What is the clinical evidence from this study?

Study design: Cohort. Population: Stroke (n=8730). Intervention: Triglyceride-glucose (TyG) index combined with obesity indicators (e.g., TyG-WC) vs. Lowest quartile of combined indices. Primary outcome: Incident stroke (HR 1.85, 95% CI 1.27-2.70, p=0.001).

What does this research mean for the field?

The highest quartile of the triglyceride-glucose and waist circumference combined index (TyG-WC) is associated with an 85% increased risk of incident stroke compared to the lowest quartile, providing superior predictive utility over the TyG index alone. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 24, 2025Scientific Reports4 citationsOpen Access

Joint association of triglyceride-glucose index and obesity indicators with stroke risk: a nationwide prospective cohort study

ZLZhihui LiBeijing Institute of Technology YBYue BanShenyang Medical College MHMinli HuAnhui Medical University

Key Result

The highest quartile of the triglyceride-glucose and waist circumference combined index (TyG-WC) was associated with an 85% increased risk of incident stroke compared to the lowest quartile.

Study Design

Type

Cohort (n=8,730)

Multicenter

Yes

Structured PICO

Do combined indices of triglyceride-glucose (TyG) and obesity indicators improve the prediction of stroke risk compared to TyG or obesity indicators alone in a Chinese cohort?

Population

8,730 participants from the China Health and Retirement Longitudinal Study (CHARLS)

Intervention

Combined indices of triglyceride-glucose (TyG) and obesity indicators (BMI, WC, WHtR, WWI, BRI, ABSI)

Comparator

TyG index alone or obesity indicators alone

Outcome

Incident strokehard clinical

Combining the triglyceride-glucose index with obesity indicators provides superior predictive utility for stroke risk compared to using either metric alone.

Main Result

Effect estimate: HR 1.85 (95% CI 1.27-2.70)

Absolute Event Rate: 7.55% vs 3.48%

p-value: p=0.001

Limitations

Observational study design may be susceptible to unmeasured or unadjusted variables.
Independent cohort study design makes it difficult to confirm turning points and predictive models for external validation.
Primarily conducted in a Chinese population aged 45 years and older, limiting generalizability to other countries and younger populations.
Did not examine longitudinal changes over time or factors that changed over time.
Did not account for competing risks from non-stroke deaths during follow-up.
Lack of data on stroke subtypes (ischemic vs. hemorrhagic).
Stroke data were collected in a self-reported format, introducing potential recall and misclassification bias.
Potential selection bias in the excluded population.

Abstract

The triglyceride-glucose (TyG) index has been identified as an independent predictor of stroke risk. However, the comprehensive impact of combined indices, integrating TyG with obesity indicators such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), on stroke risk remains insufficiently explored. Furthermore, there is a paucity of research on combined indices involving TyG and other obesity indicators like the weight-adjusted waist index (WWI), body roundness index (BRI), and a body shape index (ABSI). This study aimed to comprehensively evaluate the combined impact of TyG with various obesity indicators on stroke risk and to investigate their potential associations. This observational cohort study included 8,730 participants from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards models, smooth curve fitting, and threshold effect analysis were employed to explore the potential relationships between the combined indices and stroke risk. The predictive value of TyG alone, obesity indicators, and the combined indices for stroke risk was compared using the area under the receiver operating characteristic (ROC) curve (AUC), and was validated by Delong test. Kaplan-Meier curves were used to illustrate the cumulative incidence of stroke events. Over a median follow-up of 7 years, 456 (5.20%) incident stroke cases were identified. After adjusting for confounding factors, non-linear relationships were observed between TyG-WC, TyG-WHtR, TyG-WWI, TyG-ABSI and stroke risk, demonstrating significant dose-response relationships (all P < 0.05 for the log-likelihood ratio test); conversely, TyG, TyG-BMI, and TyG-BRI exhibited linear relationships with stroke risk (The p values respectively: p < 0.001, p = 0.004, p = 0.019). The highest stroke risk incidence (7.55%) was observed in the Q4 group of TyG-WC. Furthermore, the combined indices showed higher AUC values for stroke risk compared to TyG or obesity indicators alone. Combined indices of TyG and obesity indicators are significantly associated with stroke risk. Combined obesity indicators with the TyG index may provide additional predictive utility for stroke risk compared to the TyG index alone. The combined assessment of the TyG index and obesity indicators could be considered in stroke risk assessment and primary prevention.

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