Triglyceride-glucose waist-to-height ratio in relation to prevalent and incident multimorbidity: cross-sectional and prospective evidence from four national studies
Authors' conclusion
Higher TyG-WHtR was associated with prevalent multimorbidity in both cross-sectional samples and with incident multimorbidity in quartile-based analyses across all three prospective cohorts, although the continuous association was not statistically significant in prospective HRS. The cohort-specific inflection points suggest a provisional candidate risk-alert interval of approximately 5-7.
Study context
- Population
- Adults aged ≥50 years from National Health and Nutrition Examination Survey (NHANES) and Health and Retirement Study (HRS) cross-sectional, and China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA) and HRS prospective5 samples · 4 national studies · NHANES 1,842 · HRS 4,310 · CHARLS 4,114 · ELSA 1,310 · HRS 971
- Exposure
- Highest vs lowest triglyceride-glucose waist-to-height ratio (TyG-WHtR) quartile
- Outcome
- Prevalent and incident multimorbidity (≥2 of 8 harmonized chronic conditions)
Methodological detailsfive analytic samples from four national studies, multivariable logistic regression, Cox proportional hazards models, restricted cubic spline and two-piecewise regression
- Five analytic samples from four national studies
- Multivariable logistic regression
- Cox proportional hazards models
- Restricted cubic spline and two-piecewise regression
Main finding
As reported in the abstract
Estimate (95% CI)
Highest TyG-WHtR quartilevs Lowest TyG-WHtR quartileNHANES, cross-sectional, fully adjusted
OR 5.04(3.02–8.42)
Highest TyG-WHtR quartilevs Lowest TyG-WHtR quartileHRS, cross-sectional, fully adjusted
OR 3.63(2.70–4.90)
Highest quartilevs Lowest quartileCHARLS, prospective, fully adjusted
HR 1.87(1.59–2.21)
Highest quartilevs Lowest quartileELSA, prospective, fully adjusted
HR 1.67(1.30–2.15)
Highest quartilevs Lowest quartileHRS, prospective, fully adjusted
HR 1.57(1.08–2.29)
Observational data: associations, not effects.
Further findings
Prospective dose-response (nonlinear) inflection points
- Inflection point, CHARLS
- 5.92
- Inflection point, ELSA
- 5.80
- Inflection point, HRS
- 6.69
- Risk increased predominantly below these values
Discrimination vs five alternative TyG-related anthropometric indices
- TyG-WHtR had the largest AUC in both cross-sectional samples and in CHARLS and ELSA
Sensitivity analyses
- Lagged analyses and alternative multimorbidity definitions yielded consistent results
Original publication
Triglyceride-glucose waist-to-height ratio in relation to prevalent and incident multimorbidity: cross-sectional and prospective evidence from four national studies. Cardiovasc Diabetol. Published 24 August 2026. doi:10.
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