{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:01:20Z","timestamp":1790168480964,"version":"4.1.0"},"reference-count":78,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Insulin resistance(IR) is a key driver of cardiorenal-metabolic diseases. The Triglyceride Glucose-Body Mass Index (TyG-BMI), a composite marker of lipid-glucose metabolism and overall adiposity, has gained traction as a predictive tool. Its clinical application, however, is complicated by non-linear and sometimes paradoxical associations with clinical outcomes, a phenomenon reminiscent of the\u201dobesity paradox\u201d. This review critically evaluates the performance of TyG-BMI across the spectrum of kidney disease, aiming to reconcile these divergent findings through a metabolic-endocrine framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a narrative synthesis of observational studies and secondary analyses of large-scale public databases such as National Health and Nutrition Examination Survey(NHANES), China Health and Retirement Longitudinal Study(CHARLS), UK Biobank, Medical Information Mart for Intensive Care IV(MIMIC-IV), identified through PubMed and Google Scholar, to evaluate the association of TyG-BMI with the incidence, progression, and prognosis of acute kidney injury (AKI), diabetic kidney disease (DKD), chronic kidney disease (CKD), and Cardiovascular-Kidney-Metabolic syndrome(CKM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>TyG-BMI shows significant, context-dependent predictive value. In early-stage or metabolically heterogeneous populations, elevated TyG-BMI consistently predicts higher disease risk. Conversely, in advanced stages (e.g., end-stage renal disease, stage 4 CKM), the association frequently becomes U-shaped, with low TyG-BMI paradoxically linked to excess mortality. This reflects its dual nature: the TyG component captures \u2018metabolic toxicity\u2019, while BMI proxies \u2018nutritional reserve\u2019. Thus, the \u2018obesity paradox\u2019 may represent a metabolic phenotype spectrum\u2014from metabolically healthy obesity (MHO) to metabolically unhealthy lean (MUL)\u2014that the combination of its TyG and BMI components helps differentiate. For disease incidence prediction, TyG-BMI is often outperformed by indices of central obesity (e.g., Triglyceride-Glucose-Waist Circumference Index(TyG-WC), Triglyceride-Glucose\u2013Waist-to-Height Ratio(TyG-WHtR); for mortality in advanced illness, the standalone TyG index may be superior.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TyG-BMI is a valuable tool for metabolic phenotyping and risk stratification in kidney disease, with its paradoxical associations highlighting the complex interplay between metabolic health and nutritional reserve. Future research must establish context-specific clinical thresholds. TyG-BMI is preferentially useful in settings where waist circumference is unavailable, in early CKD screening, and in select type 2 diabetes mellitus (T2DM) subgroups. In advanced CKD, dialysis, critical illness, and CKM stage 4, alternative indices such as TyG index, TyG-WC, or TyG-WHtR should be prioritized due to the confounding effects of fluid overload and catabolic state.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1915011","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:07:35Z","timestamp":1790165255000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Insulin resistance, metabolic phenotypes, and the obesity paradox: a triglyceride glucose-body mass index framework in partial kidney diseases"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiangzhe","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Nephrology, Hebei Medical University Third Hospital","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hebei Medical University Third Hospital","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changchang","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hebei Medical University Third Hospital","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hebei Medical University Third Hospital","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongliang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hebei Medical University Third Hospital","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maodong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hebei Medical University Third Hospital","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","unstructured":"Reducing the burden of noncommunicable diseases through promotion of kidney health and strengthening prevention and control of kidney disease. 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