{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:04:31Z","timestamp":1791475471609,"version":"4.3.4"},"reference-count":50,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: The triglyceride\u2013glucose (TyG) index is a surrogate marker of insulin resistance associated with chronic kidney disease (CKD). The effect of TyG index changes on the development of CKD in young adults remains unclear. Methods: We studied 353,140 Korean adults aged 18\u201349 years who underwent at least two health screenings. The TyG index changes between visits were categorized into quintiles. Incident CKD was defined as an estimated glomerular filtration rate of &lt;60 mL\/min\/1.73 m2 or proteinuria. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for CKD risk. Results: Over 2.74 million person-years, 18,857 men and 13,394 women developed CKD. In the fully adjusted models, men in the highest quintile of TyG index increase had a higher CKD risk (HR 1.22, 95% CI 1.16\u20131.28), while those in the lowest quintile had a lower risk (HR 0.88, 95% CI 0.84\u20130.92). In women, the associations were in the same direction, but neither the highest (HR 1.01, 95% CI 0.95\u20131.07) nor the lowest quintile (HR 0.95, 95% CI 0.90\u20131.00) reached statistical significance. Risk gradients were stronger in those aged 40\u201349 years, with a baseline eGFR &lt; 90 mL\/min\/1.73 m2, higher alcohol intake, or insulin resistance. Conclusions: Among relatively young adults, greater increases in the TyG index were associated with a higher CKD risk in men, whereas decreases were protective. In contrast, no significant associations were observed in women. Monitoring TyG index trajectories may help identify high-risk individuals for early intervention.<\/jats:p>","DOI":"10.3390\/nu17182986","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T15:12:44Z","timestamp":1758121964000},"page":"2986","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Sex-Specific Associations Between Changes in Triglyceride\u2013Glucose (TyG) Index and Risk of Chronic Kidney Disease: A Cohort Study of Young and Middle-Aged Adults"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7876-9332","authenticated-orcid":false,"given":"Yoon Ji","family":"Kim","sequence":"first","affiliation":[{"name":"Big Data Research Center, Division of Healthcare Planning, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0763-5458","authenticated-orcid":false,"given":"Ye Seul","family":"Bae","sequence":"additional","affiliation":[{"name":"Big Data Research Center, Division of Healthcare Planning, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea"},{"name":"Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6945-9050","authenticated-orcid":false,"given":"Yoosoo","family":"Chang","sequence":"additional","affiliation":[{"name":"Center of Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea"},{"name":"Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea"},{"name":"Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujeong","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea"},{"name":"Graduate School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2020). WHO Technical Guidance and Specifications of Medical Devices for Screening and Treatment of Precancerous Lesions in the Prevention of Cervical Cancer, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1038\/s41581-024-00820-6","article-title":"Chronic kidney disease and the global public health agenda: An international consensus","volume":"20","author":"Francis","year":"2024","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1093\/ndt\/gfae027","article-title":"Glomerular hyperfiltration as a therapeutic target for CKD","volume":"39","author":"Kanbay","year":"2024","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Inserra, F., Forcada, P., Castellaro, A., and Castellaro, C. (2021). Chronic Kidney Disease and Arterial Stiffness: A Two-Way Path. Front. Med., 8.","DOI":"10.3389\/fmed.2021.765924"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"897","DOI":"10.21037\/atm.2020.03.62","article-title":"Understanding sex differences in progression and prognosis of chronic kidney disease","volume":"8","author":"Kattah","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1038\/s41581-023-00784-z","article-title":"Differences in the epidemiology, management and outcomes of kidney disease in men and women","volume":"20","author":"Chesnaye","year":"2024","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.kint.2020.10.012","article-title":"The case for early identification and intervention of chronic kidney disease: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference","volume":"99","author":"Shlipak","year":"2021","journal-title":"Kidney Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"sfaf123","DOI":"10.1093\/ckj\/sfaf123","article-title":"Impact of albuminuria screening in primary care on the detection and management of chronic kidney disease: Findings from the ONDAAS study","volume":"18","author":"Palencia","year":"2025","journal-title":"Clin. Kidney J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e13649","DOI":"10.1111\/obr.13649","article-title":"Association of metabolic syndrome and chronic kidney disease","volume":"25","author":"Scurt","year":"2024","journal-title":"Obes. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9609266","DOI":"10.1155\/2023\/9609266","article-title":"The growing challenge of chronic kidney disease: An overview of current knowledge","volume":"2023","author":"Borg","year":"2023","journal-title":"Int. J. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"143","DOI":"10.5527\/wjn.v3.i4.143","article-title":"Why do young people with chronic kidney disease die early?","volume":"3","author":"Kumar","year":"2014","journal-title":"World J. Nephrol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3347","DOI":"10.1210\/jc.2010-0288","article-title":"The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp","volume":"95","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1089\/met.2008.0034","article-title":"The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects","volume":"6","year":"2008","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Aliyu, U., Toor, S.M., Abdalhakam, I., Elrayess, M.A., Abou-Samra, A.B., and Albagha, O.M. (2025). Evaluating indices of insulin resistance and estimating the prevalence of insulin resistance in a large biobank cohort. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1591677"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"102581","DOI":"10.1016\/j.dsx.2022.102581","article-title":"Challenges in the diagnosis of insulin resistance: Focusing on the role of HOMA-IR and Tryglyceride\/glucose index","volume":"16","author":"Tahapary","year":"2022","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"F1087","DOI":"10.1152\/ajprenal.00340.2016","article-title":"Insulin resistance in chronic kidney disease: A systematic review","volume":"311","author":"Spoto","year":"2016","journal-title":"Am. J. Physiol.-Ren. Physiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3035","DOI":"10.1007\/s11357-023-01044-5","article-title":"Baseline and usual triglyceride-glucose index and the risk of chronic kidney disease: A prospective cohort study","volume":"46","author":"Kunutsor","year":"2024","journal-title":"Geroscience"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.numecd.2023.03.026","article-title":"Association between triglyceride-glucose index and chronic kidney disease: A cohort study and meta-analysis","volume":"33","author":"Ren","year":"2023","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Yu, C.-C., Shi, Y., Wang, T., Zhu, L., Zhou, W., Bao, H., and Cheng, X. (2024). Triglyceride\u2013glucose index change and chronic kidney disease progression in a Chinese hypertensive population. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1342408"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Hou, Q., Zhang, H., Zhang, R., Li, B., Li, L., Li, D., Wang, X., Liu, Y., Wan, Z., and Zhang, J. (2024). Relationship between the longitudinal trajectory of the triglyceride-glucose index and the development of CKD: An 8-year retrospective longitudinal cohort study. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1376166"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1007\/s10238-024-01472-3","article-title":"Elevated TyG-BMI index predicts incidence of chronic kidney disease","volume":"24","author":"Fan","year":"2024","journal-title":"Clin. Exp. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"258","DOI":"10.4235\/agmr.23.0096","article-title":"The Triglyceride-Glucose Index is Independently Associated with Chronic Kidney Disease in the Geriatric Population, Regardless of Obesity and Sex","volume":"27","author":"Kim","year":"2023","journal-title":"Ann. Geriatr. Med. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"305","DOI":"10.7326\/M15-1323","article-title":"Metabolically healthy obesity and development of chronic kidney disease: A cohort study","volume":"164","author":"Chang","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12933-023-02098-7","article-title":"Association of long-term triglyceride-glucose index patterns with the incidence of chronic kidney disease among non-diabetic population: Evidence from a functional community cohort","volume":"23","author":"Chen","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zhu, Q., Chen, Y., Cai, X., Cai, L., Hong, J., Luo, Q., Ren, Y., Guo, Y., and Li, N. (2022). The non-linear relationship between triglyceride-glucose index and risk of chronic kidney disease in hypertensive patients with abnormal glucose metabolism: A cohort study. Front. Med., 9.","DOI":"10.3389\/fmed.2022.1018083"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1093\/eurheartj\/ehae020","article-title":"Human papillomavirus infection and cardiovascular mortality: A cohort study","volume":"45","author":"Cheong","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"461","DOI":"10.7326\/0003-4819-130-6-199903160-00002","article-title":"A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group","volume":"130","author":"Levey","year":"1999","journal-title":"Ann. Intern. Med."},{"key":"ref_28","first-page":"1","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"3","author":"Levin","year":"2013","journal-title":"Kidney Int. Suppl."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1007\/s00125-011-2085-9","article-title":"The four-variable modification of diet in renal disease formula underestimates glomerular filtration rate in obese type 2 diabetic individuals with chronic kidney disease","volume":"54","author":"Nair","year":"2011","journal-title":"Diabetologia"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1186\/s13098-023-01214-7","article-title":"Comparison of METS-IR and HOMA-IR for predicting new-onset CKD in middle-aged and older adults","volume":"15","author":"Yoon","year":"2023","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2","DOI":"10.23838\/pfm.2019.00135","article-title":"Determination of cutoff values for biomarkers in clinical studies","volume":"4","author":"Woo","year":"2020","journal-title":"Precis. Future Med."},{"key":"ref_32","unstructured":"R Core Team (2025). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_33","unstructured":"Therneau, T. (2025, September 14). A Package for Survival Analysis in R. R Package Version 3.8-3. Available online: https:\/\/CRAN.R-project.org\/package=survival."},{"key":"ref_34","unstructured":"Qiu, W., Chavarro, J., Lazarus, R., Rosner, B., and Ma, J. (2025, September 14). powerSurvEpi: Power and Sample Size Calculation for Survival Analysis of Epidemiological Studies. R Package Version 0.1.5. Available online: https:\/\/CRAN.R-project.org\/package=powerSurvEpi."},{"key":"ref_35","unstructured":"Kassambara, A., Kosinski, M., and Biecek, P. (2025, September 14). survminer: Drawing Survival Curves Using \u2018ggplot2\u2019. R Package Version 0.5.0. Available online: https:\/\/CRAN.R-project.org\/package=survminer."},{"key":"ref_36","unstructured":"Gordon, M., and Lumley, T. (2025, September 14). forestplot: Advanced Forest Plot Using \u2018Grid\u2019 Graphics. R Package Version 3.1.6. Available online: https:\/\/CRAN.R-project.org\/package=forestplot."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"5381","DOI":"10.1002\/sim.5958","article-title":"Estimating and Compating time-dependent areas under receiver operating characteristic curves for censored event times with competing risks","volume":"32","author":"Blanche","year":"2013","journal-title":"Stat. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.molmet.2018.05.008","article-title":"Sex differences in lipid and lipoprotein metabolism","volume":"15","author":"Palmisano","year":"2018","journal-title":"Mol. Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1146\/annurev-nutr-071816-064827","article-title":"Genetic Basis for Sex Differences in Obesity and Lipid Metabolism","volume":"37","author":"Link","year":"2017","journal-title":"Annu. Rev. Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1159\/000093632","article-title":"Insulin Resistance, Hyperinsulinemia, and Renal Injury: Mechanisms and Implications","volume":"26","author":"Sarafidis","year":"2006","journal-title":"Am. J. Nephrol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"291","DOI":"10.2337\/db18-0638","article-title":"Estrogen Improves Insulin Sensitivity and Suppresses Gluconeogenesis via the Transcription Factor Foxo1","volume":"68","author":"Yan","year":"2018","journal-title":"Diabetes"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1159\/000339563","article-title":"Loss of Estrogen Receptor \u03b1 Signaling Leads to Insulin Resistance and Obesity in Young and Adult Female Mice","volume":"2","author":"Manrique","year":"2012","journal-title":"Cardiorenal Med."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Ruiz-Castell, M., Samouda, H., Bocquet, V., Fagherazzi, G., Stranges, S., and Huiart, L. (2021). Estimated visceral adiposity is associated with risk of cardiometabolic conditions in a population based study. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-88587-9"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"5419","DOI":"10.1210\/jc.2010-1378","article-title":"Impact of abdominal visceral and subcutaneous adipose tissue on cardiometabolic risk factors: The Jackson Heart Study","volume":"95","author":"Liu","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"427","DOI":"10.3346\/jkms.2017.32.3.427","article-title":"The Cut-off Values of Triglycerides and Glucose Index for Metabolic Syndrome in American and Korean Adolescents","volume":"32","author":"Moon","year":"2016","journal-title":"J. Korean Med. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1038\/s41581-023-00741-w","article-title":"Kidney lipid dysmetabolism and lipid droplet accumulation in chronic kidney disease","volume":"19","author":"Mitrofanova","year":"2023","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Gai, Z., Wang, T., Visentin, M., Kullak-Ublick, G., Fu, X., and Wang, Z. (2019). Lipid Accumulation and Chronic Kidney Disease. Nutrients, 11.","DOI":"10.3390\/nu11040722"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1093\/ndt\/gfac272","article-title":"Coronary artery calcium and risk of chronic kidney disease in young and middle-aged adults","volume":"38","author":"Kim","year":"2023","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/dom.16359","article-title":"Developments in albuminuria testing: A key biomarker for detection, prognosis and surveillance of kidney and cardiovascular disease-A practical update for clinicians","volume":"27","author":"Beernink","year":"2025","journal-title":"Diabetes Obes. Metab."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Li, S., Xia, R., Gong, X., Wang, C., Liu, H., Dong, H., Su, Z., Liang, Y., Wang, S., and Yang, T. (2025). Mediating effect of TyG index on the association between glucose-lipid metabolism-related dietary pattern and T2DM: A propensity score-matched analysis. BMC Endocr. Disord., 25.","DOI":"10.1186\/s12902-025-01892-6"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/18\/2986\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:47:25Z","timestamp":1760035645000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/18\/2986"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,17]]},"references-count":50,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["nu17182986"],"URL":"https:\/\/doi.org\/10.3390\/nu17182986","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,17]]}}}