Lipids & metabolic liver disease

Composite C-reactive protein-triglyceride-glucose adiposity indices and incident cardiovascular-liver-metabolic multimorbidity: a prospective cohort study

Cardiovasc DiabetolPublished Prospective cohort study

Authors' conclusion

In middle-aged and older adults, most CTI-related adiposity indices were significantly associated with the newly identified surrogate-defined CLMM phenotype, except for CTI-ABSI and CTI-WWI, which were not independently associated after full adjustment. Among them, CTI-BMI showed the strongest statistical association and the highest relative discrimination among the evaluated indices, although its absolute discrimination was modest.

Study context

Population
Middle-aged and older adults with full baseline records in China Health and Retirement Longitudinal Study (CHARLS)
Participants
6,534 participants
Exposure
Nine CTI-derived adiposity indices and incident surrogate-defined CLM multimorbidity (CLMM) phenotype
Outcome
Surrogate-defined cardiovascular-liver-metabolic multimorbidity (CLMM) phenotype (CVD mainly self-reported physician diagnosis; MASLD inferred from lipid accumulation product)
Follow-up
approximately four-year follow-up
Methodological detailsChina Health and Retirement Longitudinal Study (CHARLS)
  • China Health and Retirement Longitudinal Study (CHARLS)

Main finding

As reported in the abstract

Incident surrogate-defined CLMM phenotype

Odds ratio

3.46

P < 0.001

CTI-BMI Q4

Odds ratio

2.37

P < 0.001

CTI-CVAI Q4

Participants meeting CLMM phenotype criteria
406 (6.2%)

Observational data: associations, not effects.

Further findings

OutcomeOR (95% CI)
Joint CTI and BMI categoriesLow CTI and high BMIvs Low CTI and low BMI2.49 (1.80–3.48)
Joint CTI and BMI categoriesHigh CTI and high BMIvs Low CTI and low BMI2.53 (1.87–3.45)
OutcomeAUCP value
Discrimination of CTI-BMICTI-BMI vs BMI · IDI 0.02%, despite a positive NRI0.638 vs 0.638DeLong P = 0.924
Discrimination of CTI-BMI — AUC of CTI-BMI (highest among indices; modest)
0.638 (95% CI 0.611-0.664)
Discrimination of CTI-BMI — AUC of fully adjusted baseline model before vs after adding CTI-BMI
0.617 to 0.627
Discrimination of CTI-BMI — net reclassification improvement (NRI) on adding CTI-BMI
28.63% (95% CI 18.63-38.64%)
Discrimination of CTI-BMI — integrated discrimination improvement (IDI) on adding CTI-BMI
0.03% (95% CI 0.01-0.06%)

Joint CTI and BMI categories

No statistically significant multiplicative or additive interaction

Effect modification of CTI-BMI association

Stronger associations in men, current-smokers and current-drinkers
all P for interaction <0.001

Sensitivity analyses

CTI-BMI remained significantly associated after additional adjustment for baseline cardiovascular-liver-metabolic (CLM) component status, with reduced effect estimate

Original publication

Composite C-reactive protein-triglyceride-glucose adiposity indices and incident cardiovascular-liver-metabolic multimorbidity: a prospective cohort study. Cardiovasc Diabetol. Published 26 August 2026. doi:10.1186/s12933-026-03351-5

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