Do TyG and TyG-WHtR predict death and CVD in NAFLD?

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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

Zhang Y, Wang F, Tang J, et al. · Cardiovascular diabetology · 2024

doi.org/10.1186/s12933-024-02354-4 Read the full paper ↗103 citationscc by

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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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).