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Cross-sectional analyses included the National Health and Nutrition Examination Survey (NHANES; n\u2009=\u20091842) and the Health and Retirement Study (HRS; n\u2009=\u20094310), whereas prospective analyses included the China Health and Retirement Longitudinal Study (CHARLS; n\u2009=\u20094114), the English Longitudinal Study of Ageing (ELSA; n\u2009=\u20091310), and HRS (n\u2009=\u2009971). Multimorbidity was defined as the presence of at least two of eight harmonized chronic conditions. Multivariable logistic regression and Cox proportional hazards models were used to evaluate prevalent and incident multimorbidity, respectively. Restricted cubic spline and two-piecewise regression models were used to assess nonlinear associations, and receiver operating characteristic curves were used to compare TyG-WHtR with five alternative TyG-related anthropometric indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the cross-sectional analyses, the fully adjusted ORs comparing the highest with the lowest TyG-WHtR quartile were 5.04 (95% CI 3.02\u20138.42) in NHANES and 3.63 (95% CI 2.70\u20134.90) in HRS. In the prospective analyses, the fully adjusted HRs comparing the highest with the lowest quartile were 1.87 (95% CI 1.59\u20132.21) in CHARLS, 1.67 (95% CI 1.30\u20132.15) in ELSA, and 1.57 (95% CI 1.08\u20132.29) in HRS. Prospective dose\u2013response associations were nonlinear, with inflection points of 5.92, 5.80, and 6.69, respectively; risk increased predominantly below these values. TyG-WHtR had the largest area under the curve in both cross-sectional samples and in CHARLS and ELSA. Lagged analyses and alternative multimorbidity definitions yielded consistent results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher TyG-WHtR was associated with prevalent multimorbidity in both cross-sectional samples and with incident multimorbidity in quartile-based analyses across all three prospective cohorts, although the continuous association was not statistically significant in prospective HRS. The cohort-specific inflection points suggest a provisional candidate risk-alert interval of approximately 5\u20137. This interval requires independent external validation and should not be interpreted as a diagnostic or treatment threshold.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12933-026-03320-y","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:25:04Z","timestamp":1787549104000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Triglyceride-glucose waist-to-height ratio in relation to prevalent and incident multimorbidity: cross-sectional and prospective evidence from four national studies"],"prefix":"10.1186","volume":"25","author":[{"given":"Zhengqi","family":"Shao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HongZhi","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingjie","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangru","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danqi","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zixuan","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bai","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"issue":"1","key":"3320_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-023-04393-0","volume":"23","author":"K Xiong","year":"2023","unstructured":"Xiong K, Mao H, Zhang Q, Lei C, Liang Y. 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Cardiovasc Diabetol. 2018;17(1):122.","journal-title":"Cardiovasc Diabetol"}],"container-title":["Cardiovascular Diabetology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12933-026-03320-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12933-026-03320-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12933-026-03320-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:41:18Z","timestamp":1790167278000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12933-026-03320-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3320"],"URL":"https:\/\/doi.org\/10.1186\/s12933-026-03320-y","relation":{},"ISSN":["1475-2840"],"issn-type":[{"value":"1475-2840","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"assertion":[{"value":"9 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"NHANES protocols were approved by the National Center for Health Statistics Research Ethics Review Board, and written informed consent was obtained from all participants. CHARLS was conducted in accordance with the Declaration of Helsinki and approved by the Biomedical Ethics Review Committee of Peking University (IRB00001052-11015). ELSA received ethical approval from the London Multi-Centre Research Ethics Committee (MREC\/01\/2\/91). The HRS core and supplemental biomarker protocols were reviewed by the University of Michigan Health Sciences and Behavioral Sciences Institutional Review Board (core protocols HUM00061128 and HUM00246459).The present study was a secondary analysis of de-identified data from four national studies. No new participant contact or primary data collection was undertaken.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"286"}}