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May 8, 2026Frontiers in Endocrinology0 citationsOpen Access

Association between the triglyceride–glucose index and hypertension: potential role of fatty liver in a cross-sectional study

YLYX LinYantai UniversityRSRuixue SunWenzhou Medical UniversityLWLifeng WuKunming University of Science and Technology

Key Result

Each 1-unit increase in the triglyceride-glucose index was associated with higher odds of hypertension (OR 2.09), with fatty liver statistically accounting for 23.50% of this association.

Study Design

Type

Cross-Sectional (n=115,327)

Multicenter

No

Structured PICO

Is a higher triglyceride-glucose (TyG) index associated with increased odds of hypertension in adults undergoing routine health examinations?

P
Population
115,327 adults (≥18 years) undergoing routine health examinations at a single center in China. Key inclusion: valid blood pressure, fasting glucose, triglyceride, and fatty liver ultrasound data.
I
Intervention
Higher triglyceride-glucose (TyG) index levels (evaluated as a continuous variable and in quartiles)
C
Comparator
Lower triglyceride-glucose (TyG) index levels (e.g., lowest quartile Q1)
O
Outcome
Hypertension (defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, self-reported physician-diagnosed hypertension, or current use of antihypertensive medications)

A higher triglyceride-glucose index is significantly associated with increased odds of hypertension, a relationship that appears to be partially mediated by the presence of fatty liver.

Main Result

Effect estimate: OR 2.09 (95% CI 2.03-2.15)

p-value: p=<0.001

Limitations

  • Cross-sectional design prevents determining temporal sequence or causal inference.
  • Residual confounding from unmeasured factors such as detailed dietary intake, socioeconomic status, and sleep duration.
  • Self-reported physical activity, smoking, and alcohol consumption may introduce measurement error.
  • Ultrasound diagnosis of fatty liver may lead to misclassification and cannot distinguish etiologies.
  • Single-center study of predominantly Han ethnicity limits generalizability to other populations.
  • Cross-sectional design precludes causal inference and determination of temporal sequence
  • Residual confounding from unmeasured factors such as detailed dietary intake, socioeconomic status, sleep duration, and genetic predisposition
  • Misclassification of fatty liver via ultrasound, which cannot distinguish between different etiologies (e.g., non-alcoholic vs alcoholic)
  • Single-center study based on a health examination population (mostly Han ethnicity) may overrepresent healthier individuals and limit generalizability

Abstract

Background The triglyceride–glucose (TyG) index is widely recognized as a surrogate marker of insulin resistance and reflects disturbances in glucose and lipid metabolism. Although higher TyG index levels have been associated with hypertension, the factors related to this association remain incompletely understood. This study aimed to examine the association between the TyG index and hypertension and to explore whether fatty liver might statistically account for part of this association. Methods This cross-sectional study included participants who underwent routine health examinations at the Third Affiliated Hospital of Wenzhou Medical University between 2021 and 2025. For individuals with multiple examination records during the study period, only the first record was retained for analysis. The TyG index was calculated using fasting triglyceride and glucose levels. Fatty liver was assessed by abdominal ultrasonography, and hypertension was defined according to the 2023 European Society of Hypertension guidelines. Multivariable logistic regression models were used to evaluate the associations of the TyG index with hypertension and fatty liver. Mediation analysis was performed to explore whether fatty liver might account for part of the observed association between the TyG index and hypertension. Results A total of 115,327 participants were included in the final analysis. The TyG index was significantly associated with hypertension. Each 1-unit increase in the TyG index was associated with higher odds of hypertension (adjusted OR = 2.09, 95% CI: 2.03–2.15). The TyG index was also strongly associated with fatty liver (adjusted OR = 7.05, 95% CI: 6.82–7.28). Mediation analysis suggested that fatty liver might account for part of the observed association between the TyG index and hypertension, with a proportion statistically accounted for of 23.50% (95% CI: 21.39%–25.96%). Conclusions In this health examination population, a higher TyG index was significantly associated with hypertension, and fatty liver may account for part of the observed association. Further longitudinal studies are needed to clarify these findings.

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Cite This Study

Lin et al. (2026) conducted a cross-sectional in Hypertension (n=115,327). Triglyceride-glucose (TyG) index was evaluated on Hypertension (OR 2.09, 95% CI 2.03-2.15, p=<0.001). Each 1-unit increase in the triglyceride-glucose index was associated with higher odds of hypertension (OR 2.09), with fatty liver statistically accounting for 23.50% of this association.

synapsesocial.com/papers/6a11fb809e025569bbad1714https://doi.org/10.3389/fendo.2026.1826006
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