Retrospective Cohort Study
Copyright ©The Author(s) 2025.
World J Diabetes. Aug 15, 2025; 16(8): 108839
Published online Aug 15, 2025. doi: 10.4239/wjd.v16.i8.108839
Table 1 Baseline characteristics of participants across triglyceride glucose-body mass index quartiles
Q1 (n = 2548; 131.06-263.12)
Q2 (n = 2547; 263.12-302.56)
Q3 (n = 2547; 302.56-345.60)
Q4 (n = 2548; 345.60-536.15)
P value
TyG-BMI234.32 ± 21.93282.91 ± 11.31322.94 ± 12.37384.54 ± 30.17< 0.001
Age (years)64.32 ± 7.2063.44 ± 6.5762.37 ± 6.4161.13 ± 5.89< 0.001
Sex< 0.001
    Male1697 (66.60)1684 (66.12)1545 (60.66)1338 (52.51)
    Female851 (33.40)863 (33.88)1002 (39.34)1210 (47.49)
Race< 0.001
    White1197 (46.98)1533 (60.19)1704 (66.90)1933 (75.86)
    Non-white1351 (53.02)1014 (39.81)843 (33.10)615 (24.14)
Education< 0.001
    Less than high
school graduate		423 (16.62)418 (16.41)359 (14.11)301 (11.82)
    High school grad
(or GED)		689 (27.07)640 (25.13)683 (26.84)678 (26.63)
    Some college or technical school698 (27.43)807 (31.68)872 (34.26)964 (37.86)
    College graduate or more735 (28.88)682 (26.78)631 (24.79)603 (23.68)
CVD history885 (34.73)929 (36.47)905 (35.53)863 (33.87)0.246
Duration of diabetes (years)12.12 ± 8.1610.96 ± 7.6410.19 ± 7.199.93 ± 7.15< 0.001
Previous hypertension1837 (72.10)1901 (74.64)1943 (76.29)1998 (78.41)< 0.001
Previous hyperlipidemia1742 (68.37)1792 (70.36)1776 (69.73)1816 (71.27)0.144
Proteinuria433 (16.99)472 (18.53)525 (20.62)597 (23.43)< 0.001
Heart failure93 (3.65)113 (4.44)102 (4.01)179 (7.03)< 0.001
Depression394 (15.46)545 (21.40)612 (24.05)861 (33.79)< 0.001
Living alone2082 (81.71)2033 (79.82)2025 (79.57)1985 (77.90)0.009
Smoking< 0.001
    Yes1394 (54.71)1512 (59.36)1532 (60.15)1495 (58.67)
    No1154 (45.29)1035 (40.64)1015 (39.85)1053 (41.33)
Alcohol< 0.001
    Yes630 (24.73)664 (26.08)623 (24.49)515 (20.22)
    No1918 (75.27)1882 (73.92)1921 (75.51)2032 (79.78)
BMI (kg/m2)26.08 ± 2.4730.21 ± 2.2333.76 ± 2.5638.86 ± 3.30< 0.001
SBP (mmHg)136.45 ± 17.19136.34 ± 17.01136.47 ± 16.97136.13 ± 17.280.905
DBP (mmHg)72.71 ± 10.5574.41 ± 10.5375.72 ± 10.4276.70 ± 10.73< 0.001
Heart rate (bpm)71.07 ± 11.5471.71 ± 11.6873.40 ± 11.7074.52 ± 11.78< 0.001
FPG (mg/dL)157.67 ± 54.17170.58 ± 53.78178.59 ± 53.77193.92 ± 56.75< 0.001
HbA1c (%)8.21 ± 1.078.26 ± 1.058.29 ± 1.018.45 ± 1.09< 0.001
TC (mg/dL)174.85 ± 38.80180.92 ± 40.15183.96 ± 41.12193.46 ± 44.91< 0.001
TG (mg/dL)124.30 ± 73.92170.07 ± 99.22202.26 ± 129.90263.60 ± 213.27< 0.001
VLDL-C (mg/dL)24.67 ± 13.6833.44 ± 18.3239.08 ± 22.0848.92 ± 32.34< 0.001
LDL-C (mg/dL)104.50 ± 32.86105.44 ± 33.44104.23 ± 33.84105.43 ± 35.450.558
HDL-C (mg/dL)45.68 ± 12.9942.04 ± 11.3340.65 ± 10.8139.12 ± 10.17< 0.001
eGFR (mL/min/1.73 m2)91.07 ± 29.0290.32 ± 28.2891.68 ± 25.4391.07 ± 25.620.041
Medications
ARB/ACEI1672 (65.62)1762 (69.18)1794 (70.44)1834 (71.98)< 0.001
CCB472 (18.52)452 (17.75)486 (19.08)541 (21.23)0.012
β-blockers658 (25.89)729 (28.70)815 (32.09)862 (33.92)< 0.001
Biguanides1561 (61.26)1653 (64.90)1666 (65.44)1638 (64.29)0.009
Thiazolidinediones496 (19.47)512 (20.10)590 (23.17)648 (25.43)< 0.001
Sulfonylureas1413 (55.46)1374 (53.95)1353 (53.14)1305 (51.22)0.023
Insulins818 (32.10)853 (33.49)902 (35.41)988 (38.78)< 0.001
Statins1642 (64.75)1656 (65.33)1636 (64.41)1531 (60.28)< 0.001
Aspirin1351 (53.29)1375 (54.26)1451 (57.22)1371 (54.02)0.027
Cholesterol absorption inhibitors45 (1.78)58 (2.29)50 (1.97)54 (2.13)0.608
Data are showed as mean ± SD or as n (%). P value for the test of the difference across quartiles of triglyceride glucose-body mass index were obtained by using the χ2 test (categorical variables), ANOVA (continuous variables), or Kruskal-Wallis test (nonparametric comparisons). TyG: Triglyceride glucose; BMI: Body mass index; GED: General education development; CVD: Cardiovascular disease; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; FPG: Fasting plasma glucose; HbA1c: Glycated hemoglobin; TC: Total cholesterol; TG: Triglycerides; VLDL-C: Very low density lipoprotein-cholesterol; LDL-C: Low density lipoprotein-cholesterol; HDL-C: High density lipoprotein-cholesterol; eGFR: Estimated glomerular filtration rate; ARB: Angiotensin receptor blocker; ACEI: Angiotensin converting enzyme inhibitors; CCB: Calcium channel blocker.
Table 2 Risk of cardiovascular outcomes and total mortality based on triglyceride glucose, body mass index and triglyceride glucose-body mass index
Outcome
Non-adjusted
Model 1
Model 2
Model 3
HR (95%CI)
P value
HR (95%CI)
P value
HR (95%CI)
P value
HR (95%CI)
P value
Cardiovascular mortality
TyG-BMI
Q1ReferenceReferenceReferenceReference
Q21.03 (0.82, 1.30)0.77751.06 (0.84, 1.34)0.62471.05 (0.83, 1.33)0.65761.04 (0.82, 1.32)0.7537
Q31.23 (0.98, 1.53)0.07101.39 (1.10, 1.74)0.00501.39 (1.10, 1.75)0.00561.36 (1.07, 1.71)0.0108
Q41.45 (1.17, 1.80)0.00071.93 (1.53, 2.42)< 0.00011.81 (1.42, 2.31)< 0.00011.74 (1.36, 2.22)< 0.0001
Per 1 SD1.14 (1.05, 1.23)0.00091.27 (1.17, 1.38)< 0.00011.24 (1.13, 1.35)< 0.00011.22 (1.11, 1.33)< 0.0001
P for trend0.0002< 0.0001< 0.0001< 0.0001
TyG
Q1ReferenceReferenceReferenceReference
Q20.90 (0.71, 1.14)0.37200.89 (0.71, 1.13)0.35140.90 (0.71, 1.14)0.38190.89 (0.70, 1.13)0.3308
Q31.19 (0.96, 1.48)0.11561.21 (0.96, 1.51)0.10151.17 (0.93, 1.49)0.18591.19 (0.93, 1.51)0.1608
Q41.37 (1.11, 1.70)0.00331.46 (1.17, 1.82)0.00091.48 (1.12, 1.96)0.00581.43 (1.08, 1.89)0.0130
Per 1 SD1.15 (1.07, 1.24)0.00031.19 (1.09, 1.28)< 0.00011.23 (1.09, 1.39)0.00081.20 (1.07, 1.36)0.0024
P for trend0.0003< 0.00010.00270.0046
BMI
Q1ReferenceReferenceReferenceReference
Q21.02 (0.82, 1.28)0.84881.03 (0.82, 1.30)0.77661.04 (0.83, 1.31)0.75081.02 (0.81, 1.29)0.8433
Q31.15 (0.92, 1.43)0.21071.30 (1.04, 1.63)0.02011.30 (1.04, 1.64)0.02131.29 (1.03, 1.63)0.0266
Q41.31 (1.06, 1.62)0.01431.69 (1.34, 2.11)< 0.00011.61 (1.28, 2.02)< 0.00011.56 (1.23, 1.97)0.0002
Per 1 SD1.08 (1.00, 1.17)0.04031.20 (1.11, 1.31)< 0.00011.18 (1.09, 1.29)< 0.00011.17 (1.07, 1.27)0.0003
P for trend0.0073< 0.0001< 0.0001< 0.0001
CHF
TyG-BMI
Q1ReferenceReferenceReferenceReference
Q21.29 (1.02, 1.64)0.03311.34 (1.05, 1.70)0.01761.29 (1.01, 1.65)0.03761.29 (1.01, 1.66)0.0393
Q31.46 (1.16, 1.84)0.00151.77 (1.40, 2.25)< 0.00011.75 (1.37, 2.23)< 0.00011.71 (1.34, 2.19)< 0.0001
Q42.15 (1.73, 2.68)< 0.00013.03 (2.40, 3.83)< 0.00012.70 (2.12, 3.45)< 0.00012.65 (2.07, 3.40)< 0.0001
Per 1 SD1.32 (1.23, 1.42)< 0.00011.52 (1.41, 1.65)< 0.00011.46 (1.34, 1.58)< 0.00011.45 (1.33, 1.58)< 0.0001
P for trend< 0.0001< 0.0001< 0.0001< 0.0001
TyG
Q1ReferenceReferenceReferenceReference
Q21.22 (0.97, 1.52)0.08551.21 (0.97, 1.52)0.09021.22 (0.97, 1.53)0.08291.23 (0.98, 1.54)0.0788
Q31.13 (0.90, 1.42)0.28041.16 (0.92, 1.47)0.19661.10 (0.86, 1.40)0.44201.12 (0.88, 1.43)0.3721
Q41.56 (1.26, 1.93)< 0.00011.76 (1.41, 2.20)< 0.00011.62 (1.24, 2.13)0.00041.61 (1.22, 2.12)0.0007
Per 1 SD1.18 (1.09, 1.27)< 0.00011.25 (1.15, 1.35)< 0.00011.26 (1.12, 1.42)0.00011.26 (1.12, 1.41)0.0002
P for trend0.0002< 0.00010.00350.0042
BMI
Q1ReferenceReferenceReferenceReference
Q21.39 (1.10, 1.75)0.00541.44 (1.14, 1.82)0.00211.37 (1.09, 1.74)0.00821.40 (1.10, 1.77)0.0062
Q31.32 (1.05, 1.67)0.01941.54 (1.21, 1.95)0.00041.53 (1.20, 1.94)0.00061.53 (1.20, 1.95)0.0006
Q42.00 (1.61, 2.49)< 0.00012.67 (2.12, 3.35)< 0.00012.43 (1.92, 3.07)< 0.00012.41 (1.89, 3.06)< 0.0001
Per 1 SD1.27 (1.18, 1.37)< 0.00011.44 (1.33, 1.56)< 0.00011.39 (1.28, 1.50)< 0.00011.39 (1.28, 1.51)< 0.0001
P for trend< 0.0001< 0.0001< 0.0001< 0.0001
Total mortality
TyG-BMI
Q1ReferenceReferenceReferenceReference
Q21.04 (0.91, 1.18)0.56101.09 (0.96, 1.24)0.17401.07 (0.94, 1.22)0.31101.06 (0.93, 1.21)0.3553
Q31.01 (0.89, 1.15)0.85451.18 (1.04, 1.35)0.01311.16 (1.01, 1.32)0.03371.13 (0.99, 1.30)0.0708
Q41.19 (1.05, 1.35)0.00591.63 (1.42, 1.86)< 0.00011.48 (1.29, 1.70)< 0.00011.42 (1.23, 1.64)< 0.0001
Per 1 SD1.05 (1.00, 1.10)0.03161.19 (1.13, 1.25)< 0.00011.14 (1.08, 1.20)< 0.00011.12 (1.07, 1.18)< 0.0001
P for trend0.0123< 0.0001< 0.0001< 0.0001
TyG
Q1ReferenceReferenceReferenceReference
Q20.90 (0.79, 1.03)0.13190.91 (0.80, 1.04)0.17490.91 (0.80, 1.04)0.15700.91 (0.80, 1.04)0.1817
Q31.03 (0.91, 1.17)0.65881.06 (0.93, 1.21)0.35771.00 (0.87, 1.15)0.97521.03 (0.89, 1.18)0.7184
Q41.18 (1.05, 1.34)0.00761.31 (1.15, 1.49)< 0.00011.21 (1.03, 1.41)0.02261.21 (1.03, 1.42)0.0212
Per 1 SD1.07 (1.02, 1.12)0.00341.12 (1.07, 1.18)< 0.00011.08 (1.01, 1.15)0.03151.08 (1.01, 1.15)0.0338
P for trend0.0014< 0.00010.02700.0185
BMI
Q1ReferenceReferenceReferenceReference
Q21.03 (0.91, 1.17)0.60201.08 (0.95, 1.22)0.25411.06 (0.93, 1.21)0.37461.05 (0.92, 1.20)0.4544
Q30.96 (0.84, 1.09)0.52091.10 (0.96, 1.25)0.15501.09 (0.96, 1.25)0.18691.07 (0.94, 1.23)0.2924
Q41.11 (0.98, 1.25)0.11221.47 (1.29, 1.68)< 0.00011.39 (1.22, 1.59)< 0.00011.34 (1.17, 1.53)< 0.0001
Per 1 SD1.02 (0.98, 1.07)0.30591.15 (1.09, 1.20)< 0.00011.12 (1.07, 1.18)< 0.00011.11 (1.05, 1.16)< 0.0001
P for trend0.2515< 0.0001< 0.0001< 0.0001
Data are expressed as HR and 95%CIs (reported in parentheses) as assessed by multivariable Cox regression analysis. Model 1: Adjusted for sex, race, age, education, history of cardiovascular disease, previous hypertension, previous hyperlipidemia, systolic blood pressure and diastolic blood pressure. Model 2: Adjusted for model 1 covariables plus duration of diabetes, proteinuria, heart failure, smoking status, glycated hemoglobin, total cholesterol, low density lipoprotein-cholesterol, and estimated glomerular filtration rate. Model 3: Adjusted for model 2 covariables plus the medications use, calcium channel blocker, beta-blockers, biguanides, thiazolidinediones, insulin, aspirin, cholesterol absorption inhibitors. TyG: Triglyceride glucose; BMI: Body mass index.
Table 3 Analysis of the threshold effects of triglyceride glucose-body mass index levels on cardiovascular and total mortality
Outcomes
One linear-regression model
Inflection point (K)
< K, effect 1
> K, effect 2
P value for LRT
Cardiovascular mortality1.03 (1.02, 1.05), P < 0.0001252.770.95 (0.89, 1.01), P = 0.11611.05 (1.03, 1.06), P < 0.00010.012
Total mortality1.02 (1.01, 1.03), P < 0.0001245.900.96 (0.92, 1.00), P = 0.03021.03 (1.02, 1.04), P < 0.00010.002
The effects shown are adjusted for model 3, including sex, race, age, education, history of cardiovascular disease, previous hypertension, previous hyperlipidemia, systolic blood pressure, diastolic blood pressure, duration of diabetes, proteinuria, heart failure, smoking status, glycated hemoglobin, total cholesterol, low density lipoprotein-cholesterol, estimated glomerular filtration rate, calcium channel blocker, beta-blockers, biguanides, thiazolidinediones, insulin, aspirin, cholesterol absorption inhibitors. LRT: Likelihood ratio test.