Do TyG and TyG-WHtR predict death and CVD in NAFLD?
In 6,627 NHANES adults with NAFLD, TyG-WHtR better predicted all-cause death, CVD death, and heart failure, while the TyG index tracked total CVD, CHD, and angina.
Source
Association of triglyceride glucose-related parameters with all-cause mortality and cardiovascular disease in NAFLD patients: NHANES 1999-2018
Study at a glance
- Design
- Cohort — NHANES 1999–2018 NAFLD adults; Cox models for mortality via NDI and logistic models for prevalent CVD; TyG vs TyG-WHtR quartiles
- N
- N=6627 · 6,627 adults ≥18 years with NAFLD (USFLI ≥30) from NHANES 1999–2018
- Population
- US adults with NAFLD in NHANES 1999–2018
- Outcome
- All-cause mortality, CVD mortality, and prevalent total-CVD, CHF, CHD, and angina
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Do TyG and TyG-WHtR predict death and CVD in NAFLD?
These passages occur verbatim in the stored paper text. They support the points listed below; they do not verify every statement in the explanation.
Analytic sample was 6,627 NHANES adults with NAFLD.
This study enrolled 6627 adults aged 18 and above diagnosed NAFLD from the National Health and Nutrition Examination Survey (NHANES, 1999–2018).
TyG-WHtR HRs/OR: 1.31 all-cause death, 2.22 CVD death, 3.99 CHF.
For all-cause mortality, CVD mortality and CHF, TyG-WHtR was a better predictor than TyG (TyG-WHtR: HR 1.31, 95%CI 1.03–1.66; HR 2.22, 95%CI 1.42–3.47; OR 3.99, 95%CI 1.79–8.93).
What they did
Identified NAFLD by USFLI ≥30 in NHANES 1999–2018, computed TyG and TyG-WHtR quartiles, and modeled mortality (Cox/NDI) and self-reported CVD (logistic regression), with RCS curves and mediation by HbA1c, insulin, and hypertension.
What they found
TyG-WHtR predicted all-cause mortality (HR 1.31), CVD mortality (HR 2.22), and CHF (OR 3.99) more strongly than TyG; TyG was stronger for total-CVD (OR 2.00), CHD (OR 1.85), and angina (OR 2.93). Mean TyG was 9.05 and TyG-WHtR 6.03. Adding either index improved C-statistics.
The limits
What it doesn't show
Observational NHANES data cannot prove TyG causes CVD; NAFLD was index-defined not biopsy-proven, CVD was often self-reported, and findings may not generalize beyond US survey participants.
Key terms
- TyG index
- ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2], a surrogate of insulin resistance.
- TyG-WHtR
- TyG multiplied by waist-to-height ratio, combining insulin resistance with central adiposity.
- NAFLD
- Here defined as US fatty liver index (USFLI) ≥30 in NHANES adults without excess alcohol or viral hepatitis exclusions.
- USFLI
- US fatty liver index; AUROC 0.80 versus ultrasound-confirmed NAFLD in prior validation.
- NHANES
- Repeated US survey with exam, labs, and National Death Index linkage.
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The NAFLD analytic sample numbered about:
Common questions
How many people were analyzed?
6,627 adults aged 18+ with NAFLD from NHANES 1999–2018.
How was NAFLD defined?
USFLI of 30 or higher (AUROC 0.80 vs ultrasound NAFLD).
Which index better predicted death and CHF?
TyG-WHtR (HR 1.31 all-cause; HR 2.22 CVD death; OR 3.99 CHF).
Which index better tracked CHD/angina?
The TyG index (OR 1.85 CHD; OR 2.93 angina).
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