Association of the triglyceride-glucose index and its combination with obesity indices with cardio-renal-metabolic multimorbidity: two decades of follow-up in the Tehran Lipid and Glucose Study
Authors' conclusion
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.
Study context
- Population
- Iranian adults from the Tehran Lipid and Glucose Study, initially free of cardiovascular disease (CVD), T2D and chronic kidney disease (CKD)
- Participants
- 5,845 adults
- Exposure
- Triglyceride-glucose (TyG) index and TyG-obesity indices and incident cardio-renal-metabolic multimorbidity (CRMM)
- Outcome
- Incident cardio-renal-metabolic multimorbidity (CRMM)
- Follow-up
- Median 15.3 years (IQR: 11.9-16.4)
Methodological detailspopulation-based, multivariable Cox proportional hazards models
- Population-based
- Multivariable Cox proportional hazards models
Main finding
As reported in the abstract
Incident CRMM, HR per 1-SD increase · median 15.3 years
Hazard ratio (95% CI)P value
TyG index (per 1-SD)
1.41(1.24–1.60)
all P < 0.001TyG-BMI (per 1-SD)
1.52(1.36–1.71)
all P < 0.001TyG-WC (per 1-SD)
1.57(1.38–1.78)
all P < 0.001TyG-WHtR (per 1-SD)
1.57(1.38–1.78)
all P < 0.001TyG-WHR (per 1-SD)
1.42(1.24–1.63)
all P < 0.001Per 1-SD, as printed
- Developed CRMM
- 344 individuals (5.9%)
Observational data: associations, not effects.
Further findings
Effect size of TyG-obesity indices vs TyG index (Wald test)
- Adding anthropometric measures to TyG did not substantially enhance association with CRMM risk
- all P for differences ≥ 0.05
Incremental predictive performance (Harrell's C-index, integrated discrimination improvement (IDI))
- Modest but significant improvement adding TyG and TyG-obesity indices to conventional risk factors
- all P < 0.05
- No additional improvement adding anthropometric-based indices to a model with TyG
- all P > 0.05
Adjustment for HOMA-IR and sensitivity analyses
- Majority of associations remained robust
TyG-WHR and CRMM by obesity status
- Association more pronounced in non-obese than obese individuals
- P for interaction < 0.001
Original publication
Association of the triglyceride-glucose index and its combination with obesity indices with cardio-renal-metabolic multimorbidity: two decades of follow-up in the Tehran Lipid and Glucose Study. Cardiovasc Diabetol. Published 29 September 2025. doi:10.
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