regression analysis indicated that glycemic status was independently associated with moderate to high CVD risk (OR in IFG: 1.13; 95% CI: 1.09-1.18), even after adjusting for age, gender, and central obesity. (4) Conclusions: This study emphasizes the need for early cardiovascular risk assessment and intervention, even in pre-diabetic stages like IFG.
Scopus© Citations 2

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