{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:53:16Z","timestamp":1781650396614,"version":"3.54.5"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005892","name":"China Academy of Chinese Medical Sciences","doi-asserted-by":"crossref","award":["CI2023C011LH"],"award-info":[{"award-number":["CI2023C011LH"]}],"id":[{"id":"10.13039\/501100005892","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The triglyceride-glucose (TyG) index is a recognized marker of insulin resistance, whereas the frailty index (FI) reflects cumulative physiological decline. However, the combined effect of metabolic dysfunction and frailty\u2014referred to as the TyG-Frailty Index (TyGFI)\u2014has not been systematically evaluated. This study aimed to examine the association between TyGFI, analyzed as both continuous and categorical variable, and the risk of chronic liver disease (CLD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Baseline and follow-up data were collected from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). Multivariable logistic regression models were utilized to evaluate the association between the TyGFI and the risk of CLD, adjusting for demographic characteristics, lifestyle factors, and clinical variables. Restricted cubic spline (RCS) and subgroup analyses were conducted to assess nonlinear dose - response relationships and interaction effects. Sensitivity analyses were performed to evaluate the robustness of the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 7,417 participants were included, of whom 265 developed CLD during follow-up. Elevated TyGFI levels were significantly associated with an increased risk of CLD after multivariable adjustment. Participants in the highest TyGFI quartile exhibited the greatest risk of CLD (OR\u2009=\u20093.19, 95% CI: 2.16\u20134.80,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Each unit increase in TyGFI was associated with a 38% higher odds of incident CLD (OR\u2009=\u20091.38, 95% CI: 1.23\u20131.45,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). RCS analysis demonstrated a consistent nonlinear dose-response relationship. ROC analysis showed that TyGFI had moderate discriminative ability for CLD (AUC\u2009=\u20090.64). No significant interaction was observed across subgroups, and sensitivity analyses further confirmed the robustness of the findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TyGFI is independently associated with an increased risk of incident CLD and demonstrates modest discriminative ability. By integrating metabolic and functional dimensions, TyGFI may serve as a complementary indicator for risk stratification in middle-aged and older adults, potentially supporting the early identification of individuals at increased risk of CLD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-026-04818-1","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:15:13Z","timestamp":1776212113000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The association of the combined triglyceride-glucose and frailty index with chronic liver disease: evidence from the CHARLS study"],"prefix":"10.1186","volume":"26","author":[{"given":"Xiaohan","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeyu","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luzhou","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaowei","family":"Shan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"issue":"1","key":"4818_CR1","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.jhep.2018.09.014","volume":"70","author":"SK Asrani","year":"2019","unstructured":"Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151\u201371. https:\/\/doi.org\/10.1016\/j.jhep.2018.09.014.","journal-title":"J Hepatol"},{"issue":"5","key":"4818_CR2","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1002\/cld.1061","volume":"17","author":"S Cheemerla","year":"2021","unstructured":"Cheemerla S, Balakrishnan M. Global Epidemiology of Chronic Liver Disease. Clin Liver Dis (Hoboken). 2021;17(5):365\u201370. https:\/\/doi.org\/10.1002\/cld.1061.","journal-title":"Clin Liver Dis (Hoboken)"},{"issue":"10159","key":"4818_CR3","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","volume":"392","author":"GBD 2017 Disease and Injury Incidence and Prevalence Collaborators","year":"2018","unstructured":"GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789\u2013858. https:\/\/doi.org\/10.1016\/S0140-6736(18)32279-7.","journal-title":"Lancet"},{"issue":"2","key":"4818_CR4","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1016\/j.jhep.2023.03.017","volume":"79","author":"H Devarbhavi","year":"2023","unstructured":"Devarbhavi H, Asrani SK, Arab JP, Nartey YA, Pose E, Kamath PS. Global burden of liver disease: 2023 update. J Hepatol. 2023;79(2):516\u201337. https:\/\/doi.org\/10.1016\/j.jhep.2023.03.017.","journal-title":"J Hepatol"},{"issue":"9","key":"4818_CR5","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/S2468-1253(22)00165-0","volume":"7","author":"K Riazi","year":"2022","unstructured":"Riazi K, et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022;7(9):851\u201361. https:\/\/doi.org\/10.1016\/S2468-1253(22)00165-0.","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"4","key":"4818_CR6","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1016\/j.jhep.2018.05.036","volume":"69","author":"C Estes","year":"2018","unstructured":"Estes C, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016\u20132030. J Hepatol. 2018;69(4):896\u2013904. https:\/\/doi.org\/10.1016\/j.jhep.2018.05.036.","journal-title":"J Hepatol"},{"issue":"7","key":"4818_CR7","doi-asserted-by":"publisher","first-page":"3347","DOI":"10.1210\/jc.2010-0288","volume":"95","author":"F Guerrero-Romero","year":"2010","unstructured":"Guerrero-Romero F, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(7):3347\u201351. https:\/\/doi.org\/10.1210\/jc.2010-0288.","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"4818_CR8","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1186\/s12933-023-02018-9","volume":"22","author":"S Tao","year":"2023","unstructured":"Tao S, et al. Association between the triglyceride-glucose index and 1-year major adverse cardiovascular events in patients with coronary heart disease and hypertension. Cardiovasc Diabetol. 2023;22(1):305. https:\/\/doi.org\/10.1186\/s12933-023-02018-9.","journal-title":"Cardiovasc Diabetol"},{"issue":"1","key":"4818_CR9","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s12933-025-02622-x","volume":"24","author":"Q Huang","year":"2025","unstructured":"Huang Q, Nan W, He B, Xing Z, Peng Z. Association of baseline and trajectory of triglyceride-glucose index with the incidence of cardiovascular autonomic neuropathy in type 2 diabetes mellitus. Cardiovasc Diabetol. 2025;24(1):66. https:\/\/doi.org\/10.1186\/s12933-025-02622-x.","journal-title":"Cardiovasc Diabetol"},{"issue":"9","key":"4818_CR10","doi-asserted-by":"publisher","first-page":"5409","DOI":"10.1097\/JS9.0000000000001795","volume":"110","author":"Y Jiang","year":"2024","unstructured":"Jiang Y, et al. Association of triglyceride glucose index with stroke: from two large cohort studies and Mendelian randomization analysis. Int J Surg. 2024;110(9):5409\u201316. https:\/\/doi.org\/10.1097\/JS9.0000000000001795.","journal-title":"Int J Surg"},{"issue":"1","key":"4818_CR11","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1186\/s12933-024-02354-4","volume":"23","author":"Y Zhang","year":"2024","unstructured":"Zhang Y, Wang F, Tang J, Shen L, He J, Chen Y. Association of triglyceride glucose-related parameters with all-cause mortality and cardiovascular disease in NAFLD patients: NHANES 1999\u20132018. Cardiovasc Diabetol. 2024;23(1):262. https:\/\/doi.org\/10.1186\/s12933-024-02354-4.","journal-title":"Cardiovasc Diabetol"},{"issue":"1","key":"4818_CR12","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1186\/s12933-024-02343-7","volume":"23","author":"Q Chen","year":"2024","unstructured":"Chen Q, et al. Association between triglyceride-glucose related indices and mortality among individuals with non-alcoholic fatty liver disease or metabolic dysfunction-associated steatotic liver disease. Cardiovasc Diabetol. 2024;23(1):232. https:\/\/doi.org\/10.1186\/s12933-024-02343-7.","journal-title":"Cardiovasc Diabetol"},{"key":"4818_CR13","doi-asserted-by":"publisher","first-page":"951689","DOI":"10.3389\/fendo.2022.951689","volume":"13","author":"Y Xue","year":"2022","unstructured":"Xue Y, Xu J, Li M, Gao Y. Potential screening indicators for early diagnosis of NAFLD\/MAFLD and liver fibrosis: Triglyceride glucose index-related parameters. Front Endocrinol. 2022;13:951689. https:\/\/doi.org\/10.3389\/fendo.2022.951689.","journal-title":"Front Endocrinol"},{"issue":"1","key":"4818_CR14","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12933-024-02572-w","volume":"24","author":"Y Qiao","year":"2025","unstructured":"Qiao Y, Wang Y, Chen C, Huang Y, Zhao C. Association between triglyceride-glucose (TyG) related indices and cardiovascular diseases and mortality among individuals with metabolic dysfunction-associated steatotic liver disease: a cohort study of UK Biobank. Cardiovasc Diabetol. 2025;24(1):12. https:\/\/doi.org\/10.1186\/s12933-024-02572-w.","journal-title":"Cardiovasc Diabetol"},{"issue":"6","key":"4818_CR15","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1056\/NEJMra2301292","volume":"391","author":"DH Kim","year":"2024","unstructured":"Kim DH, Rockwood K. Frailty in Older Adults. N Engl J Med. 2024;391(6):538\u201348. https:\/\/doi.org\/10.1056\/NEJMra2301292.","journal-title":"N Engl J Med"},{"issue":"10206","key":"4818_CR16","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1016\/S0140-6736(19)31786-6","volume":"394","author":"EO Hoogendijk","year":"2019","unstructured":"Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365\u201375. https:\/\/doi.org\/10.1016\/S0140-6736(19)31786-6.","journal-title":"Lancet"},{"issue":"3","key":"4818_CR17","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.jhep.2024.08.024","volume":"82","author":"Q Zhong","year":"2025","unstructured":"Zhong Q, et al. Frailty and risk of metabolic dysfunction-associated steatotic liver disease and other chronic liver diseases. J Hepatol. 2025;82(3):427\u201337. https:\/\/doi.org\/10.1016\/j.jhep.2024.08.024.","journal-title":"J Hepatol"},{"issue":"3","key":"4818_CR18","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1111\/apt.17324","volume":"57","author":"SP Bowers","year":"2023","unstructured":"Bowers SP, Brennan PN, Dillon JF. Systematic review: the role of frailty in advanced chronic liver disease. Aliment Pharmacol Ther. 2023;57(3):280\u20139. https:\/\/doi.org\/10.1111\/apt.17324.","journal-title":"Aliment Pharmacol Ther"},{"issue":"1","key":"4818_CR19","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1002\/lt.25346","volume":"25","author":"RA Bhanji","year":"2019","unstructured":"Bhanji RA, et al. Differing Impact of Sarcopenia and Frailty in Nonalcoholic Steatohepatitis and Alcoholic Liver Disease. Liver Transpl. 2019;25(1):14\u201324. https:\/\/doi.org\/10.1002\/lt.25346.","journal-title":"Liver Transpl"},{"issue":"3","key":"4818_CR20","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1002\/hep.32157","volume":"75","author":"S Wang","year":"2022","unstructured":"Wang S, et al. Frailty is associated with increased risk of cirrhosis disease progression and death. Hepatology. 2022;75(3):600\u20139. https:\/\/doi.org\/10.1002\/hep.32157.","journal-title":"Hepatology"},{"issue":"1","key":"4818_CR21","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1097\/HEP.0000000000000842","volume":"81","author":"K Patel","year":"2025","unstructured":"Patel K, et al. Accuracy of blood-based biomarkers for staging liver fibrosis in chronic liver disease: A systematic review supporting the AASLD Practice Guideline. Hepatology. 2025;81(1):358\u201379. https:\/\/doi.org\/10.1097\/HEP.0000000000000842.","journal-title":"Hepatology"},{"issue":"1","key":"4818_CR22","doi-asserted-by":"publisher","first-page":"2420858","DOI":"10.1080\/07853890.2024.2420858","volume":"56","author":"Y Tan","year":"2024","unstructured":"Tan Y, Zhang X. Diagnostic accuracy of FibroScan-AST (FAST) score, non-alcoholic fatty liver fibrosis score (NFS), FibroScan, and liver fibrosis index (FIB-4) for identifying fibrotic non-alcoholic steatohepatitis in patients with chronic hepatitis B with metabolic dysfunction-associated fatty liver disease. Ann Med. 2024;56(1):2420858. https:\/\/doi.org\/10.1080\/07853890.2024.2420858.","journal-title":"Ann Med"},{"issue":"1","key":"4818_CR23","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1186\/s12933-025-02880-9","volume":"24","author":"YC Zhao","year":"2025","unstructured":"Zhao YC, et al. Predictive value of the combined triglyceride-glucose and frailty index for cardiovascular disease and stroke in two prospective cohorts. Cardiovasc Diabetol. 2025;24(1):318. https:\/\/doi.org\/10.1186\/s12933-025-02880-9.","journal-title":"Cardiovasc Diabetol"},{"issue":"1","key":"4818_CR24","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12933-026-03076-5","volume":"25","author":"Y Wang","year":"2026","unstructured":"Wang Y, Wei N, Li M, Liu JW, Lin HB, Zhang HF. Association between the triglyceride-glucose-frailty index and all-cause and cardiovascular mortality in individuals with cardiovascular-kidney-metabolic syndrome: the mediating role of the poverty-income ratio. Cardiovasc Diabetol. 2026;25(1):58. https:\/\/doi.org\/10.1186\/s12933-026-03076-5.","journal-title":"Cardiovasc Diabetol"},{"key":"4818_CR25","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.ejim.2024.08.026","volume":"131","author":"Y Sun","year":"2025","unstructured":"Sun Y, Ji H, Sun W, An X, Lian F. Triglyceride glucose (TyG) index: A promising biomarker for diagnosis and treatment of different diseases. Eur J Intern Med. 2025;131:3\u201314. https:\/\/doi.org\/10.1016\/j.ejim.2024.08.026.","journal-title":"Eur J Intern Med"},{"key":"4818_CR26","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1471-2318-8-24","volume":"8","author":"SD Searle","year":"2008","unstructured":"Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008;8:24. https:\/\/doi.org\/10.1186\/1471-2318-8-24.","journal-title":"BMC Geriatr"},{"issue":"10","key":"4818_CR27","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1016\/j.jclinepi.2006.01.014","volume":"59","author":"AR Donders","year":"2006","unstructured":"Donders AR, van der Heijden GJ, Stijnen T, Moons KG. Review: a gentle introduction to imputation of missing values. J Clin Epidemiol. 2006;59(10):1087\u201391. https:\/\/doi.org\/10.1016\/j.jclinepi.2006.01.014.","journal-title":"J Clin Epidemiol"},{"issue":"21","key":"4818_CR28","doi-asserted-by":"publisher","first-page":"4640","DOI":"10.3390\/nu14214640","volume":"14","author":"R Deusdar\u00e1","year":"2022","unstructured":"Deusdar\u00e1 R, de Moura Souza A, Szklo M. Positive Additive and Multiplicative Interactions among Clustered Components of Metabolic Syndrome with Type 2 Diabetes Mellitus among Brazilian Adolescent Students. Nutrients. 2022;14(21):4640. https:\/\/doi.org\/10.3390\/nu14214640.","journal-title":"Nutrients"},{"key":"4818_CR29","doi-asserted-by":"publisher","unstructured":"Zheng J, Xie D, Nong Y, Jia K, Sha D. Association of the C-reactive protein-triglyceride-glucose index with liver disease risk: findings from a nationwide Chinese cohort. BMC Gastroenterol. 2026;3. https:\/\/doi.org\/10.1186\/s12876-025-04588-2.","DOI":"10.1186\/s12876-025-04588-2"},{"key":"4818_CR30","doi-asserted-by":"publisher","first-page":"112354","DOI":"10.1016\/j.diabres.2025.112354","volume":"226","author":"M Liu","year":"2025","unstructured":"Liu M, Li J, Yan K, Zhang K, Wang M, Guo J, Heisha N, Yang Y, Yuan J, Ye Y, Zhao X. Synergistic interaction and cumulative effect between frailty and triglyceride-glucose index exacerbate cardiovascular disease burden in middle-aged and older adults. Diabetes Res Clin Pract. 2025;226:112354. https:\/\/doi.org\/10.1016\/j.diabres.2025.112354.","journal-title":"Diabetes Res Clin Pract"},{"key":"4818_CR31","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyaf088","author":"A Discacciati","year":"2025","unstructured":"Discacciati A, Palazzolo MG, Park JG, Melloni GEM, Murphy SA, Bellavia A. Estimating and presenting non-linear associations with restricted cubic splines. Int J Epidemiol. 2025. https:\/\/doi.org\/10.1093\/ije\/dyaf088.","journal-title":"Int J Epidemiol"},{"issue":"8","key":"4818_CR32","doi-asserted-by":"publisher","first-page":"102581","DOI":"10.1016\/j.dsx.2022.102581","volume":"16","author":"DL Tahapary","year":"2022","unstructured":"Tahapary DL, et al. Challenges in the diagnosis of insulin resistance: Focusing on the role of HOMA-IR and Tryglyceride\/glucose index. Diabetes Metab Syndr. 2022;16(8):102581. https:\/\/doi.org\/10.1016\/j.dsx.2022.102581.","journal-title":"Diabetes Metab Syndr"},{"issue":"19","key":"4818_CR33","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.1056\/NEJMcibr1910023","volume":"381","author":"VT Samuel","year":"2019","unstructured":"Samuel VT, Shulman GI. Nonalcoholic Fatty Liver Disease, Insulin Resistance, and Ceramides. N Engl J Med. 2019;381(19):1866\u20139. https:\/\/doi.org\/10.1056\/NEJMcibr1910023.","journal-title":"N Engl J Med"},{"issue":"1","key":"4818_CR34","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1186\/s12933-024-02392-y","volume":"23","author":"SS Nayak","year":"2024","unstructured":"Nayak SS, et al. Diagnostic and prognostic value of triglyceride glucose index: a comprehensive evaluation of meta-analysis. Cardiovasc Diabetol. 2024;23(1):310. https:\/\/doi.org\/10.1186\/s12933-024-02392-y.","journal-title":"Cardiovasc Diabetol"},{"key":"4818_CR35","doi-asserted-by":"publisher","first-page":"1321922","DOI":"10.3389\/fendo.2024.1321922","volume":"15","author":"H Liu","year":"2024","unstructured":"Liu H, et al. Association between TyG index trajectory and new-onset lean NAFLD: a longitudinal study. Front Endocrinol. 2024;15:1321922. https:\/\/doi.org\/10.3389\/fendo.2024.1321922.","journal-title":"Front Endocrinol"},{"issue":"1","key":"4818_CR36","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12944-017-0409-6","volume":"16","author":"S Zhang","year":"2017","unstructured":"Zhang S, et al. The triglyceride and glucose index (TyG) is an effective biomarker to identify nonalcoholic fatty liver disease. Lipids Health Dis. 2017;16(1):15. https:\/\/doi.org\/10.1186\/s12944-017-0409-6.","journal-title":"Lipids Health Dis"},{"key":"4818_CR37","doi-asserted-by":"publisher","first-page":"1626672","DOI":"10.3389\/fmed.2025.1626672","volume":"12","author":"Y Chen","year":"2025","unstructured":"Chen Y, Lin X, Chen Y, Wang B, Xu C, Wang Y. Triglyceride-glucose index and related parameters in the diagnosis and predictive efficacy for older adults with NAFLD\/MASLD: a prospective cohort study. Front Med. 2025;12:1626672. https:\/\/doi.org\/10.3389\/fmed.2025.1626672.","journal-title":"Front Med"},{"key":"4818_CR38","doi-asserted-by":"publisher","first-page":"1043169","DOI":"10.3389\/fendo.2022.1043169","volume":"13","author":"Q Ling","year":"2022","unstructured":"Ling Q, et al. The triglyceride and glucose index and risk of nonalcoholic fatty liver disease: A dose-response meta-analysis. Front Endocrinol. 2022;13:1043169. https:\/\/doi.org\/10.3389\/fendo.2022.1043169.","journal-title":"Front Endocrinol"},{"issue":"23","key":"4818_CR39","doi-asserted-by":"publisher","first-page":"4969","DOI":"10.3390\/nu14234969","volume":"14","author":"J Wang","year":"2022","unstructured":"Wang J, Yan S, Cui Y, Chen F, Piao M, Cui W. The Diagnostic and Prognostic Value of the Triglyceride-Glucose Index in Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD): A Systematic Review and Meta-Analysis. Nutrients. 2022;14(23):4969. https:\/\/doi.org\/10.3390\/nu14234969.","journal-title":"Nutrients"},{"key":"4818_CR40","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.clnesp.2021.04.025","volume":"44","author":"H Tutunchi","year":"2021","unstructured":"Tutunchi H, Naeini F, Mobasseri M, Ostadrahimi A. Triglyceride glucose (TyG) index and the progression of liver fibrosis: A cross-sectional study. Clin Nutr ESPEN. 2021;44:483\u20137. https:\/\/doi.org\/10.1016\/j.clnesp.2021.04.025.","journal-title":"Clin Nutr ESPEN"},{"key":"4818_CR41","doi-asserted-by":"publisher","first-page":"1514093","DOI":"10.3389\/fendo.2025.1514093","volume":"16","author":"B Yang","year":"2025","unstructured":"Yang B, et al. Correlation between liver fibrosis in non-alcoholic fatty liver disease and insulin resistance indicators: a cross-sectional study from NHANES 2017\u20132020. Front Endocrinol. 2025;16:1514093. https:\/\/doi.org\/10.3389\/fendo.2025.1514093.","journal-title":"Front Endocrinol"},{"issue":"3","key":"4818_CR42","doi-asserted-by":"publisher","first-page":"e8649","DOI":"10.1371\/journal.pone.0008649","volume":"5","author":"K Kim","year":"2010","unstructured":"Kim K, Kim KH, Cheong J. Hepatitis B virus X protein impairs hepatic insulin signaling through degradation of IRS1 and induction of SOCS3. PLoS ONE. 2010;5(3):e8649. https:\/\/doi.org\/10.1371\/journal.pone.0008649.","journal-title":"PLoS ONE"},{"key":"4818_CR43","doi-asserted-by":"publisher","first-page":"737","DOI":"10.2147\/JHC.S454037","volume":"11","author":"SH Yang","year":"2024","unstructured":"Yang SH, He YS, Zheng SQ, Zhang XJ, Dai H, Xue Y. Triglyceride-Glucose Index is an Independent Risk Factor for Hepatocellular Carcinoma Development in Patients with HBV-Related Liver Cirrhosis. J Hepatocell Carcinoma. 2024;11:737\u201346. https:\/\/doi.org\/10.2147\/JHC.S454037.","journal-title":"J Hepatocell Carcinoma"},{"issue":"12","key":"4818_CR44","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1111\/liv.13917","volume":"38","author":"R Laube","year":"2018","unstructured":"Laube R, et al. Frailty in advanced liver disease. Liver Int. 2018;38(12):2117\u201321128. https:\/\/doi.org\/10.1111\/liv.13917.","journal-title":"Liver Int"},{"issue":"18","key":"4818_CR45","doi-asserted-by":"publisher","first-page":"e37821","DOI":"10.1016\/j.heliyon.2024.e37821","volume":"10","author":"Y Yang","year":"2024","unstructured":"Yang Y, Li C, Hong Y, Sun J, Chen G, Ji K. Association between functional dependence and cardiovascular disease among middle-aged and older adults: Findings from the China health and retirement longitudinal study. Heliyon. 2024;10(18):e37821. https:\/\/doi.org\/10.1016\/j.heliyon.2024.e37821.","journal-title":"Heliyon"},{"key":"4818_CR46","doi-asserted-by":"publisher","first-page":"113869","DOI":"10.1016\/j.addr.2021.113869","volume":"176","author":"S Kumar","year":"2021","unstructured":"Kumar S, Duan Q, Wu R, Harris EN, Su Q. Pathophysiological communication between hepatocytes and non-parenchymal cells in liver injury from NAFLD to liver fibrosis. Adv Drug Deliv Rev. 2021;176:113869. https:\/\/doi.org\/10.1016\/j.addr.2021.113869.","journal-title":"Adv Drug Deliv Rev"},{"issue":"3","key":"4818_CR47","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1053\/j.gastro.2018.06.083","volume":"155","author":"A Mansouri","year":"2018","unstructured":"Mansouri A, Gattolliat CH, Asselah T. Mitochondrial Dysfunction and Signaling in Chronic Liver Diseases. Gastroenterology. 2018;155(3):629\u201347. https:\/\/doi.org\/10.1053\/j.gastro.2018.06.083.","journal-title":"Gastroenterology"},{"issue":"5","key":"4818_CR48","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1016\/j.cmet.2024.03.012","volume":"36","author":"M Mishra","year":"2024","unstructured":"Mishra M, Wu J, Kane AE, Howlett SE. The intersection of frailty and metabolism. Cell Metab. 2024;36(5):893\u2013911. https:\/\/doi.org\/10.1016\/j.cmet.2024.03.012.","journal-title":"Cell Metab"},{"issue":"8","key":"4818_CR49","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1016\/j.metabol.2015.12.012","volume":"65","author":"E Buzzetti","year":"2016","unstructured":"Buzzetti E, Pinzani M, Tsochatzis EA. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD). Metabolism. 2016;65(8):1038\u201348. https:\/\/doi.org\/10.1016\/j.metabol.2015.12.012.","journal-title":"Metabolism"},{"key":"4818_CR50","doi-asserted-by":"publisher","first-page":"1083032","DOI":"10.3389\/fendo.2023.1083032","volume":"14","author":"H Peng","year":"2023","unstructured":"Peng H, et al. Prediction of MAFLD and NAFLD using different screening indexes: A cross-sectional study in U.S. adults. Front Endocrinol. 2023;14:1083032. https:\/\/doi.org\/10.3389\/fendo.2023.1083032.","journal-title":"Front Endocrinol"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-026-04818-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-026-04818-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-026-04818-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:02:55Z","timestamp":1781647375000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12876-026-04818-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4818"],"URL":"https:\/\/doi.org\/10.1186\/s12876-026-04818-1","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]},"assertion":[{"value":"17 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The research protocol was approved by the Ethical Review Committee of Peking University (approval number: IRB00001052-11015 for the household survey and IRB00001052-11014 for blood samples). The studies were conducted in accordance with the local legislation and institutional requirements. All participants provided their written informed consent to participate in this study. All procedures involving human participants were conducted in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Consent for publication has been obtained. All patient information in this manuscript has been de-identified to ensure anonymity. Informed consent has been obtained from the participating patients or their legal guardians for the publication of any potentially identifiable personal images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"317"}}