Association between triglyceride-glucose-related indices and all-cause and cause-specific mortality among individuals with periodontitis: A population-based study.
Cen D, Wang Z, et al. • The Journal of international medical research • 2026
Triglyceride-glucose-waist-to-height ratio demonstrated the most consistent association with mortality outcomes among US adults with periodontitis, being associated with all-cause and cardiovascular disease-related mortality in continuous analyses.
Key Findings
Results
The triglyceride-glucose (TyG) index was significantly associated with all-cause mortality in adults with periodontitis.
Hazard ratio of 1.15 (95% CI: 1.04–1.28; p = 0.009) per unit increase in TyG index in fully adjusted Cox models
Study included 6,789 adult participants with periodontitis over a median follow-up of 14.46 years
A total of 2,883 all-cause deaths were documented during follow-up
Data drawn from NHANES datasets covering 1988–1994, 1999–2004, and 2009–2014, with follow-up through December 31, 2019
Results
The TyG index was significantly associated with cardiovascular disease-related mortality in adults with periodontitis.
Hazard ratio of 1.23 (95% CI: 1.03–1.47; p = 0.025) in fully adjusted models
983 cardiovascular-related deaths were documented during the follow-up period
Association remained significant after adjustment for demographic, socioeconomic, lifestyle, cardiometabolic, and cohort-period covariates
Results
The triglyceride-glucose-waist circumference (TyG-WC) index was significantly associated with all-cause mortality but not cardiovascular disease-related or cancer-related mortality.
Hazard ratio of 1.05 (95% CI: 1.00–1.09; p = 0.033) per 100-unit increase in TyG-WC
TyG-WC was not significantly associated with cardiovascular disease-related or cancer-related mortality in fully adjusted models
Association with all-cause mortality was identified in continuous analyses only; no significant increasing trend was observed across quartiles
Results
The triglyceride-glucose-waist-to-height ratio (TyG-WHtR) demonstrated the most consistent association with mortality, being significantly associated with both all-cause and cardiovascular disease-related mortality.
HR for all-cause mortality: 1.11 (95% CI: 1.03–1.19; p = 0.006) in fully adjusted models
HR for cardiovascular disease-related mortality: 1.15 (95% CI: 1.01–1.32; p = 0.035)
TyG-WHtR was described as demonstrating 'the most consistent association with mortality outcomes' among all indices examined
Associations were found in continuous analyses; quartile analyses did not show significant increasing trends
Results
The triglyceride-glucose-body mass index (TyG-BMI) was not significantly associated with all-cause, cardiovascular disease-related, or cancer-related mortality.
TyG-BMI showed no significant association in fully adjusted Cox proportional hazards models for any mortality outcome
This was in contrast to TyG, TyG-WC, and TyG-WHtR, which showed at least one significant mortality association
No significant increasing trend was observed across quartiles of TyG-BMI
Results
No significant increasing trend in mortality risk was observed across quartiles of any triglyceride-glucose-related index.
Quartile analyses were performed for TyG, TyG-BMI, TyG-WC, and TyG-WHtR
Significant associations were identified only in continuous analyses, not in quartile-based trend analyses
Authors note this discrepancy warrants cautious interpretation
Methods
Periodontitis was defined using partial-mouth periodontal examination based on clinical attachment loss and probing pocket depth, and participants were drawn from three NHANES cycles.
NHANES cycles used: 1988–1994, 1999–2004, and 2009–2014
6,789 adult participants with periodontitis were included in the analysis
Mortality data were obtained by linking participants to National Death Index records with follow-up through December 31, 2019
Models were adjusted for demographic, socioeconomic, lifestyle, cardiometabolic, and cohort-period covariates
Results
None of the triglyceride-glucose-related indices were significantly associated with cancer-related mortality.
Cancer-related mortality was examined as a cause-specific outcome alongside cardiovascular disease-related mortality
No significant associations were found for TyG, TyG-BMI, TyG-WC, or TyG-WHtR with cancer-related mortality in fully adjusted models
The number of cancer-related deaths during follow-up was not separately specified in the abstract
What This Means
This research suggests that certain measures of metabolic health—specifically indices combining blood triglyceride and glucose levels with body size measurements—are linked to a higher risk of dying from any cause or from heart disease in people who have periodontitis (a serious form of gum disease). The study followed nearly 6,800 American adults with periodontitis for a median of about 14.5 years, drawing on large national health surveys conducted between 1988 and 2014. During that time, more than 2,800 participants died from any cause, and nearly 1,000 died from cardiovascular disease.
The study found that a basic triglyceride-glucose (TyG) index and a version that incorporates the ratio of waist size to height (TyG-WHtR) were associated with both overall and cardiovascular mortality risk. A version using waist circumference (TyG-WC) was linked only to overall mortality, while a version incorporating body mass index (TyG-BMI) showed no significant links to any type of mortality. The TyG-WHtR performed most consistently across outcomes. Notably, when participants were grouped into quartiles by their index scores, no clear step-wise increasing risk trend was seen—significant associations only appeared when the indices were treated as continuous measurements.
This research suggests that among people with periodontitis, simple metabolic indices—particularly those combining blood fat and sugar levels with measures of abdominal obesity—may help identify individuals at higher risk of premature death, especially from heart disease. However, the authors caution that because multiple comparisons were made and the study is observational (meaning it cannot prove cause and effect), these findings should be interpreted carefully and confirmed in future independent studies before drawing firm conclusions.
Cen D, Wang Z, Toufani N, Li T, Lin S. (2026). Association between triglyceride-glucose-related indices and all-cause and cause-specific mortality among individuals with periodontitis: A population-based study.. The Journal of international medical research. https://doi.org/10.1177/03000605261489330