Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2024; 12(6): 1094-1103
Published online Feb 26, 2024. doi: 10.12998/wjcc.v12.i6.1094
Assessment of the triglyceride glucose index in adult patients with chronic diarrhea and constipation
Jing-Yi Zhu, Mu-Yun Liu, Chang Sun
Jing-Yi Zhu, Chang Sun, Department of Gastroenterology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
Mu-Yun Liu, Department of Gastroenterology, Navy No. 905 Hospital, Naval Medical University, Shanghai 200433, China
Author contributions: All contributors participated in study formulation and design. Zhu JY prepared the initial draft of the manuscript; Liu MY prepared, collected, and analyzed the data; Sun C revised and reviewed the manuscript; the manuscript was accepted for publication after final approval from the authors.
Institutional review board statement: The NHANES is a publicly available database, and this research was reviewed and approved by the Research Ethics Review Board of the National Center for Health Statistics.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: The dataset supporting the conclusions of this article is available in the NHANES repository: NHANES-National Health and Nutrition Examination Survey Homepage (
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Chang Sun, MD, Associate Professor, Department of Gastroenterology, The First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Shanghai 200433, China.
Received: December 8, 2023
Peer-review started: December 8, 2023
First decision: December 20, 2023
Revised: January 3, 2024
Accepted: January 19, 2024
Article in press: January 19, 2024
Published online: February 26, 2024

Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance (IR). However, the link between two of the most prevalent bowel disorders, chronic diarrhea and constipation, and the triglyceride glucose (TyG) index, a marker of IR, has not yet been investigated.


To investigate the potential association between TyG and the incidence of chronic diarrhea and constipation.


This cross-sectional study enrolled 2400 participants from the National Health and Nutrition Examination Survey database from 2009-2010. TyG was used as an exposure variable, with chronic diarrhea and constipation as determined by the Bristol Stool Form Scale used as the outcome variables. A demographic investigation based on TyG quartile subgroups was performed. The application of multivariate logistic regression models and weighted generalized additive models revealed potential correlations between TyG, chronic diarrhea, and constipation. Subgroup analyses were performed to examine the stability of any potential associations.


In the chosen sample, chronic diarrhea had a prevalence of 8.00%, while chronic constipation had a prevalence of 8.04%. In multiple logistic regression, a more prominent positive association was found between TyG and chronic diarrhea, particularly in model 1 (OR = 1.45; 95%CI: 1.17-1.79, P = 0.0007) and model 2 (OR = 1.40; 95%CI: 1.12-1.76, P = 0.0033). No definite association was observed between the TyG levels and chronic constipation. The weighted generalized additive model findings suggested a more substantial positive association with chronic diarrhea when TyG was less than 9.63 (OR = 1.89; 95%CI: 1.05-3.41, P = 0.0344), and another positive association with chronic constipation when it was greater than 8.2 (OR = 1.74; 95%CI: 1.02-2.95, P = 0.0415). The results of the subgroup analyses further strengthen the extrapolation of these results to a wide range of populations.


Higher TyG levels were positively associated with abnormal bowel health.

Keywords: Triglyceride glucose index, National Health and Nutrition Examination Survey, Chronic diarrhea, Chronic constipation, Cross-sectional study, Bowel health

Core Tip: Chronic diarrhea and constipation are two common conditions that interfere with daily life. Herein, we identified a positive association between the triglyceride glucose index, a marker of insulin resistance (IR), and chronic diarrhea in the National Health and Nutrition Examination Survey database. These results suggest that early and comprehensive management of IR may be beneficial for maintaining normal bowel health. Further investigations should be conducted on the underlying pathological mechanisms.