Association between atherogenic index of plasma and MASLD in patients with type 2 diabetes: a cross-sectional study

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in patients with type 2 diabetes mellitus (T2DM). The atherogenic index of plasma (AIP), calculated as the logarithmic ratio of triglycerides to high-density lipoprotein cholesterol (HDL-C), reflects atherogenic dyslipidemia; however, its association with MASLD specifically in patients with T2DM remains insufficiently characterized. METHODS: In this retrospective cross-sectional study, 216 adults with T2DM who underwent abdominal ultrasonography between January and September 2025 were evaluated. MASLD was diagnosed based on hepatic steatosis in the presence of metabolic dysfunction. Clinical, anthropometric, and biochemical variables were recorded. Comparative analyses, receiver operating characteristic (ROC) curve analyses, and multivariable logistic regression models were performed to assess the association between AIP and MASLD and to compare its performance with other non-invasive metabolic indices. RESULTS: MASLD was identified in 163 patients (75.5%). Individuals with MASLD had higher body mass index (BMI), fasting glucose, triglycerides, uric acid, and AIP levels, and lower HDL cholesterol (all p < 0.01). ROC analysis demonstrated a modest discriminative ability of AIP for MASLD (AUC = 0.690, 95% CI 0.62-0.76, p < 0.001), with an optimal cutoff value of 0.068 yielding 66.9% sensitivity and 67.9% specificity. In logistic regression analyses, AIP showed a significant association with MASLD in both univariate analysis (OR 14.66, 95% CI 4.35-54.94, p < 0.001) and after adjustment for BMI and glycated hemoglobin (HbA1c) (OR 10.40, 95% CI 2.71-44.30, p < 0.001). Similarly, the triglyceride-glucose (TyG) index remained independently associated with MASLD in adjusted models (OR 2.81, 95% CI 1.54-5.43, p = 0.001), whereas Fatty liver index (FLI) and Hepatic steatosis index (HSI) were not significantly associated with MASLD. CONCLUSION: AIP was independently associated with MASLD in patients with T2DM; however, its discriminative performance was modest and did not exceed that of its individual lipid components. Therefore, AIP should be interpreted primarily as a composite indicator of atherogenic dyslipidemia rather than a standalone diagnostic marker for MASLD. CLINICAL TRIAL NUMBER: Not applicable.