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The novel nutritional metabolic risk index and established triglyceride-glucose indices in type 2 diabetes: modifying role of biological aging assessed by telomere length
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DOI：10.3389/fnut.2026.1911472.png)
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Abstract
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BackgroundTriglyceride-glucose (TyG) derivatives are recognized markers of type 2 diabetes (T2DM) risk. However; the association between composite indices integrating nutritional and metabolic status and biological aging in T2DM patients remains unclear.MethodsData from 4; 572 adults were analyzed to evaluate the association between four indices; including the geriatric nutritional risk index (GNRI); TyG; triglyceride glucose-waist-to-height ratio (TyG-WHtR); and the composite nutritional metabolic risk index (NMRI); and T2DM prevalence using logistic regression and restricted cubic spline analysis. The potential mediating and moderating roles of relative telomere length (RTL) were also explored.ResultsTyG and TyG-WHtR were strongly associated with higher odds of T2DM; with TyG-WHtR presenting the strongest association (odds ratio [OR] = 10.20; 95% confidence interval [CI]: 8.64–12.10). NMRI was independently inversely associated with T2DM in a non-linear manner; and the inverse association was stronger among participants with shorter RTL (interaction OR = 1.007; 95% CI: 1.000–1.014; p = 0.041). RTL did not mediate but moderated the NMRI–T2DM link. GNRI exhibited no significant association with T2DM.ConclusionTyG and TyG-WHtR may serve as useful indicators of T2DM risk; while NMRI is inversely associated with T2DM. RTL appeared to modify the association between NMRI and T2DM; suggesting potential value for individualized metabolic risk stratification; which warrants further investigation in longitudinal studies. These findings suggest that the interplay between nutritional-metabolic indices and biological aging in diabetes pathogenesis warrants further investigation.
Keywords:
type 2 diabetes mellitus
triglyceride glucose index
telomere length
geriatric nutritional risk index
effect modification
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