{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:50:12Z","timestamp":1791352212898,"version":"4.3.1"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"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>Hypertension, diabetes, and dyslipidemia frequently co-occur, yet simple screening tools are lacking in resource-limited settings. The hypertriglyceridemic waist-to-height ratio (HTH\/WH) phenotype has emerged as a potential indicator, but its utility for identifying the triple burden of hypertension, diabetes, and dyslipidemia remains underexplored, particularly in underdeveloped regions of China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study included 10,796 adults (\u226518 years) from the Ningxia Hui Autonomous Region, Northwest China. The HTH\/WH phenotype was defined as triglycerides \u22651.7 mmol\/L combined with waist-to-height ratio \u22650.5. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for the association between the HTH\/WH phenotype and coexisting hypertension, diabetes, and dyslipidemia. Mixed graphical models were employed to characterize the network associations among the HTH\/WH phenotype, the three cardiometabolic disorders, and modifiable lifestyle factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prevalence of concurrent hypertension, diabetes, and dyslipidemia was 3.99% in Ningxia, exceeding the Northwest China regional average of 2.33%. The HTH\/WH phenotype was present in 21.30% of the population and demonstrated a significant, dose-response association with the triple burden (adjusted OR\u00a0=\u00a05.29, 95% CI: 4.14\u20136.74), as well as with two diseases (adjusted OR\u00a0=\u00a05.12, 95% CI: 4.22\u20136.21) and one disease (adjusted OR\u00a0=\u00a01.97, 95% CI: 1.77\u20132.20). Factors independently associated with the triple burden included age \u226540 years, smoking, alcohol consumption, and elevated BMI (\u226524 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), while higher education and married status were inversely protective. Mixed graphical modeling revealed the HTH\/WH phenotype as a central bridge node (bridge strength = 0.67) within the metabolic disorder network, with strong direct connections to hypertension, diabetes, and dyslipidemia. BMI exhibited the highest bridge centrality (bridge strength = 1.72), followed by smoking (bridge strength = 0.32).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In Ningxia Hui Autonomous Region, concurrent hypertension, diabetes, and dyslipidemia pose a substantial health burden among adults. The HTH\/WH phenotype may serve as a practical risk assessment indicator for identifying high-risk individuals with this metabolic multimorbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1932657","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:53:41Z","timestamp":1791348821000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hypertriglyceridemic waist-to-height ratio and the triple burden of hypertension, diabetes, and dyslipidemia in adults: association and network analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Lanqiqi","family":"Wu","sequence":"first","affiliation":[{"name":"School of Public Health, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaoyang","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Public Health, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"He","sequence":"additional","affiliation":[{"name":"People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","place":["Yinchuan, China"]},{"name":"Ningxia Institute of Clinical Medicine, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Ma","sequence":"additional","affiliation":[{"name":"School of Public Health, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Cheng","sequence":"additional","affiliation":[{"name":"School of Public Health, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yining","family":"Liu","sequence":"additional","affiliation":[{"name":"People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinyu","family":"Ma","sequence":"additional","affiliation":[{"name":"People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huitian","family":"Tong","sequence":"additional","affiliation":[{"name":"People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Shi","sequence":"additional","affiliation":[{"name":"People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","place":["Yinchuan, China"]},{"name":"Ningxia Institute of Clinical Medicine, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.559751","article-title":"Global, regional, and national death, and disability-adjusted life-years (DALYs) for cardiovascular disease in 2017 and trends and risk analysis from 1990 to 2017 using the Global Burden of Disease Study and implications for prevention","volume":"9","author":"Li","year":"2021","journal-title":"Front Public Health"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2022.42.19.22184","article-title":"The magnitude of type 2 diabetes mellitus and cardiovascular disease risk factors among young adults in urban settings: a cross-sectional survey in Mwanza, Tanzania","volume":"42","author":"Malindisa","year":"2022","journal-title":"Pan Afr Med J"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/s2589-7500(22)00187-x","article-title":"Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study","volume":"5","author":"Kuan","year":"2023","journal-title":"Lancet Digital Health"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.4103\/hm.HM-D-24-00109","article-title":"Dietary trends, microbiome, and cardiovascular health: a narrative review","volume":"9","author":"Sanchis-Gomar","year":"2025","journal-title":"Heart Mind"},{"key":"B5","doi-asserted-by":"publisher","first-page":"17579","DOI":"10.1038\/s41598-021-96864-w","article-title":"Prevalence and related factors of dyslipidemia among urban adults aged 35 to 79 years in Southwestern China","volume":"11","author":"Huang","year":"2021","journal-title":"Sci Rep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"88","DOI":"10.4314\/ahs.v17i1.12","article-title":"A cross-sectional analysis of the association between age and gender and prescribed minimum benefit chronic disease list conditions among South Africans with concomitant hypertension, diabetes and dyslipidaemia","volume":"17","author":"Burger","year":"2017","journal-title":"Afr Health Sci"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.4103\/hm.HM-D-24-00106","article-title":"Effects of a diet rich in polyphenols on lipid metabolism: an updated narrative review","volume":"9","author":"Scavuzzi","year":"2025","journal-title":"Heart Mind"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/83.6.1248","article-title":"Does a diagnosis of metabolic syndrome have value in clinical practice","volume":"83","author":"Grundy","year":"2006","journal-title":"Am J Clin Nutr"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.46234\/ccdcw2020.039","article-title":"Interpretation of the diabetes prevention and control action of the healthy china initiative 2019-2030","volume":"2","author":"Wang","year":"2020","journal-title":"China CDC Wkly"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1673-4254.2017.10.16","article-title":"Association between hypertriglyceridemic waist?to?height ratio phenotype and chronic kidney disease in a community population in South China: a cross-sectional study","volume":"37","author":"Shao","year":"2017","journal-title":"Nan Fang Yi Ke Da Xue Xue Bao"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-050096","article-title":"BMI, waist to height ratio and waist circumference as a screening tool for hypertension in hospital outpatients: a cross-sectional, non-inferiority study","volume":"11","author":"Shrestha","year":"2021"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1111\/dom.13311","article-title":"Use of the waist-to-height ratio to predict cardiovascular risk in patients with diabetes: Results from the ADVANCE-ON study","volume":"20","author":"R\u00e5dholm","year":"2018"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1292738","article-title":"The relationship between hypertriglyceridemic wait-to-height ratio and hypertension\u2013diabetes comorbidity among older adult","volume":"11","author":"Zhang","year":"2023","journal-title":"Front Public Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"398","DOI":"10.4103\/hm.HM-D-24-00161","article-title":"Anti-dyslipidemic, anti-hypertensive, and glycemic control effects of Akkermansia muciniphila: Lesser-known benefits in metabolic syndrome \u2013 a narrative review","volume":"9","author":"Abolhassani","year":"2025","journal-title":"Heart Mind"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(24)00179-7","article-title":"Meat consumption and incident type 2 diabetes: an individual-participant federated meta-analysis of 1\u00b797 million adults with 100\u2008000 incident cases from 31 cohorts in 20 countries","volume":"12","author":"Li","year":"2024","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(17)33109-4","article-title":"The primary health-care system in China","volume":"390","author":"Li","year":"2017","journal-title":"Lancet"},{"key":"B17","doi-asserted-by":"publisher","first-page":"5528007","DOI":"10.1155\/2021\/5528007","article-title":"Prevalence and risk factors of hypertension, diabetes, and dyslipidemia among adults in Northwest China","volume":"2021","author":"Qiu","year":"2021"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112338-20240422-00208","article-title":"Prevalence and influencing factors of patients with comorbidity of hypertension, diabetes and dyslipidemia in residents aged 35-75 years in Tianjin","volume":"45","author":"Wang","year":"2024","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.12114\/j.issn.1007-9572.2023.0625","article-title":"Status and influencing factors of dyslipidemia, hypertension and diabetes comorbidities among Kazakhs in Xinjiang","volume":"27","author":"Jin","year":"2024","journal-title":"Chin Gen Pract"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1097\/hjh.0000000000002186","article-title":"Association of hypertriglyceridemic waist-to-height ratio and its dynamic status with incident hypertension: the Rural Chinese Cohort Study","volume":"37","author":"Li","year":"2019","journal-title":"J Hypertens"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-072408","article-title":"Prevalence of hyperuricaemia among adults from Ningxia Hui Autonomous Region, China: a cross-sectional study","volume":"13","author":"Shi","year":"2023","journal-title":"BMJ Open"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyx042","article-title":"Fresh fruit consumption and all-cause and cause-specific mortality: findings from the China Kadoorie Biobank","volume":"46","author":"Du","year":"2017","journal-title":"Int J Epidemiol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1017\/s1368980020003274","article-title":"Disparities in fresh fruit and vegetable intake by sociodemographic and behavioural factors among adults in China","volume":"25","author":"Li","year":"2022","journal-title":"Public Health Nutr"},{"key":"B24","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1097\/hjh.0000000000002453","article-title":"2020 International Society of Hypertension global hypertension practice guidelines","volume":"38","author":"Unger","year":"2020","journal-title":"J Hypertens"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-S002","article-title":"Diagnosis and classification of diabetes: Standards of care in diabetes-2024","volume":"47","year":"2024","journal-title":"Diabetes Care"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112338-20230715-00008","article-title":"Association between unhealthy lifestyles and hypertension, diabetes and dyslipidemia in old adults in China","volume":"45","author":"Ye","year":"2024","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"B27","doi-asserted-by":"publisher","first-page":"495","DOI":"10.4103\/hm.HM-D-25-00050","article-title":"Association of systemic metabolic dysregulation with moderate-to-severe depressive episodes and psychotic symptoms: a propensity score-matched case-control study","volume":"9","author":"Yang","year":"2025","journal-title":"Heart Mind"},{"key":"B28","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1002\/erv.2933","article-title":"A network analysis in adolescent anorexia nervosa exploring the connection between both patient and carer reactions and outcome","volume":"31","author":"Monteleone","year":"2023"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1111\/jch.14965","article-title":"Diabetes mellitus and hyperlipidemia status among hypertensive patients in the community and influencing factors analysis of blood pressure control","volume":"27","author":"Zhang","year":"2025","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.12114\/j.issn.1007-9572.2023.0625","article-title":"Status and influencing factors of dyslipidemia, hypertension and diabetes comorbidities among kazakhs in xinjiang","volume":"27","author":"Jin","year":"2024","journal-title":"Chinese General Practice"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1007\/s40801-023-00400-3","article-title":"Clinical and demographic characteristics of patients with coexistent hypertension, type 2 diabetes mellitus, and dyslipidemia: a retrospective study from India","volume":"11","author":"Dalal","year":"2024","journal-title":"Drugs Real World Outcomes"},{"key":"B32","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/s0212-6567(14)70047-2","article-title":"Cardiovascular preventive recommendations","author":"Maiques Gal\u00e1n","year":"2014","journal-title":"Aten Primaria"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(19)30427-1","article-title":"Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"394","author":"Zhou","year":"2019","journal-title":"Lancet"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.120.16156","article-title":"Dietary Approaches to Stop Hypertension dietary intervention improves blood pressure and vascular health in youth with elevated blood pressure","volume":"77","author":"Couch","year":"2021","journal-title":"Hypertension"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1097\/jom.0000000000000533","article-title":"Job strain, occupational category, systolic blood pressure, and hypertension prevalence: the Multi-Ethnic Study of Atherosclerosis","volume":"57","author":"Landsbergis","year":"2015","journal-title":"J Occup Environ Med"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.23501","article-title":"Does insufficient sleep increase the risk of developing insulin resistance: a systematic review","volume":"14","author":"Singh","year":"2022","journal-title":"Cureus"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1177\/14703203251353658","article-title":"Prevalence of dyslipidemia and its associated risk factors in hypertensive population: a single-center cross-sectional study in southern China","volume":"26","author":"Sun","year":"2025","journal-title":"J Renin-Angiotensin-Aldosterone Syst"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/gln016","article-title":"Prevalence, awareness, and management of hypertension, dyslipidemia, and diabetes among United States adults aged 65 and older","volume":"64","author":"McDonald","year":"2009","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.2174\/1570161116666181002145340","article-title":"Cardiovascular risk in perimenopausal women","volume":"17","author":"Stevenson","year":"2019","journal-title":"Curr Vasc Pharmacol"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2024.102629","article-title":"Lifestyle and clinical risk factors in relation with the prevalence of diabetes in the Indonesian urban and rural populations: the 2018 Indonesian Basic Health Survey","volume":"38","author":"Kurniawan","year":"2024","journal-title":"Prev Med Rep"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112148-20240914-00540","article-title":"Prevalence of comorbidity of hypertension, diabetes and dyslipidemia and the association between comorbidity and cardiovascular mortality in population aged 40 years and over in Liaoning Province","volume":"52","author":"Jing","year":"2024","journal-title":"Zhonghua Xin Xue Guan Bing Za Zhi"},{"key":"B42","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1038\/nrendo.2017.151","article-title":"Global aetiology and epidemiology of type 2 diabetes mellitus and its complications","volume":"14","author":"Zheng","year":"2018","journal-title":"Nat Rev Endocrinol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1292738","article-title":"The relationship between hypertriglyceridemic wait-to-height ratio and hypertension-diabetes comorbidity among older adult","volume":"11","author":"Zhang","year":"2023","journal-title":"Front Public Health"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.940168","article-title":"Association between hypertriglyceridemic-waist phenotype and cardiovascular disease: a cohort study and meta-analysis","volume":"9","author":"Zheng","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2725","article-title":"Prevalence of hypertriglyceridemic waist and association with risk of type 2 diabetes mellitus: a meta-analysis","volume":"32","author":"Ren","year":"2016","journal-title":"Diabetes Metab Res Rev"},{"key":"B46","doi-asserted-by":"publisher","first-page":"20283","DOI":"10.1038\/s41598-024-71217-5","article-title":"Multipartite network analysis to identify environmental and genetic associations of metabolic syndrome in the Korean population","volume":"14","author":"Shin","year":"2024","journal-title":"Sci Rep"},{"key":"B47","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1186\/s12889-024-17890-7","article-title":"Trajectories network analysis of chronic diseases among middle-aged and older adults: evidence from the China Health and Retirement Longitudinal Study (CHARLS)","volume":"24","author":"Chen","year":"2024","journal-title":"BMC Public Health"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.3390\/nu10081011","article-title":"Different risk for hypertension, diabetes, dyslipidemia, and hyperuricemia according to level of body mass index in Japanese and American subjects","volume":"10","author":"Kuwabara","year":"2018","journal-title":"Nutrients"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000027484","article-title":"Obesity and risk for hypertension and diabetes among Kenyan adults: results from a national survey","volume":"100","author":"Temu","year":"2021","journal-title":"Med (Baltimore)"},{"key":"B50","doi-asserted-by":"publisher","first-page":"2346","DOI":"10.1038\/s41598-023-29276-7","article-title":"Obesity and risk for its comorbidities diabetes, hypertension, and dyslipidemia in Japanese individuals aged 65 years","volume":"13","author":"Yamada","year":"2023","journal-title":"Sci Rep"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19148635","article-title":"Dietary habits of patients with coronary artery disease: A case-control study from Pakistan","volume":"19","author":"Hanif","year":"2022","journal-title":"Ijerph"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1932657\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:53:49Z","timestamp":1791348829000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1932657\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":51,"alternative-id":["10.3389\/fendo.2026.1932657"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1932657","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"1932657"}}