Triglyceride–glucose index and its derived anthropometric indices: a comparative analysis for mortality prediction in the population cohort of the URRAH study
BACKGROUND AND AIMS: The triglyceride-glucose (TyG) index is an established surrogate marker of insulin resistance and has been consistently associated with adverse cardiovascular outcomes. Composite indices combining TyG with anthropometric measures, such as body mass index (BMI) and waist circumference (WC), have been proposed to enhance risk prediction. However, their incremental prognostic value remains uncertain. This study aimed to compare the predictive performance of TyG, BMI, and WC with that of their derived multiplicative indices (TyG-BMI and TyG-WC) for all-cause and cardiovascular mortality. METHODS AND RESULTS: Data were analysed from the multicentre URRAH cohort, including 17,742 participants for the evaluation of TyG-BMI and a sub-analysis of 7052 individuals for TyG-WC. Over a median follow-up of 11.7 years, 2650 all-cause deaths occurred, including 1158 cardiovascular deaths. The TyG index showed a strong and independent association with both outcomes. Although TyG-BMI and TyG-WC were significantly associated with mortality, their risk patterns largely reflected those of their individual components. In multivariable models, inclusion of the derived indices did not meaningfully improve model fit, discrimination, individual risk prediction, or clinical usefulness. CONCLUSION: In this large general cohort, the TyG index was confirmed as a robust predictor of all-cause and cardiovascular mortality. In contrast, derived indices combining TyG with BMI or WC did not confer meaningful incremental prognostic value beyond modelling TyG and anthropometric measures separately, supporting the use of TyG as a simple and clinically informative marker for mortality risk stratification.
Authors
- Massimo Salvetti (ORCID: https://orcid.org/0000-0001-8101-1374)
- Maria Masulli (ORCID: https://orcid.org/0000-0002-7848-6456)
- María Lorenza Muiesan (ORCID: https://orcid.org/0000-0002-4007-9441)
- Luciano Lippa (ORCID: https://orcid.org/0000-0003-1249-3861)
- Pietro Nazzaro (ORCID: https://orcid.org/0000-0002-6713-1027)
- Edoardo Casiglia (ORCID: https://orcid.org/0000-0002-0003-3289)
- Valérie Tikhonoff (ORCID: https://orcid.org/0000-0001-7846-0101)
- Giulia Rivasi (ORCID: https://orcid.org/0000-0002-2736-2242)
- Massimo Círillo (ORCID: https://orcid.org/0000-0002-6409-3504)
- Francesca Viazzi (ORCID: https://orcid.org/0000-0003-4219-7043)
- Marcello Rattazzi (ORCID: https://orcid.org/0000-0003-3437-7263)
- Claudio Ferri (ORCID: https://orcid.org/0000-0002-3594-2503)
- Rosario Cianci (ORCID: https://orcid.org/0000-0001-7886-8027)
- Michele Bombelli (ORCID: https://orcid.org/0000-0002-8459-711X)
- Pietro Cirillo (ORCID: https://orcid.org/0000-0003-4164-6978)
- Elisa Russo (ORCID: https://orcid.org/0000-0003-1279-3178)
- Arrigo F.G. Cicero (ORCID: https://orcid.org/0000-0002-4367-3884)
- Andrea Ungar (ORCID: https://orcid.org/0000-0002-8965-4523)
- Gianpaolo Reboldi (ORCID: https://orcid.org/0000-0002-9877-0702)
- Roberto Pontremoli (ORCID: https://orcid.org/0000-0003-1238-872X)
- Carlo Maria Barbagallo
- Agostino Virdis
- Michele Ciccarelli
- Guido Iaccarino
- Fabio Angeli
- Arrigo F. G. Cicero
- Lanfranco D'Elia
- Loreto Gesualdo
- Alessandro Mengozzi
- Giuliano Tocci
- Massimo Volpe
- Alberto Mazza
- Fosca Quarti-Trevano
- Cristina Giannattasio
- Giovambattista Desideri
- Gianfranco Parati
- Paolo Palatini
- Claudio Borghi (
- Raffaella Dell'Oro
- Alessandro Maloberti
- Stefano Masi
- Francesca Mallamaci
- Ferruccio Galletti
- Claudio Borghi
- Paolo Verdecchia
- Guido Grassi
- Noemi Pardini
Institutions
- University of Pisa (IT)
- University of Insubria (IT)
- University of Salerno (IT)
- University of Padua (IT)
- University of L'Aquila (IT)
- University of Perugia (IT)
- European Society of Hypertension (IT)
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
- Department of Health (ES)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Ospedale Santa Maria (IT)
- Federico II University Hospital (IT)
- Azienda USL di Bologna (IT)
- Azienda Ospedaliera Sant'Andrea (IT)
- IRCCS Istituto Auxologico Italiano (IT)
- Società Italiana di Medicina Generale (IT)
- Ca' Foncello Hospital (IT)
- Ospedale San Bortolo (IT)
- University of Bari Aldo Moro (IT)
- University of Milano-Bicocca (IT)
- Misericordia University (US)
- University of Naples Federico II (IT)
- University of Brescia (IT)
- University of Genoa (IT)
- Sapienza University of Rome (IT)
- University of Bologna (IT)
Publication Details
- Journal
- Nutrition Metabolism and Cardiovascular Diseases
- Published
- 2026-04-01
- DOI
- https://doi.org/10.1016/j.numecd.2026.104726
- Primary Topic
- Diabetes, Cardiovascular Risks, and Lipoproteins
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Società Italiana dell'Ipertensione Arteriosa