Association between estimated glucose disposal rate and overall and disease-specific mortality in NAFLD patients

The correlation between estimated glucose disposal rate (eGDR) and both overall and cardiovascular disease (CVD) mortality in individuals with non-alcoholic fatty liver disease (NAFLD) was still unclear. This was a prospective cohort study that utilized data from the 2005–2018 National Health and Nutrition Examination Survey (NHANES). A comprehensive cohort of 4760 individuals with NAFLD (defined by a U.S. Fatty Liver Index [USFLI] score ≥ 30) was included. To determine outcomes of interest (overall mortality and CVD mortality), the NHANES data set was linked with the National Death Index (NDI) to obtain information on longitudinal follow-up duration, survival status, and cause of death. To examine the correlation between eGDR and both overall and cardiovascular disease mortality, the Cox proportional hazards model, Kaplan–Meier survival curves, and restricted cubic spline (RCS) analysis were applied. Sensitivity analysis was performed to assess the stability of the results, and the incremental predictive capacity of eGDR was also assessed. This study included 4760 patients with NAFLD, consisting of 2179 women and 2581 men, with a median age of 54 (39, 65). Multivariate Cox regression analysis revealed a conspicuous connection between eGDR and overall mortality among individuals with NAFLD. For the third tertile of eGDR, the unadjusted hazard ratio (HR) for overall mortality was 0.34 (95% confidence interval [CI] 0.24–0.47, p < 0.001). After minimal adjustment, the HR for overall mortality was 0.70 (95% CI 0.51–0.95, p = 0.024), and after full adjustment, it was 0.67 (95% CI 0.47–0.96, p = 0.030). Similarly, eGDR was related to cardiovascular disease mortality, with the unadjusted HR of 0.17 (95% CI 0.09–0.31, p < 0.001), the minimally adjusted HR of 0.36 (95% CI 0.19–0.66, p = 0.001), and the fully adjusted HR of 0.44 (95% CI 0.23–0.86, p = 0.016). RCS curves demonstrated a linear correlation between eGDR and overall mortality (non-linear p = 0.1021; overall p < 0.001), whereas a significant non-linear correlation was demonstrated for CVD mortality (non-linear p = 0.0492; overall p < 0.001). Among patients with NAFLD, higher eGDR is significantly associated with lower risks of overall mortality and CVD mortality. This study underscores the clinical significance of eGDR as a prognostic indicator for evaluating mortality risk in NAFLD patients, providing valuable evidence for risk stratification in this population.