Deciphering the Association Between Homeostatic Model Assessment of Insulin Resistance and Chronic Diarrhea and the Mediating Role of Lymphocyte-to-Monocyte Ratio

Abstract

Background/Aims: Metabolic disorders and insulin resistance (IR) may elevate the risk of chronic diarrhea (CrD), yet the association between the homeostatic model assessment of IR (HOMA-IR) and CrD remains unclear. This study aims to examine the HOMA-IR-CrD relationship and investigate the mediating role of lymphocyte-to-monocyte ratio (LMR).

Materials and Methods: A total of 4984 participants from the National Health and Nutrition Examination Survey database were included. The weighted logistic regression analysis was performed to assess the linkage between HOMA-IR and CrD. Through subgroup analyses, differences in various populations were evaluated. Moreover, mediation analysis was conducted to assess the mediating role of LMR.

Results: After adjusting for all covariates, HOMA-IR was positively linked with CrD (OR = 1.03, 95% CI: 1.00-1.05). The risk of CrD in the fourth quartile array of HOMA-IR was 1.68 times higher than that in the first quartile array (95% CI: 1.03-2.74). The subgroup analysis revealed a positive correlation between HOMA-IR levels and CrD in females (OR = 1.04, 95% CI: 1.00-1.08), people with a university and above educational background (OR = 1.06, 95% CI: 1.01-1.12), and the current smoking population (OR = 1.07, 95% CI: 1.03-1.12). Furthermore, LMR partially mediated the relationship between HOMA-IR and CrD, with a mediation ratio of 3.76%.

Conclusion: Elevated HOMA-IR is significantly linked with the risk of CrD, especially in women, people with a university or higher background, and current smokers. The LRM assumes a partial mediating role in that process. The study suggests that interventions targeting IR may contribute to the management and prevention of CrD.

Cite this article as: Chen Y, Xiao Y, Chen Z. Deciphering the association between homeostatic model assessment of insulin resistance and chronic diarrhea and the mediating role of lymphocyte-to-monocyte ratio. Turk J Gastroenterol. Published online January 26, 2026. doi: 10.5152/tjg.2026.25247.