ArticleFrontiers in public health2026
Cross-lag association between TyG-CVAI and frailty index: evidence from a natural population cohort in southwestern China.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: 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. Methods: 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. Results: Baseline TyG-CVAI significantly predicted follow-up frailty index (standardized Conclusion: 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.
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