Higher baseline TyG-FI was associated with subsequent progression from CKM stages 0-2 to stages 3-4 and stage 4, and cumulative TyG-FI and two-wave patterns were associated with progression status at follow-up, so TyG-FI may provide an accessible composite measure for identifying individuals with early CKM syndrome at increased risk of advanced-stage progression.
Among 3,473 CHARLS adults with CKM stages 0-2 at Wave 1, 319 reached CKM stage 4 and 975 reached CKM stages 3-4 by Wave 3.
Higher baseline TyG-FI was associated with progression to CKM stage 4 and to stages 3-4 in fully adjusted models.
Estimated cumulative TyG-FI was associated with higher odds of both progression endpoints, with a steep gradient across tertiles.
K-means clustering identified three two-wave TyG-FI patterns, and Class 3 was associated with markedly higher odds of progression.
The dose-response associations between TyG-FI and CKM progression were nonlinear.
Baseline TyG-FI had modest discrimination for progression, with performance similar to FI alone.
This study followed 3,473 middle-aged and older Chinese adults who had early-stage cardiovascular-kidney-metabolic (CKM) syndrome (stages 0-2) to see who progressed to more advanced disease. The researchers used a combined measure, TyG-FI, that multiplies the triglyceride-glucose index (a marker of metabolic problems such as insulin resistance) by a frailty index (a measure of overall vulnerability). By the second follow-up, 319 people had reached stage 4 and 975 had reached stages 3-4. Higher TyG-FI at the start was linked to a greater likelihood of later progression, especially to stage 4. Higher cumulative TyG-FI, which reflects exposure over two measurements, and a high-risk two-wave pattern were associated with much higher odds of being in advanced stages at follow-up. For example, the highest tertile of cumulative TyG-FI had about 12 times the odds of stage 4 compared with the lowest. These cumulative and pattern analyses describe status at follow-up, so they do not show the order of events. The measure was only modestly accurate at distinguishing who would progress (AUCs of 0.67 and 0.57) and did no better than the frailty index alone. This research suggests TyG-FI may be an accessible way to flag people with early CKM syndrome at higher risk, but it is an observational study and does not show that changing TyG-FI would prevent progression.
Xiong H, Lei Y, Zhou J, Zou J. (2026). Associations of baseline levels, cumulative exposure, and two-wave patterns of the combined triglyceride-glucose index and frailty index with progression from cardiovascular-kidney-metabolic syndrome stages 0-2 to stages 3-4 and stage 4: a prospective cohort study from CHARLS.. Cardiovascular diabetology. https://doi.org/10.1186/s12933-026-03411-w