Hypertriglyceridemic waist-to-height ratio and the triple burden of hypertension, diabetes, and dyslipidemia in adults: association and network analysis

Background Hypertension, diabetes, and dyslipidemia frequently co-occur, yet simple screening tools are lacking in resource-limited settings. The hypertriglyceridemic waist-to-height ratio (HTH/WH) phenotype has emerged as a potential indicator, but its utility for identifying the triple burden of hypertension, diabetes, and dyslipidemia remains underexplored, particularly in underdeveloped regions of China. Methods This cross-sectional study included 10,796 adults (≥18 years) from the Ningxia Hui Autonomous Region, Northwest China. The HTH/WH phenotype was defined as triglycerides ≥1.7 mmol/L combined with waist-to-height ratio ≥0.5. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for the association between the HTH/WH phenotype and coexisting hypertension, diabetes, and dyslipidemia. Mixed graphical models were employed to characterize the network associations among the HTH/WH phenotype, the three cardiometabolic disorders, and modifiable lifestyle factors. Results The prevalence of concurrent hypertension, diabetes, and dyslipidemia was 3.99% in Ningxia, exceeding the Northwest China regional average of 2.33%. The HTH/WH phenotype was present in 21.30% of the population and demonstrated a significant, dose-response association with the triple burden (adjusted OR = 5.29, 95% CI: 4.14–6.74), as well as with two diseases (adjusted OR = 5.12, 95% CI: 4.22–6.21) and one disease (adjusted OR = 1.97, 95% CI: 1.77–2.20). Factors independently associated with the triple burden included age ≥40 years, smoking, alcohol consumption, and elevated BMI (≥24 kg/m 2 ), while higher education and married status were inversely protective. Mixed graphical modeling revealed the HTH/WH phenotype as a central bridge node (bridge strength = 0.67) within the metabolic disorder network, with strong direct connections to hypertension, diabetes, and dyslipidemia. BMI exhibited the highest bridge centrality (bridge strength = 1.72), followed by smoking (bridge strength = 0.32). Conclusions In Ningxia Hui Autonomous Region, concurrent hypertension, diabetes, and dyslipidemia pose a substantial health burden among adults. The HTH/WH phenotype may serve as a practical risk assessment indicator for identifying high-risk individuals with this metabolic multimorbidity.