The prevalence of MASLD is 40.6% in normoglycemia, 62.7% in prediabetes, and 85.5% in T2DM, with TyG-WHtR showing the strongest association (OR 5.58) in T2DM.
Do non-invasive metabolic indices accurately predict MASLD and significant fibrosis across different glycemic states in adults?
TyG-WC and FLI are consistent and high-performing non-invasive indices for individualized MASLD and liver fibrosis risk assessment across different glycemic states.
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Abstract Background Metabolic dysfunction–associated steatotic liver disease (MASLD) is a global health challenge, with early detection and risk stratification across glycemic states still unresolved. This study aimed to evaluate the performance of 18 non-invasive metabolic indices in predicting MASLD (defined as hepatic steatosis with metabolic risk factors) and significant fibrosis across glycemic states and demographic subgroups. Methods Cross-sectional analyses were performed on 2,794 individuals aged ≥ 20 years from the 2017–2020 National Health and Nutrition Examination Survey cycle, stratified by glycemic status and demographic factors. Eighteen indices were assessed: triglyceride-glucose index (TyG), TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), TyG-weight-adjusted waist index (TyG-WWI), visceral adiposity index (VAI), homeostatic model assessment of insulin resistance (HOMA-IR), metabolic score for IR (METS-IR), Framingham steatosis index (FSI), fatty liver index (FLI), USFLI, Zhejiang University index (ZJU), lipid accumulation product (LAP), hepatic steatosis index (HSI), non-high-density lipoprotein cholesterol (HDL-C) to HDL-C ratio (NHHR), Nonalcoholic fatty liver disease fibrosis score (NFS), fibrosis-4 index (FIB-4), and BMI-aspartate aminotransferase/alanine aminotransferase ratio and diabetes score (BARD). Associations and diagnostic performance were examined using multivariable logistic regression and receiver operating characteristic analyses. Results MASLD prevalence increased with worsening glycemic status: 40.6% in normoglycemia, 62.7% in prediabetes, and 85.5% in type 2 diabetes mellitus (T2DM). TyG-WHtR exhibited the strongest association with MASLD (odds ratio OR 3.83), with an even higher risk in T2DM (OR 5.58). FLI, TyG-WHtR, and NFS were associated with fibrosis, though the associations were weaker in normoglycemia. TyG-WC demonstrated the highest diagnostic accuracy for MASLD (area under the curve AUC 0.830), particularly in males and adults ≤ 50 years (AUCs 0.842–0.853). FLI performed consistently across glycemic strata (AUCs 0.769–0.821). FSI performed well in T2DM (AUC 0.823) and in males (AUC 0.829). For significant fibrosis, FLI showed the best performance, particularly in prediabetes (AUC 0.761) and T2DM (AUC 0.754). Traditional markers (FIB-4, BARD) demonstrated limited utility. Conclusions Glycemic deterioration is strongly linked to MASLD and fibrosis. TyG-WC and FLI were the most consistent and high-performing indices across glycemic and demographic groups, supporting their use as broadly applicable non-invasive tools for individualized MASLD risk assessment.
Zhao et al. (Mon,) reported a other. The prevalence of MASLD is 40.6% in normoglycemia, 62.7% in prediabetes, and 85.5% in T2DM, with TyG-WHtR showing the strongest association (OR 5.58) in T2DM.