{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T06:03:59Z","timestamp":1789365839157,"version":"build-2803163510"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Frailty is a major public health challenge among middle-aged and older adults, closely associated with metabolic dysregulation and visceral fat accumulation. The product of the triglyceride-glucose index and the Chinese Visceral Adiposity Index (TyG-CVAI) comprehensively reflects insulin resistance and visceral adiposity, yet its bidirectional temporal association with the frailty index remains unclear. This study aimed to examine this bidirectional association using cross-lagged panel models and characterize the predominant prospective temporal association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included 2,476 participants from the China Multi-Ethnic Cohort study who completed both the 2018 baseline survey and the 2021 follow-up survey and had complete data. The frailty index was constructed using the cumulative deficit model, based on 25 health-deficit items. A two-wave cross-lagged panel model was developed, with adjustment for age, sex, ethnicity, educational attainment, marital status, smoking status, and alcohol consumption. Model fit was evaluated using the comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR). The robustness of the findings was assessed through sensitivity analyses that excluded overlapping components. Additional cross-lagged analyses were performed using the TyG index and CVAI separately to verify the advantages of the composite indicator. Subgroup analyses and restricted cubic spline regression were used to explore population heterogeneity and nonlinear exposure-response relationships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline TyG-CVAI significantly predicted follow-up frailty index (standardized\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.165,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), whereas the reverse path was considerably weaker (standardized\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.035,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), indicating a predominant prospective temporal association. Sensitivity analyses excluding overlapping indicators yielded consistent results. Supplementary cross-lagged analyses using the TyG index and CVAI separately confirmed that the composite TyG-CVAI indicator exhibited a stronger prospective association with the frailty index than either individual component, and demonstrated superior model fit. Subgroup analyses revealed this association was significantly stronger among participants aged under 60, ethnic minorities, and those without hypertension or diabetes. Restricted cubic spline regression identified a significant non-linear relationship between baseline TyG-CVAI and follow-up frailty index, with an inflection point at approximately TyG-CVAI\u202f=\u202f750.10 (the 50th percentile), beyond which the marginal association with frailty index attenuated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A significant bidirectional temporal association exists between TyG-CVAI and the frailty index, dominated by a positive prospective temporal association from TyG-CVAI to frailty, suggesting metabolic dysregulation may serve as a temporally preceding risk marker in frailty development. As a composite indicator based on routine clinical tests, TyG-CVAI may serve as a feasible biomarker for early frailty screening in community-dwelling middle-aged and older populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1892429","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:39:05Z","timestamp":1789364345000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cross-lag association between TyG-CVAI and frailty index: evidence from a natural population cohort in southwestern China"],"prefix":"10.3389","volume":"14","author":[{"given":"Hao","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuming","family":"Ji","sequence":"additional","affiliation":[{"name":"Institute of Hospital Management, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Science and Technology, Clinical Research Management Office, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqin","family":"Gan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruoyu","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaili","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e198398","DOI":"10.1001\/jamanetworkopen.2019.8398","article-title":"Global incidence of frailty and Prefrailty among community-dwelling older adults: a systematic review and Meta-analysis","volume":"2","author":"Ofori-Asenso","year":"2019","journal-title":"JAMA Netw Open"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1093\/ageing\/afaa219","article-title":"Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level 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health and retirement longitudinal study (CHARLS)","volume":"25","author":"Zheng","year":"2026","journal-title":"Cardiovasc Diabetol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"104721","DOI":"10.1016\/j.numecd.2026.104721","article-title":"Association of triglyceride-glucose index combined with Chinese visceral adiposity index and cardiovascular diseases in middle-aged and older adults: a cohort study","volume":"36","author":"Fei","year":"2026","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1186\/s12933-025-02972-6","article-title":"Associations of longitudinal trajectories of triglyceride-glucose index combined with classical and novel obesity indices and cardiovascular disease: evidence from a nationwide prospective cohort study in China","volume":"24","author":"Wang","year":"2025","journal-title":"Cardiovasc 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