INS and diabetes mellitus: In the final model, after adjusting for all potential confounders including age, sex, smoking status, PA, BMI, energy intake, education level, hypertension, and diabetes, participants in the highest tertile of ELIH score had a greater risk of developing hyperinsulinemia (OR:2.42, 95%CI:1.52–3.86, P for trend =  < 0.001), IR (OR:2.71, 95%CI:1.75–4.18, P for trend =  < 0.001) and insulin insensitivity (OR:2.65, 95%CI: 1.72–4.10, P for trend =  < 0.001) compared with those in the lowest tertile.