Xie Jiejie, Pei Xiong, Zhu Shixuan, Jiang Wei, Tang Hong, Wu Dongbo, Xie Yan
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Front Cardiovasc Med. 2025 Apr 24;12:1570239. doi: 10.3389/fcvm.2025.1570239. eCollection 2025.
The triglyceride-glucose (TyG) index serves as a reliable indicator of insulin resistance and metabolic risk factors. Most research has focused on obese individuals, with limited exploration in those with a normal body mass index (BMI).
This study analyzed 4,440 adults with normal BMI from NHANES 2003-2018. Logistic regression, linear regression, subgroup analysis, and survival analysis examined the relationship between TyG-related indices (TyG, TyG-BMI, TyG-WC, TyG-WHtR) and outcomes like liver fibrosis, stroke, cardiovascular disease (CVD), and mortality.
In 4,440 individuals, 279 developed CVD, 134 had stroke, 1,382 developed liver fibrosis, and 548 died, with a median observation period of 100 months (IQR, 59-145 months). The TyG index was divided into four quartiles (Q1, Q2, Q3, Q4) and significant trends in various clinical indicators across the quartiles were observed (demographic characteristics, metabolic and biochemical indicators). Further analysis revealed linear correlations between TyG, TyG-WC, TyG-BMI, TyG-WHtR and liver function metrics (ALT, AST, GGT, FIB-4, APRI), kidney function metrics (creatinine, eGFR, uric acid), and blood lipids (triglycerides, cholesterol) ( < 0.01). Univariate logistic regression showed that compared to Q1, Q4 showed a significantly higher risk of liver fibrosis, CVD, stroke, and death for all TyG-related parameters ( < 0.001). After adjusting for cofounders, TyG Q4 still had a significantly higher risk of liver fibrosis ( < 0.05) and mortality ( < 0.001); TyG-BMI Q4 showed a higher risk of mortality ( < 0.001); TyG-WC Q4 showed a significantly higher risk of liver fibrosis ( < 0.001), stroke ( < 0.01), CVD ( < 0.001), and mortality ( < 0.001); TyG-WHtR Q4 showed a significantly higher risk of liver fibrosis ( < 0.001), stroke ( < 0.01), CVD ( < 0.001), and mortality ( < 0.001). Subgroup analysis yielded similar conclusions. Additionally. Survival analysis revealed significant differences in survival across the different quartiles of TyG, TyG-WC, TyG-BMI, and TyG-WHtR ( < 0.001).
The study identified a link between TyG-related markers and negative outcomes in individuals with a normal BMI, indicating that insulin resistance exists even in non-obese populations.
甘油三酯-葡萄糖（TyG）指数是胰岛素抵抗和代谢风险因素的可靠指标。大多数研究集中在肥胖个体，对正常体重指数（BMI）个体的探索有限。
本研究分析了2003 - 2018年美国国家健康与营养检查调查（NHANES）中4440名BMI正常的成年人。采用逻辑回归、线性回归、亚组分析和生存分析来研究TyG相关指数（TyG、TyG - BMI、TyG - WC、TyG - WHtR）与肝纤维化、中风、心血管疾病（CVD）和死亡率等结局之间的关系。
在4440名个体中，279人发生CVD，134人发生中风，1382人发生肝纤维化，548人死亡，中位观察期为100个月（四分位间距，59 - 145个月）。TyG指数分为四个四分位数（Q1、Q2、Q3、Q4），观察到各四分位数间各种临床指标存在显著趋势（人口统计学特征、代谢和生化指标）。进一步分析显示，TyG、TyG - WC、TyG - BMI、TyG - WHtR与肝功能指标（谷丙转氨酶、谷草转氨酶、γ-谷氨酰转肽酶、FIB - 4、APRI）、肾功能指标（肌酐、估算肾小球滤过率、尿酸）和血脂（甘油三酯、胆固醇）之间存在线性相关性（<0.01）。单因素逻辑回归显示，与Q1相比，所有TyG相关参数的Q4发生肝纤维化、CVD、中风和死亡的风险显著更高（<0.001）。在调整混杂因素后，TyG Q4发生肝纤维化（<0.05）和死亡率（<0.001）的风险仍显著更高；TyG - BMI Q4显示出更高的死亡风险（<0.001）；TyG - WC Q4发生肝纤维化（<0.001）、中风（<0.01）、CVD（<0.001）和死亡率（<0.001）的风险显著更高；TyG - WHtR Q4发生肝纤维化（<0.001）、中风（<0.01）、CVD（<0.001）和死亡率（<0.001）的风险显著更高。亚组分析得出了类似的结论。此外，生存分析显示，TyG、TyG - WC、TyG - BMI和TyG - WHtR的不同四分位数之间的生存存在显著差异（<0.001）。
该研究确定了TyG相关标志物与BMI正常个体的不良结局之间的联系，表明即使在非肥胖人群中也存在胰岛素抵抗。
