Soraneh Soroush, Ebrahimi Navid, Masrouri Soroush, Tohidi Maryam, Azizi Fereidoun, Hadaegh Farzad
School of Medicine, Babol University of Medical Sciences, Babol, Iran.
Prevention of Metabolic Disorders Research Center, Research Institute for Metabolic and Obesity Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran.
Cardiovasc Diabetol. 2025 Sep 29;24(1):369. doi: 10.1186/s12933-025-02944-w.
To investigate the associations between the triglyceride-glucose (TyG) index and its obesity-related derivatives with the risk of incident cardio-renal-metabolic multimorbidity (CRMM) in a Middle Eastern adult population initially free of cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD).
In this prospective cohort analysis of 5845 Iranian adults from the Tehran Lipid and Glucose Study, we evaluated the associations of the TyG index and its combinations with body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), and waist-hip ratio (WHR) with the incidence of CRMM. Multivariable Cox proportional hazards models were used to estimate the associations between TyG indices and CRMM risk. The Wald test was used to formally compare the effect sizes of each TyG-related index with that of the TyG index in multivariable models. The predictive performance of these indices was evaluated using Harrell's C-index and the integrated discrimination improvement (IDI).
Over a median follow-up of 15.3 years (IQR: 11.9-16.4), 344 individuals (5.9%) developed CRMM. Restricted cubic spline models demonstrated significant linear associations between TyG indices and CRMM risk. The corresponding HRs (95% CI) per 1-SD increase were 1.41 (1.24-1.60) for the TyG index, 1.52 (1.36-1.71) for TyG-BMI, 1.57 (1.38-1.78) for TyG-WC, 1.57 (1.38-1.78) for TyG-WHtR, and 1.42 (1.24-1.63) for TyG-WHR (all P < 0.001). The inclusion of anthropometric measures alongside the TyG index did not substantially enhance its association with CRMM risk (all P for differences ≥ 0.05). Incremental predictive performance analyses showed modest but statistically significant improvements when adding TyG and TyG-obesity indices to conventional risk factors (all P < 0.05), whereas incorporating anthropometric-based indices to a model already containing TyG did not yield additional predictive improvement (all P > 0.05). The majority of associations remained robust after adjustment for homeostatic model assessment of insulin resistance and in sensitivity analyses. The association between TyG-WHR and CRMM was more pronounced among non-obese than obese individuals (P for interaction < 0.001).
Higher levels of TyG and TyG-obesity indices were independently associated with an increased risk of CRMM; however, incorporating obesity indices did not confer substantial improvement over the TyG index alone.
在最初无心血管疾病（CVD）、2型糖尿病（T2DM）和慢性肾脏病（CKD）的中东成年人群中，研究甘油三酯-葡萄糖（TyG）指数及其与肥胖相关的衍生指标与发生心肾代谢多重疾病（CRMM）风险之间的关联。
在对来自德黑兰血脂与血糖研究的5845名伊朗成年人进行的这项前瞻性队列分析中，我们评估了TyG指数及其与体重指数（BMI）、腰围（WC）、腰高比（WHtR）和腰臀比（WHR）的组合与CRMM发病率之间的关联。使用多变量Cox比例风险模型来估计TyG指数与CRMM风险之间的关联。在多变量模型中，使用Wald检验正式比较每个TyG相关指数与TyG指数的效应大小。使用Harrell's C指数和综合判别改善（IDI）来评估这些指数的预测性能。
在中位随访15.3年（四分位间距：11.9 - 16.4）期间，344人（5.9%）发生了CRMM。受限立方样条模型显示TyG指数与CRMM风险之间存在显著的线性关联。TyG指数每增加1个标准差，相应的风险比（HR）（95%置信区间）为1.41（1.24 - 1.60），TyG - BMI为1.52（1.36 - 1.71），TyG - WC为1.57（1.38 - 1.78），TyG - WHtR为1.57（1.38 - 1.78），TyG - WHR为1.42（1.24 - 1.63）（所有P < 0.001）。在TyG指数之外纳入人体测量指标并没有显著增强其与CRMM风险的关联（所有差异P≥0.05）。增量预测性能分析表明，在传统风险因素中加入TyG和TyG - 肥胖指数时，有适度但具有统计学意义的改善（所有P < 0.05），而将基于人体测量的指数纳入已包含TyG的模型中并没有带来额外的预测改善（所有P > 0.05）。在调整胰岛素抵抗的稳态模型评估后以及敏感性分析中，大多数关联仍然稳健。TyG - WHR与CRMM之间的关联在非肥胖个体中比肥胖个体中更明显（交互作用P < 0.001）。
较高水平的TyG和TyG - 肥胖指数与CRMM风险增加独立相关；然而，纳入肥胖指数并没有比单独的TyG指数带来实质性的改善。
