Association between the triglyceride-glucose index and the presence and severity of hemorrhoidal disease: a cross-sectional study based on retrospectively collected clinical data.

OBJECTIVE: To investigate the association between the triglyceride-glucose (TyG) index and the prevalence and severity of hemorrhoidal disease in adults undergoing anorectal evaluation. METHODS: This cross-sectional study analyzed retrospectively collected data from 528 adults undergoing anorectal evaluation and fasting biochemical testing. The TyG index was calculated as ln[fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. Multivariable logistic regression, restricted cubic spline analysis, subgroup, sensitivity, severity, and exploratory mediation analyses were performed to assess the association between TyG and hemorrhoidal disease. RESULTS: Among the 528 participants, 196 (37.1%) had hemorrhoidal disease. Its prevalence increased progressively across TyG quartiles, from 23.5% in Q1 to 53.8% in Q4 (P for trend<0.001). After adjustment for demographic, metabolic, lifestyle, medication-related, and bowel-related factors, each 1-unit increase in the TyG index was associated with higher odds of hemorrhoidal disease (OR = 1.68, 95% CI: 1.24-2.28; P = 0.001). Compared with Q1, participants in Q4 had significantly greater odds of hemorrhoidal disease (OR = 2.43, 95% CI: 1.34-4.41; P for trend=0.002). Restricted cubic spline analysis showed a significant overall association (P<0.001) without evidence of nonlinearity (P = 0.184). The findings remained consistent across subgroup and sensitivity analyses. A higher TyG index was also associated with advanced hemorrhoidal disease (OR per 1-unit increase=1.62, 95% CI: 1.01-2.61). CONCLUSION: A higher TyG index was independently associated with hemorrhoidal disease severity. BMI partially mediated this association (~27%), suggesting a potential metabolic pathway that requires validation in longitudinal studies.