Association of the triglyceride glucose-waist circumference index with hypertension among US adults: A cross-sectional study from NHANES

The triglyceride glucose-weight-adjusted waist index (TyG-WWI), integrating glycolipid metabolism and central obesity, may offer a novel approach to identifying metabolic dysregulation linked to hypertension, yet its association with hypertension among general adults remains inadequately characterized. In this cross-sectional analysis of 2716 adults (aged ≥ 20 years) from the National Health and Nutrition Examination Survey 2015 to 2018, hypertension was defined by self-reported physician diagnosis. Multivariable logistic regression, restricted cubic splines, subgroup analyses, and exploratory mediation analyses were applied, accounting for the complex survey design with fasting subsample weights. Of 2716 participants, 890 (32.8%) had hypertension. After full adjustment, each unit increase in TyG-WWI was associated with a 2% increase in the odds of hypertension (OR = 1.02, 95% confidence interval: 1.01-1.03, P < .001). A nonlinear dose-response relationship was observed (P for nonlinearity < .05), with risk accelerating at higher TyG-WWI levels; participants in the highest quartile had 72% higher odds than those in the lowest quartile (OR = 1.72, 95% confidence interval: 1.21-2.46; P for trend < .001). Subgroup analyses showed stronger associations in females and in normal-weight individuals. Exploratory mediation analyses suggested that body mass index and uric acid may account for 30.49% and 7.95% of the association, respectively; these estimates are descriptive and should not be interpreted as evidence of biological mediation. Higher TyG-WWI was independently associated with a higher prevalence of self-reported hypertension among United States adults across all body mass index categories. These findings support TyG-WWI as a promising composite marker for hypertension risk stratification; the exploratory mediation estimates warrant confirmation in prospective studies.