TyG-ABSI and TyG-WWI as insulin-resistance body shape markers of mortality in middle-aged and older adults within the cardiovascular-kidney-metabolic framework: A multi-cohort observational study with external survival-model validation.
TyG-ABSI and TyG-WWI were the most consistent TyG-related body shape markers of all-cause mortality across international aging cohorts, but their incremental predictive value beyond established clinical and CKM variables was limited.
Key Findings
Results
All seven TyG-related indices were associated with higher all-cause mortality in NHANES, with TyG-ABSI and TyG-WWI showing the strongest associations.
TyG-ABSI had a hazard ratio of 1.159 (95% CI 1.115–1.205) in fully adjusted Cox models
TyG-WWI had a hazard ratio of 1.155 (95% CI 1.113–1.199) in fully adjusted Cox models
The primary NHANES analytic sample included 21,044 participants with 5,566 deaths during follow-up
All associations were based on standardized TyG-related indices allowing comparison across indices
Results
TyG-ABSI was positively associated with all-cause mortality in the Chinese cohort (CHARLS), though estimates in the English cohort (ELSA) were imprecise.
In CHARLS, TyG-ABSI HR was 1.088 (95% CI 1.029–1.151)
CHARLS included 11,157 participants with 1,393 deaths
ELSA included 5,454 participants with 116 deaths; estimates in ELSA were described as 'imprecise'
The imprecision in ELSA estimates likely reflects the relatively small number of deaths in that cohort
Results
In the HRS sensitivity cohort, TyG-WWI and TyG-ABSI remained positively associated with all-cause mortality.
The HRS sensitivity cohort included 4,103 participants and 484 deaths
Positive associations for TyG-WWI and TyG-ABSI were consistent with findings in NHANES and CHARLS
HRS was used specifically as an external sensitivity cohort to test robustness of findings
Results
Adding TyG-related indices to a clinical Cox prediction framework produced only minimal absolute gains in discrimination.
Incremental prediction analysis showed that TyG-related indices provided only minimal gains beyond established clinical and CKM variables
This finding held despite statistically significant associations with mortality in Cox models
The authors conclude these indices serve 'primarily as interpretable, low-cost CKM risk markers rather than standalone prediction tools'
Results
A TyG-ABSI extreme gradient boosting survival model achieved strong discrimination performance in internal testing and acceptable performance in external validation.
The model yielded a 5-year time-dependent AUC of 0.808 in the NHANES internal test set
External validation in CHARLS produced a 5-year time-dependent AUC of 0.760
The model used extreme gradient boosting (XGBoost) survival methodology
A research-use web calculator was developed for 5-year and 8-year mortality-risk estimation based on this model
Methods
The study analyzed seven distinct TyG-related indices across four international cohorts of middle-aged and older adults within the cardiovascular-kidney-metabolic framework.
The seven indices were: TyG, TyG-BMI, TyG-waist circumference, TyG-waist-to-height ratio, TyG-WWI, TyG-ABSI, and TyG-body roundness index
Cohorts included NHANES (US), ELSA (England), CHARLS (China), and HRS (US, sensitivity cohort)
Eligible participants were aged ≥50 years with follow-up beyond baseline, available mortality status, and complete data for all 7 TyG-related indices
Analyses included assessment of nonlinearity, proportional-hazards assumptions, sensitivity analyses, and NHANES heart disease mortality
Background
The study situated TyG-related body shape indices within the cardiovascular-kidney-metabolic (CKM) framework, highlighting the interconnection of insulin resistance, adiposity, kidney dysfunction, and cardiovascular disease in older adults.
TyG-related indices combine routine lipid, glucose, and anthropometric information
The authors note that 'cross-population consistency and incremental prognostic value for mortality-risk assessment remain uncertain' prior to this study
The CKM framework was used as the conceptual basis for variable selection and model construction
Both ABSI and WWI are anthropometric indices designed to capture central adiposity and body shape beyond BMI
What This Means
This research suggests that two composite measures combining blood fat and blood sugar levels with body shape measurements — called TyG-ABSI and TyG-WWI — are consistently linked to a higher risk of death in middle-aged and older adults across multiple countries including the United States, China, and England. These indices are inexpensive to calculate because they rely on routine clinical measurements (triglycerides, blood glucose, and waist or body shape measurements), making them potentially useful as simple screening tools for identifying higher-risk individuals in the context of metabolic and cardiovascular health.
However, the study also found an important limitation: while these indices are statistically associated with mortality risk, they do not meaningfully improve mortality prediction when added to models that already include standard clinical information about cardiovascular, kidney, and metabolic health. This means that although TyG-ABSI and TyG-WWI signal elevated risk, they do not add much new information beyond what doctors can already gather from routine clinical assessments. The researchers also developed a machine-learning model using TyG-ABSI that performed well at predicting 5-year survival risk, and they made this available as a web calculator, though they caution it is intended for research use.
This research suggests that TyG-ABSI and TyG-WWI are best understood as low-cost, easy-to-interpret markers of metabolic and cardiovascular risk — potentially useful for flagging at-risk individuals in population screening or research settings — rather than as standalone tools that replace comprehensive clinical evaluation. The consistency of these findings across cohorts from different countries adds confidence to their cross-cultural relevance for aging populations.
Xiao F, Guo H, Wang L, Qu Y, Dai C. (2026). TyG-ABSI and TyG-WWI as insulin-resistance body shape markers of mortality in middle-aged and older adults within the cardiovascular-kidney-metabolic framework: A multi-cohort observational study with external survival-model validation.. Medicine. https://doi.org/10.1097/MD.0000000000051089