Association of Triglyceride-glucose Related Indices with Mortality Among Individuals with MASLD Combined with Prediabetes or Diabetes

Overview

Journal Cardiovasc Diabetol

Publisher Biomed Central

Date 2025 Feb 1

PMID 39893457

Authors

Yiheng Zhang

Juanli Wu

Tao Li

Yundong Qu

Yan Wang

Affiliations

Soon will be listed here.

Abstract

Background: The prognostic significance of triglyceride-glucose (TyG)-related indices in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) combined with prediabetes or diabetes is not yet fully understood. In this study, we explored their predictive value for mortality in this specific population.

Methods: Patients with MASLD were identified from the National Health and Nutrition Examination Survey (NHANES III) database. TyG and its related parameters [TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), TyG-weight-adjusted waist index (TyG-WWI), and TyG-body mass index (TyG-BMI), ] were calculated. To examine the association between TyG-related indices and mortality risk, Cox regression models were utilized. Furthermore, we employed restricted cubic spline (RCS) analysis to investigate potential dose-response relationships. The predictive ability of the TyG indices for mortality was assessed by analyzing the time-dependent area under the curve (AUC).

Results: In the cohort of patients with prediabetes or diabetes, 46.5% were diagnosed with MASLD. Over a median follow-up of 25.4 years, 1,163 individuals (53.9%) died, with 329 (15.3%) deaths attributed to cardiovascular causes and 78 (3.6%) to diabetes. Multivariate Cox regression models showed that TyG, TyG-BMI, TyG-WHtR, TyG-WWI, and TyG-WC were associated with all-cause and cardiovascular/diabetes-specific mortality. Furthermore, RCS analysis revealed a positive linear relationship between the TyG and TyG-WWI indices and all-cause mortality (p for nonlinear = 0.920; p = 0.525, respectively). In contrast, the TyG-WC, TyG-BMI, and TyG-WHtR indices exhibited a positive nonlinear association with all-cause mortality (p for nonlinear = 0.001; = 0.003; = 0.007, respectively). Time-dependent AUC curves demonstrated that the TyG-WWI index was the most robust predictor of both all-cause and cardiovascular mortality.

Conclusions: Elevated levels of TyG, TyG-BMI, TyG-WHtR, TyG-WWI, and TyG-WC indices were associated with a poorer prognosis in MASLD patients with prediabetes or diabetes, with TyG-WWI being the strongest predictor.

References

Ceriello A, Motz E . Is oxidative stress the pathogenic mechanism underlying insulin resistance, diabetes, and cardiovascular disease? The common soil hypothesis revisited. Arterioscler Thromb Vasc Biol. 2004; 24(5):816-23. DOI: 10.1161/01.ATV.0000122852.22604.78. View

Bland J, Altman D . Multiple significance tests: the Bonferroni method. BMJ. 1995; 310(6973):170. PMC: 2548561. DOI: 10.1136/bmj.310.6973.170. View

Xiao S, Zhang Q, Yang H, Tong J, Yang R . The association between triglyceride glucose-body mass index and all-cause and cardiovascular mortality in diabetes patients: a retrospective study from NHANES database. Sci Rep. 2024; 14(1):13884. PMC: 11180665. DOI: 10.1038/s41598-024-63886-z. View

Sheng G, Lu S, Xie Q, Peng N, Kuang M, Zou Y . The usefulness of obesity and lipid-related indices to predict the presence of Non-alcoholic fatty liver disease. Lipids Health Dis. 2021; 20(1):134. PMC: 8502416. DOI: 10.1186/s12944-021-01561-2. View

Malek M, Khamseh M, Chehrehgosha H, Nobarani S, Alaei-Shahmiri F . Triglyceride glucose-waist to height ratio: a novel and effective marker for identifying hepatic steatosis in individuals with type 2 diabetes mellitus. Endocrine. 2021; 74(3):538-545. DOI: 10.1007/s12020-021-02815-w. View

Sardu C, Gatta G, Pieretti G, D Onofrio N, Balestrieri M, Scisciola L . SGLT2 breast expression could affect the cardiovascular performance in pre-menopausal women with fatty vs. non fatty breast via over-inflammation and sirtuins' down regulation. Eur J Intern Med. 2023; 113:57-68. DOI: 10.1016/j.ejim.2023.04.012. View

Priego-Parra B, Reyes-Diaz S, Ordaz-Alvarez H, Bernal-Reyes R, Icaza-Chavez M, Martinez-Vazquez S . Diagnostic performance of sixteen biomarkers for MASLD: A study in a Mexican cohort. Clin Res Hepatol Gastroenterol. 2024; 48(7):102400. DOI: 10.1016/j.clinre.2024.102400. View

Song S, Son D, Baik S, Cho W, Lee Y . Triglyceride Glucose-Waist Circumference (TyG-WC) Is a Reliable Marker to Predict Non-Alcoholic Fatty Liver Disease. Biomedicines. 2022; 10(9). PMC: 9496145. DOI: 10.3390/biomedicines10092251. View

Sakurai Y, Kubota N, Yamauchi T, Kadowaki T . Role of Insulin Resistance in MAFLD. Int J Mol Sci. 2021; 22(8). PMC: 8072900. DOI: 10.3390/ijms22084156. View

10.

Wei X, Min Y, Song G, Ye X, Liu L . Association between triglyceride-glucose related indices with the all-cause and cause-specific mortality among the population with metabolic syndrome. Cardiovasc Diabetol. 2024; 23(1):134. PMC: 11044377. DOI: 10.1186/s12933-024-02215-0. View

11.

Xu A, Jin Q, Shen Z, Zhang J, Fu Q . Association between the risk of hypertension and triglyceride glucose index in Chinese regions: a systematic review and dose-response meta-analysis of a regional update. Front Cardiovasc Med. 2023; 10:1242035. PMC: 10424922. DOI: 10.3389/fcvm.2023.1242035. View

12.

Pranata R, Huang I, Irvan , Lim M, Vania R . The association between triglyceride-glucose index and the incidence of type 2 diabetes mellitus-a systematic review and dose-response meta-analysis of cohort studies. Endocrine. 2021; 74(2):254-262. DOI: 10.1007/s12020-021-02780-4. View

13.

Ding C, Shi Y, Li J, Li M, Hu L, Rao J . Association of weight-adjusted-waist index with all-cause and cardiovascular mortality in China: A prospective cohort study. Nutr Metab Cardiovasc Dis. 2022; 32(5):1210-1217. DOI: 10.1016/j.numecd.2022.01.033. View

14.

Eslam M, Sanyal A, George J . MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology. 2020; 158(7):1999-2014.e1. DOI: 10.1053/j.gastro.2019.11.312. View

15.

Cai W, Xu J, Wu X, Chen Z, Zeng L, Song X . Association between triglyceride-glucose index and all-cause mortality in critically ill patients with ischemic stroke: analysis of the MIMIC-IV database. Cardiovasc Diabetol. 2023; 22(1):138. PMC: 10262584. DOI: 10.1186/s12933-023-01864-x. View

16.

Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V . FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007; 46(1):32-6. DOI: 10.1002/hep.21669. View

17.

Dang K, Wang X, Hu J, Zhang Y, Cheng L, Qi X . The association between triglyceride-glucose index and its combination with obesity indicators and cardiovascular disease: NHANES 2003-2018. Cardiovasc Diabetol. 2024; 23(1):8. PMC: 10771672. DOI: 10.1186/s12933-023-02115-9. View

18.

Zhang Y, Wang F, Tang J, Shen L, He J, Chen Y . Association of triglyceride glucose-related parameters with all-cause mortality and cardiovascular disease in NAFLD patients: NHANES 1999-2018. Cardiovasc Diabetol. 2024; 23(1):262. PMC: 11264797. DOI: 10.1186/s12933-024-02354-4. View

19.

Kim H, Lee D, An T, Park H, Kim W, Bae K . Metabolic Spectrum of Liver Failure in Type 2 Diabetes and Obesity: From NAFLD to NASH to HCC. Int J Mol Sci. 2021; 22(9). PMC: 8123490. DOI: 10.3390/ijms22094495. View

20.

Tahapary D, Pratisthita L, Fitri N, Marcella C, Wafa S, Kurniawan F . Challenges in the diagnosis of insulin resistance: Focusing on the role of HOMA-IR and Tryglyceride/glucose index. Diabetes Metab Syndr. 2022; 16(8):102581. DOI: 10.1016/j.dsx.2022.102581. View