Association of triglyceride-glucose related indices with mortality among individuals with MASLD combined with prediabetes or diabetes

Abstract

Background: The prognostic significance of triglyceride-glucose (TyG)-related indices in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) combined with prediabetes or diabetes is not yet fully understood. In this study, we explored their predictive value for mortality in this specific population.

Methods: Patients with MASLD were identified from the National Health and Nutrition Examination Survey (NHANES III) database. TyG and its related parameters [TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), TyG-weight-adjusted waist index (TyG-WWI), and TyG-body mass index (TyG-BMI), ] were calculated. To examine the association between TyG-related indices and mortality risk, Cox regression models were utilized. Furthermore, we employed restricted cubic spline (RCS) analysis to investigate potential dose-response relationships. The predictive ability of the TyG indices for mortality was assessed by analyzing the time-dependent area under the curve (AUC).

Results: In the cohort of patients with prediabetes or diabetes, 46.5% were diagnosed with MASLD. Over a median follow-up of 25.4 years, 1,163 individuals (53.9%) died, with 329 (15.3%) deaths attributed to cardiovascular causes and 78 (3.6%) to diabetes. Multivariate Cox regression models showed that TyG, TyG-BMI, TyG-WHtR, TyG-WWI, and TyG-WC were associated with all-cause and cardiovascular/diabetes-specific mortality. Furthermore, RCS analysis revealed a positive linear relationship between the TyG and TyG-WWI indices and all-cause mortality (p for nonlinear = 0.920; p = 0.525, respectively). In contrast, the TyG-WC, TyG-BMI, and TyG-WHtR indices exhibited a positive nonlinear association with all-cause mortality (p for nonlinear = 0.001; = 0.003; = 0.007, respectively). Time-dependent AUC curves demonstrated that the TyG-WWI index was the most robust predictor of both all-cause and cardiovascular mortality.

Conclusions: Elevated levels of TyG, TyG-BMI, TyG-WHtR, TyG-WWI, and TyG-WC indices were associated with a poorer prognosis in MASLD patients with prediabetes or diabetes, with TyG-WWI being the strongest predictor.

Keywords: Diabetes; MASLD; Mortality; Triglyceride-glucose related indices.

Fig. 1

Flowchart for selection of study population

Fig. 2

RCS curves were employed to illustrate the correlation between TyG-related indices and all-cause mortality in MASLD patients with prediabetes or diabetes, adjusting for factors such as age, sex, ethnicity, family income ratio, marital status, education level, smoking, and FIB-4. A TyG index; B TyG-BMI index; C TyG-WHtR index; D TyG-WWI index; E TyG-WC index. Abbreviations: MASLD, Metabolic Dysfunction-Associated Steatotic Liver Disease; TyG, Triglyceride-glucose; BMI, Body mass index; WHtR, Waist-height ratio; WWI, Weight-adjusted waist index; WC, waist circumference; RCS, Restricted cubic spline; FIB-4, Fibrosis-4 index.

Fig. 3

Time-dependent AUC curves assessing the predictive power of the TyG correlation index for all-cause and cause-specific mortality in MASLD patients with prediabetes or diabetes. A All-cause mortality; B Cardiovascular mortality; C Diabetes mortality. Abbreviations: MASLD, Metabolic Dysfunction-Associated Steatotic Liver Disease; AUC, Area under the curve; TyG, Triglyceride-glucose; BMI, Body mass index; WHtR, Waist-height ratio; WWI, Weight-adjusted waist index; WC, waist circumference.

Fig. 4

Subgroup analysis of the correlation between TyG-related indices and all-cause mortality in MASLD patients with prediabetes or diabetes. A TyG index; B TyG-BMI index; C TyG-WHtR index; D TyG-WWI index; E TyG-WC index. Abbreviations: MASLD, Metabolic Dysfunction-Associated Steatotic Liver Disease; TyG, Triglyceride-glucose; BMI, Body mass index; WHtR, Waist-height ratio; WWI, Weight-adjusted waist index; WC, waist circumference.