Evaluative performance of triglyceride-glucose-frailty index versus surrogate insulin resistance indices for advanced cardiovascular-kidney-metabolic syndrome, cardiometabolic multimorbidity, and mortality: the role of estimated glomerular filtration rate
Authors' conclusion
TyG-FI, which captures both metabolic dysfunction and physiological frailty, showed stronger associations with advanced CKM syndrome, prevalent CMM, and mortality than most surrogate insulin resistance indices. In exploratory analyses, lower baseline eGFR partly accounted for a proportion of the association with mortality.
Study context
- Population
- Adults aged 20–79 years, National Health and Nutrition Examination Survey 2001–2018
- Participants
- 11,228 adults
- Exposure
- Highest vs lowest triglyceride-glucose-frailty index (TyG-FI) quartile
- Outcome
- Advanced cardiovascular-kidney-metabolic (CKM) syndrome, cardiometabolic multimorbidity (CMM), all-cause and cardiovascular mortality
- Follow-up
- Median 90 months
Methodological detailssurvey-weighted, NHANES 2001-2018
- Survey-weighted
- NHANES 2001-2018
Main finding
As reported in the abstract
Advanced CKM syndrome, CMM, all-cause and cardiovascular death
Each group vs lowest TyG-FI quartileEstimate (95% CI)
Highest TyG-FI quartile
OR (advanced CKM syndrome) 4.57(3.50–5.99)
Highest TyG-FI quartile
OR (CMM) 5.09(2.83–9.16)
Highest TyG-FI quartile
HR (all-cause death) 3.90(2.96–5.13)
Highest TyG-FI quartile
HR (cardiovascular death) 5.82(3.38–10.03)
- Deaths: all-cause / cardiovascular
- 1,220 / 379
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause death among participants with CMM | 2.69 (1.69–4.28) | |
| 0.20.5125Hazard ratio (log scale) |
Dose-response pattern
- Non-linear dose-response for outcomes
- P for non-linearity < 0.001
Discrimination and estimated glomerular filtration rate (eGFR) mediation
- Proportion of mortality associations accounted for by lower baseline eGFR
- 16.45% to 26.74%
- TyG-FI showed higher discrimination than most surrogate insulin resistance indices
- Exploratory mediation analyses
Original publication
Evaluative performance of triglyceride-glucose-frailty index versus surrogate insulin resistance indices for advanced cardiovascular-kidney-metabolic syndrome, cardiometabolic multimorbidity, and mortality: the role of estimated glomerular filtration rate. Cardiovasc Diabetol. Published 3 September 2026. doi:10.
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