Abstract
AIMS: To characterize the complex relationships of body mass index (BMI) and triglyceride-glucose index (TyG) with 5-year all-cause mortality in patients with diabetes mellitus and comorbid hypertension. METHODS: Overall, 5,728 patients from the 1999-2014 US National Health and Nutrition Examination Survey (NHANES) cycles and 3,456 from the 2005-2010 China Kailuan cycles were included. TyG was calculated as the logarithmic product of the fasting triglyceride and glucose concentrations. RESULTS: The prevalence of 5-year all-cause mortality was 8.4 % in the NHANES population and 9.2 % in the Kailuan cohort. TyG mediated the association between BMI and all-cause mortality, being responsible for 38.4 % in the NHANES database and 41.6 % in the Kailuan cohort. Significant multiplicative effects were identified between TyG and BMI, which were closer for patients with high BMI. When stratified by BMI and TyG, high-risk subgroups were identified and had higher risks of all-cause mortality than the intermediate- and low-risk subgroups (both log-rank P < 0.001). CONCLUSIONS: TyG mediated a considerable proportion of the effect of BMI on all-cause mortality in patients with diabetes and hypertension. The combination of BMI and TyG could be useful for the risk stratification of all-cause mortality. Measures aimed at weight loss might reduce the all-cause mortality risk associated with insulin resistance.