Associations of TNF-α, Uric Acid, and the Leptin/Adiponectin Ratio with HOMA-IR in Hospitalized Adults: A Cross-Sectional Secondary Analysis of 147 Patients

Background and Objectives: Anthropometric measures incompletely capture the inflammatory and adipokine heterogeneity underlying insulin resistance. We examined associations of tumor necrosis factor-alpha (TNF-α), serum uric acid, and the leptin/adiponectin ratio with HOMA-IR after adjustment. Materials and Methods: This single-center cross-sectional secondary analysis included 147 of 239 hospitalized adults with HOMA-IR and predefined core data; fasting glucose, insulin, and biomarker testing was elective and patient-funded. Continuous ln(HOMA-IR) was the primary outcome. A secondary upper-quartile phenotype (HOMA-IR ≥ 4.78; n = 37) was cohort-specific and non-diagnostic. Robust linear regression used HC3 standard errors. Sensitivity analyses excluded T2DM and replaced BMI with waist circumference or visceral fat area. Binary and AUC analyses were exploratory (expanded complete-case model, n = 112).