The Triglyceride–Glucose Index is a powerful biomarker for cardiovascular disease, depression, dementia, cancer and much more
The Triglyceride–Glucose Index is proving to be a more accurate predictor of cardiovascular disease.
The Cardiovascular-Kidney-Metabolic model corresponds more closely to heart attack pathogenesis than the outdated cholesterol dogma and predicts risk for a number of biologically related disorders.
There is a growing wealth of evidence supporting the Cardio-Kidney-Metabolic model (aka the Cardio-Renal-Metabolic model) as a more accurate description and predictor of cardiovascular disease than the scientifically flawed cholesterol dogma. Not surprisingly given the vital importance of insulin resistance as a major cause of chronic inflammation and tissue damage, it is relevant for multiple other diseases as well.
A novel biomarker in the era of cardiometabolic medicine
In a paper published this month in the International Journal of Cardiology the authors introduce this topic of the Triglyceride-Glucose Indes (TyG) by stating:
“…an accurate global assessment of insulin resistance is of utmost importance…This narrative review article aims to provide a comprehensive evaluation of the credibility of TyG as a surrogate marker of insulin resistance…”
They highlight these points:
The TyG index is increasingly recognized as a promising new biomarker for evaluating insulin resistance and cardiometabolic risk.
Extensive research has highlighted the robust link between elevated TyG index and heightened risk of cardiometabolic conditions.
The TyG index has demonstrated comparable or even superior efficacy to traditional markers like HOMA-IR in forecasting cardiometabolic outcomes, positioning it as a valuable tool for risk assessment.
Cardiovascular-Kidney-Metabolic (CKM) Syndrome
A cluster of papers published in the journal Circulation serve as a summary introduction to the CKM model for those still unfamiliar.
“Poor cardiovascular-kidney-metabolic (CKM) health is a major determinant of premature morbidity and mortality. Consequently, developing comprehensive strategies to augment CKM health across the life course is a key clinical and public health priority.”
Elevated triglyceride glucose index is associated with advanced cardiovascular kidney metabolic syndrome
In this study, the authors conclude:
“In conclusion, there is a significant positive association between the risk of the TyG index and advanced CKM syndrome. Our findings suggest that the TyG index may serve as a practical tool for early risk identification, stratification, and management guidance for CKM syndrome, particularly in primary care settings.”
The impact of the triglyceride-glucose index on the deterioration of kidney function in patients with cardiovascular-kidney-metabolic syndrome
In this paper, one of many highlighting the connection with CKM (chronic kidney disease), the authors noted that diabetes (DM) does not have to have developed yet for the kidney damage to be occurring.
“Among individuals with CKM syndrome, the study suggested a non-linear U-shaped relationship between the baseline TyG index and the deterioration of kidney function, regardless of whether the patient had DM. Furthermore, the TyG index with the lowest risk of deterioration of kidney function ranges from 8.65 to 9.15, with an inflection point at 8.88. Therefore, this study indicates that maintaining optimal TyG index levels in patients with CKM syndrome may be of great significance in delaying the kidney function decline. Deviations from the appropriate range, either higher or lower, may lead to an elevated risk of deterioration of kidney function in patients with CKM syndrome.”
The Triglyceride–Glucose Index is associated with unstable plaque, the dangerous soft and gooey form that produces the clots that cause heart attacks and strokes.
Unstable plaque is also known as ‘vulnerable plaque’ because it is vulnerable to rupture and formation of a clot that plugs a downstream vessel. If it’s a coronary vessel (going to the heart), that’s a heart attack. If a cerebral vessel (going to the brain), that’s a stroke. The calcified plaque as shown in a CAC scan (carotid artery calcium scan) has been stabilized by calcification. It shows that there’s some history of vascular inflammation, but it is not a ‘hanging sword’ like the unstable plaque.
In a research article published in the Journal of the American Heart Association, the authors investigated the association between the TyG index and unstable carotid plaque. They concluded:
“The TyG index has a significant association with unstable carotid plaque. The association between the TyG index and unstable carotid plaque is similar between men and women, and the association in older patients is higher than that in middle‐aged patients.”
This makes it a very important independent risk factor because it is associated with the most proximal risk for a heart attack or stroke.
Here’s how they summarize their findings:
This is the first large‐scale study to explore the relationship between the triglyceride–glucose index and unstable carotid plaque in different glycemic statuses.
The research revealed a strong association between the triglyceride–glucose index and unstable carotid plaque; this relationship is similar for both men and women, but it is notably stronger in older patients compared with middle‐aged patients.In different glycemic status, those with diabetes exhibit the most significant connection between the triglyceride–glucose index and unstable carotid plaque.
In different glycemic status, those with diabetes exhibit the most significant connection between the triglyceride–glucose index and unstable carotid plaque.
The results of this study emphasize the need for risk management strategies for different sexes, ages, and glycemic statuses to prevent patients from developing unstable carotid plaque.
And The role of the triglyceride-glucose index as a biomarker of cardio-metabolic syndromes in the journal Lipids in Health and Disease:
“Overall, our findings support the use of the TyG index as a valid biomarker to assess the risk of developing MetS, T2DM, as well as atherosclerotic cardiovascular disease.”
The TyG Index is superior to HOMA-IR as a metric for insulin sensitivity.
Given that insulin resistance is at the core of the damage associated with the cardio-kidney-metabolic syndrome, this is particularly important.
In the paper Comparison of triglyceride-glucose index and HOMA-IR for predicting prevalence and incidence of metabolic syndrome, the authors demonstrated:
HOMA-IR and TyG index are commonly used insulin resistance index.
TyG index is superior to HOMA-IR for predicting the prevalence of metabolic syndrome.
The predictive power for incident metabolic syndrome is significant only for the TyG index, not HOMA-IR.
TyG index is a useful surrogate marker for the management and prevention of metabolic syndrome.
Triglyceride glucose index: A new biomarker in predicting cardiovascular risk
The authors of this paper note:
“Insulin resistance can be assessed by the Triglyceride-Glucose Index (TyG), a simple, low-cost, and easy-to-apply method.”
And they found it to a very effective predictor of cardiovascular risk:
“Elevated TyG values (≥9.04) were positively associated with cardiometabolic risk factors (total cholesterol, LDL, VLDL, uric acid, alanine aminotransferase, aspartate aminotransferase, waist-hip ratio, systolic blood pressure, HOMA-IR, smoking, metabolic syndrome, diabetes, and hepatic steatosis)…The TyG index showed a good predictive capacity for cardiovascular risk in ten years assessed by the FRS [Framingham risk score].
Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage
And in research published in the prestigious journal The Lancet, the authors note:
“Insulin resistance (IR) is an important risk factor for multiple chronic diseases, increasing mortality and reducing life expectancy.”
Their research of the TyG Index as a metric for insulin resistance found it to be closely associated with all-cause mortality and life expectancy in middle-aged and older patients in primary care.
“TyG-BMI and TyG-WC demonstrated a U-shaped* association with total and premature all-cause mortality. Low and high levels of TyG-BMI and TyG-WC were associated with reduced life expectancy.”
*The first are of the U-curve would be seriously underweight.
TyG Index and carotid imtima-media thickness (c-IMT)
Carotid intima-media thickness (c-IMT) refers to the thickness of the carotid artery's inner layers. A c-IMT test uses ultrasound imaging to detect plaque buildup in the carotid arteries, an indicator of cardiovascular risk. In this paper, the data showed:
“There was a significant association between the TyG index and all c-IMT measurements. Those in the highest TyG index quartiles had significantly higher IMTmean and IMTmax compared to those in the lower quartiles. These associations were consistent across all vascular sites examined and remained significant after adjusting for all potential confounders.”.
Summarizing their conclusions:
“The triglyceride-glucose (TyG) index is now widely recognized as a marker of insulin resistance and has been linked to the development and prognosis of atherosclerotic cardiovascular diseases (ASCVD) in numerous populations…TyG index is a sensitive marker of risk in a European population with moderate ASCVD risk, as assessed by c-IMT measurements, in a large cohort of Lipid Clinic patients.”
And from the same journal, the connection with vascular stiffness and calcification: Association between triglyceride glucose index and arterial stiffness and coronary artery calcification: a systematic review and exposure-effect meta-analysis.
And arterial stiffness is one of the mediators for insulin-related atherosclerotic cardiovascular pathology as demonstrated in this paper.
Naturally, with the arterial stiffness and other endovascular effects there is a strong association with hypertension as shown in this paper.
“TyG is an independent risk factor for hypertension across different thresholds, showing a clear dose-response relationship. BMI may influence this association, emphasizing the importance of managing insulin resistance early to aid hypertension prevention.”
Importantly, the TyG Index can predict subclinical coronary disease that is brewing but not yet apparent and traditional risk factors are not evident as shown in this study.
“TyG index is an independent marker for predicting subclinical CAD in individuals conventionally considered healthy.”
The TyG Index and Afib (Atrial Fibrillation)
In The association of the triglyceride-glucose index with the risk of atrial fibrillation: Analysis of the UK Biobank, the authors demonstrate:
“The triglyceride-glucose index is U-shapedly associated with the risk of atrial fibrillation, with higher risk at both low and high levels.
The U-shaped association between the triglyceride-glucose index and atrial fibrillation risk remains significant regardless of genetic predisposition.
The U-shaped association between the triglyceride-glucose index and atrial fibrillation risk remains significant regardless of glucose metabolism, or heart valve disease.”
And concluded:
“This study demonstrates a U-shaped association between the TyG index and the risks of AF, underscoring the index's potential utility in identifying individuals at elevated risk for these conditions.”
It is also predictive for how well radiofrequency ablation for afib will work. In Association between triglyceride–glucose index trajectories and radiofrequency ablation outcomes in patients with stage 3D atrial fibrillation:
“The TyG trajectories in patients with stage 3D AF are significantly linked to the outcomes of AF recurrence. Continuous monitoring of TyG levels during follow-up may help in identifying patients at high risk of AF recurrence, enabling the early application of effective interventions.”
Research published in Scientific Reports demonstrated the association with the TyG Index with both afib and all-cause mortality after a heart attack.
And in Clinical predictive model of new-onset atrial fibrillation in patients with acute myocardial infarction after percutaneous coronary intervention in Scientific Reports, the TyG Index is an indicator of new-onset afib (NOAF) after recovery from a heart attack.
A paper published in the same journal found the TyG Index was effective at detecting higher risk for all-cause mortality after PCI treatment for a heart attack.
The TyG + NLR predict death from all causes
The association between triglyceride-glucose index and neutrophil-lymphocyte ratio and all-cause mortality in the general US population: NHANES 2001–2018
In this superlative research, the investigators found that risk prediction of death from all causes can be sharpened and rendered invulnerable to confounders by combining the TyG with the NLR (neutrophil-lymphocyte ratio). Clinicians should always be keenly observing the NLR already since it’s such an important biomarker for systemic inflammation.
”IR [insulin resistance] and inflammation are closely associated with various metabolic diseases and adverse outcomes (24, 25). NLR reflects the systemic inflammatory status of the body and has been shown to be related to poor outcomes and prognosis in several studies (26, 27). Therefore, in this study, we combined the TyG index with NLR, an indicator of the degree of inflammatory response, to construct a new index, TyG-NLR...In our study, the TyG index showed an association with all-cause mortality before adjusting for confounders. However, this association became non-significant after adjusting for confounders, which is consistent with previous studies, demonstrating the instability of the TyG index when used alone (33). However, when we utilized the combined TyG-NLR index, our results showed that TyG-NLR was significantly associated with all-cause mortality. After adjusting for all confounders, participants in the highest quartile of the TyG-NLR index had a 1.63-fold increased risk of all-cause mortality compared to those in the lowest quartile. Additionally, we observed that participants with TyG-NLR indices in the second and third quartiles had 1.05-fold and 1.19-fold increased mortality risks, respectively, compared to those in the lowest quartile. These characteristics not only establish the TyG-NLR index as an effective tool for evaluating the risk of all-cause mortality but also further support the central role of insulin resistance and inflammation in adverse health outcomes, providing a crucial theoretical basis for future risk stratification, prediction, and intervention strategies.
…chronic insulin resistance is not only highly correlated with systemic inflammation but also leads to lipid metabolism disorders…NLR, as a sensitive indicator of systemic inflammatory status, can assess the body’s immune response capacity. Chronic inflammation may suppress normal immune function, making individuals more susceptible to infections or malignant diseases, which may directly or indirectly increase the risk of mortality. Additionally, the interaction between insulin resistance and inflammation may exacerbate tissue and organ damage and functional decline through elevated pro-inflammatory cytokines (such as TNF-α and IL-6) and oxidative stress levels, playing a critical role in the progression of various chronic diseases (36, 37).”
The TyG Index and Urinary Incontinence
Cardiometabolic Index and Stress Urinary Incontinence in US Women: The Mediating Role of the Triglyceride Glucose Index
Stress urinary incontinence (SUI) is a prevalent condition among women, significantly impairing their quality of life. Emerging evidence suggests that metabolic dysfunction may play a role in the development of SUI.
Essentially, the data in this study shows that the TyG Index, stress urinary incontinence, and the CKM syndrome are all connected.
“Higher CMI was significantly associated with increased SUI risk in women (P < 0.001). RCS analysis revealed a nonlinear relationship, with a threshold at 1.64….Mediation analysis showed that the TyG index completely mediated the relationship between CMI and SUI, accounting for 97.67% of the total effect. Sensitivity analyses using PSM confirmed the robustness of these results.”
More on the association between the TyG Index and urinary incontinence:
The TyG Index - Depression, Cognitive Dysfunction, & Dementia
Exploring the triglyceride-glucose index's role in depression and cognitive dysfunction: Evidence from NHANES with machine learning support
The authors of this paper state:
“In conclusion, our study suggests that the triglyceride-glucose (TyG) index may serve as an important indicator of psychocognitive health in older adults. The NHANES-based analysis highlights significant associations between the TyG index, depression, and cognitive function, emphasizing its potential role in identifying individuals at risk. Additionally, machine learning models demonstrated strong predictive performance, suggesting potential clinical applications for assessing depression risk.”
The importance of assessing the triglyceride-glucose index (TyG) in patients with depression: A systematic review
In this important study, the authors state:
“Insulin resistance (IR) has been proposed as a potential risk factor for depression, a major common disorder affecting a significant proportion of adults worldwide. Based on this premise, this study systematically investigated all the studies examining the triglyceride-glucose (TyG) index, a surrogate marker of IR, in patients with depression or suicidal ideas/attempts.”
Their data showed:
”The present study analyzed seven studies involving 58,981 individuals to investigate the association between the TyG index and depression. The key findings of this study implied that a high TyG index is associated with depression. Moreover, the TyG index can act as a predictor of depression-related events such as suicidal ideation and attempts.”
“In conclusion, our study provides evidence for a significant association between the TyG index and depression, supporting the hypothesis that disturbances in glucose and lipid metabolism may contribute to the rise of depression and related events, such as suicidal ideation and attempts. The TyG index holds promise as a clinically relevant tool for assessing metabolic abnormalities and identifying individuals at risk for depression and other IR-related disorders.”
More on depression and the TyG Index:
The central role of pro-inflammatory cytokines (PICs)—which are associated with the TyG Index—in depression: Pro-inflammatory cytokines in stress-induced depression: Novel insights into mechanisms and promising therapeutic strategies
PICs affects symptom, development, severity, and treatment outcome of depression.
PICs may be a potential biomarker of depression.
Anti-inflammatory therapy is a promising treatment for depression.
Regulating PICs may represent a promising therapeutic strategy for depression.
And The association between insulin resistance and depression in the Korean general population in which the authors state:
Increased insulin resistance was associated with depressive symptoms in the Korean general population (N=165,443).
These findings suggest that early management of insulin resistance may prevent progression toward depressive symptoms.
Role of Peripheral and Central Insulin Resistance in Neuropsychiatric Disorders
Higher insulin levels in response to insulin resistance are responsible for damage to the brain as well for the rest of the body. This paper unpacks the mechanisms involved.
“Insulin signaling, as well as insulin resistance (IR), is a major contributor in the regulation of mood, behavior, and cognition. Recent evidence showed that both peripheral and central insulin resistance play a role in the pathophysiology, clinical presentation, and management of neuropsychiatric disorders like Cognitive Impairment/Dementia, Depression, and Schizophrenia. Many human studies point out Insulin Resistance/Metabolic Syndrome can increase the risk of dementia especially Alzheimer’s dementia (AD). IR has been shown to play a role in AD development but also in its progression.”
“IR has been shown to precede neurodegeneration…Early identification and management of IR may help as a strategy to potentially alter neuropsychiatric disorders onset as well as its progression.”
“…insulin resistance in otherwise healthy young and middle-aged adults was found to be associated with preclinical signs of neuropsychiatric impairment (cognition and mood).”
Decreased apoptosis and autophagy = diminished ability to maintain and renew brain cells.
““Insulin resistance is defined as an impaired response to insulin stimulation in peripheral tissues, which leads to increased peripheral insulin levels” [44]. Brain insulin resistance is defined as the reduced physiological actions of insulin in the brain. In the nerve cells, insulin modulate neurotransmitters like N-methyl-d-aspartate (NMDA) and γ-aminobutyric acid (GABA) as well as catecholamines [45]. There is a bidirectional relationship between peripheral and brain insulin resistance, with each one influencing the other [17,46]. Since the pancreas is the main source of CSF Insulin levels, its level correlate with peripheral levels [47] and altered transport across BBB has been shown in IR [48]. Brain insulin resistance can induce activation of microglia and astrocyte and impair intracellular signaling leading to mood disorders and cognitive impairment [46,49] (Table 2). A decrease in the cerebrovascular cell’s cytoplasmic insulin receptors along with defective coupling are seen in BIR as well as in AD [50,51].”
Exploring the Association Between Cognitive Decline and Triglyceride-Glucose Index: A Systematic Review and Meta-Analysis
This original article assesses the association of the TyG Index (indicating insulin resistance) and cognitive decline.
“Our study supports a significant association between cognitive decline and high TyG index values. We revealed the heightened risk of cognitive decline with an increased TyG index and underscored the potential diagnostic capability of this surrogate marker of IR. The assessment of the TyG index's predictive capacity for cognitive decline yielded promising outcomes and highlighted its diagnostic potential with an impressive overall AUC of 0.74, a sensitivity of 0.695, and a specificity of 0.68. Moreover, our multivariate meta-regression analysis revealed a significant association between the observed pooled estimate and the publication year, sample size, and male ratio.”
Association of the Triglyceride-Glucose Index With Risk of Alzheimer's Disease: A Prospective Cohort Study
The connection reported in this research article can hardly be over-emphasized.
“Triglyceride-glucose index (TyG) is a reliable surrogate marker of insulin resistance, and insulin resistance has been implicated in Alzheimer's disease pathophysiology…This study showed that moderately elevated TyG index was independently associated with a higher incidence of Alzheimer's disease. TheTyG index might be used to define a high-risk population of Alzheimer's disease.”
Association between the triglyceride glucose index and cognitive impairment and dementia: a meta-analysis
In this systematic review:
“Our study found that a higher TyG index was significantly associated with an increased risk of cognitive impairment and dementia. When the TyG index was regarded as a categorical variable, the risk of cognitive impairment and dementia in the high TyG index group was 2.32 and 1.14 times higher than that in the low TyG index group, respectively. For each additional unit of the TyG index, the risk for cognitive impairment and dementia increased by 3.39 and 1.37, respectively.”
“Our study found a link between an elevated TyG index and the risk of cognitive impairment and dementia. The TyG index values can be easily obtained in clinical practice by measuring plasma glucose and TG levels. Several studies have suggested that the TyG index has the potential to serve as an indicator of cognitive impairment.”
Relationship between triglyceride-glucose index and cognitive function among community-dwelling older adults: a population-based cohort study
And in this research article:
“The results of this study reveal a notable association between elevated TyG index levels and the occurrence of cognitive impairment among the elderly Chinese demographic. The initiation of targeted intervention strategies may effectively mitigate cognitive impairment, potentially decreasing the prevalence of dementia.”
Association Between Triglyceride Glucose Index with Cognitive Impairment and Dementia in Adult Population: A Meta-Analysis
The authors of this paper state:
“Compared to those with the low TyG index, subjects with the high TyG index were significantly associated with the risk of cognitive impairment…The association was consistent for Alzheimer’s disease and vascular dementia…In conclusion, a high TyG index may be associated with higher risk of cognitive impartment and dementia in adult population.”
Association of Triglyceride-Glucose Index With Cognitive Function and Brain Atrophy: A Population-Based Study
Not surprisingly, this research article demonstrates the association of the TyG Index with brain atrophy. This is in keeping with the loss of autophagy described above.
“Insulin resistance, as indicated by a high TyG index, was associated with poor function in multiple cognitive domains and global brain atrophy.”
The TyG Index and Cancer
The TyG Index has been shown to be associated with a number of cancers. This is to be expected given how significant a biomarker it is for major drivers of malignancy: chronic inflammation and excessive growth hormone (insulin) proliferation of abnormal cells.
Breast Cancer
Triglyceride-glucose index and triglyceride-glucose–body mass index as prognostic factors for early stage breast cancer patients receiving neoadjuvant chemotherapy
This research confirms:
Insulin resistance markers TyG index and TyG-BMI index can play a predictive role in the long-term prognosis of breast cancer patients undergoing NACT [neoadjuvant chemotherapy].
TyG and TyG-BMI show a linear correlation with disease-free survival [DFS] and overall survival by restricted cubic spline analyses.
“This study suggests that the TyG index level before NACT is an independent prognostic factor for DFS and OS and can serve as a promising biomarker to predict the long-term prognosis of breast cancer patients undergoing NACT. Moreover, the TyG index and TyG-BMI show a linear correlation with DFS and OS [overall survival].”
Prostate Cancer
Triglyceride-glucose index is a predictor of the risk of prostate cancer: a retrospective study based on a transprostatic aspiration biopsy population
This research arrives at very important conclusions of great practical relevance:
“This study found that the TyG index is a risk factor for prostate cancer, and the interaction between the TyG index and different risk factors may increase the risk of prostate cancer. There is a linear dose-response relationship between the TyG index and the risk of prostate cancer, and the TyG index has a certain predictive value of the risk of prostate cancer, and the risk of prostate cancer can be reduced by controlling the levels of blood lipids and blood glucose. By controlling blood lipid and blood glucose levels, the risk of prostate cancer can be reduced.”
Remember that insulin is what drives higher triglyceride levels.
In Association of triglyceride-glucose index with the risk of prostate cancer: a retrospective study:
“Prostate cancer is the most common malignancy in men, and its incidence is increasing year by year. Some studies have shown that risk factors for prostate cancer are related to insulin resistance. The triglyceride-glucose (TyG) index is a marker of insulin resistance. We investigated the validity of TyG index for predicting prostate cancer and the dose-response relationship in prostate cancer in relation to it.”
“TyG index may be a more accurate and efficient predictor of prostate cancer.”
A novel prognostic risk factor for patients undergoing radical prostatectomy: Triglyceride-glucose index
In this paper:
“Association between TyG index and prostate cancer may facilitate to predict unfavorable prognostic factors of radical prostatectomy. Increased TyG index may used as a predictive marker of positive surgical margin status before radical prostatectomy, BCR, advanced cT and pT stages after radical prostatectomy or worse biopsy gleason score in clinical practice.”
Prediagnostic markers of insulin resistance and prostate cancer risk and death: A pooled study
This paper highlights how the TyG Index reveals what is not disclosed by other biomarkers used for insulin resistance.
“The results of this study showed no associations of insulin resistance markers with the risk of clinically relevant PCa, but higher glucose and TyG index were associated with poorer survival from PCa.”
In fact, fasting glucose and HgA1c may often not reveal spiking of insulin during the day, which is why we use 1,5-Anhydroglucitol (Glycomark) as a blood biomarker for glucose instability and CGMs (continous glucose monitors) to overcome those limitations.
Body mass index, triglyceride-glucose index, and prostate cancer death: a mediation analysis in eight European cohorts
And in this paper in the prestigious British Journal of Cancer:
“In the PCa-case-only analysis, baseline TyG index was positively associated with PCa death (HR per 1-standard deviation: 1.11, 95% confidence interval (CI); 1.01–1.22), and mediated a substantial proportion of the baseline BMI effect on PCa death (HRtotal effect per 5-kg/m2 BMI: 1.24; 1.14–1.35, of which 28%; 4%–52%, mediated)…Insulin resistance could be an important pathway through which obesity accelerates PCa progression to death.”
Of course, it’s insulin resistance that accelerates visceral obesity. Importantly, there can be fatty liver disease and other depredations of visceral obesity without being ‘fat’.
Clinical Notes
How to calculate the TyG Index? To do it manually, it’s TyG index = Ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL) / 2]. But who wants to do that? Instead, there are a number of online medical calculators. The TyG Index calculator I use is here.
‘Moving the ball’ in case management including the TyG Index and what drives it is a complex matter and addressed on an individual basis. But because it’s often overlooked, the role of the vitamin D effect is worth mentioning here.
The mediating role of vitamin D in the relationship between triglyceride glucose index and mortality in patients with diabetes mellitus: a causal mediation analysis
“The results demonstrated that the TyG index was positively associated with all-cause and cardiovascular mortality in diabetic patients, whereas vitamin D levels were negatively associated with mortality, exhibiting an overall U-shaped association. The results indicated that vitamin D partially mediated the association between TyG and all-cause mortality…
This finding underscores the necessity of evaluating the influence of vitamin D on survival outcomes in individuals with disparate levels of the TyG index.”
Note: It’s not enough to know the serum level of 25-OH Vitamin D which, for the purposes of immune system and metabolic health should be in the upper end of the reference range. Because of genetic variations in sensitivity of the VDR (vitamin D receptor) and the binding affinity of DBP (vitamin D binding protein), these must be evaluated by observing 25-OH Vitamin D, 1,25-OH Vitamin D, and PTH (parathyroid hormone) in the same serum specimen.
