Triglyceride-to-HDL Cholesterol Ratio is Associated with Hepatic Steatosis but not Fibrosis in Patients with Severe Obesity: A Cross-Sectional Study

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among individuals with severe obesity. The triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C) is an accessible surrogate marker of insulin resistance, but its association with hepatic steatosis and fibrosis in candidates for metabolic and bariatric surgery remains incompletely defined. METHODS: This retrospective cross-sectional study included 99 patients undergoing preoperative evaluation for metabolic and bariatric surgery between 2020 and 2024. Hepatic steatosis was assessed by ultrasonography and liver fibrosis by elastography. Associations with TG/HDL-C were examined using categorical analyses and multivariable logistic regression. Because diabetes perfectly predicted hepatic steatosis, Firth penalized logistic regression was used for the primary adjusted analysis. RESULTS: The cohort included 61 women (61.6%), with a mean age of 37.0 ± 9.8 years and body mass index of 40.4 ± 4.2 kg/m². Hepatic steatosis was present in 81 of 99 patients (81.8%), whereas fibrosis was identified in 35 of 98 patients with evaluable elastography (35.7%). Higher TG/HDL-C categories were associated with hepatic steatosis (p = 0.0016). After adjustment, each unit increase in TG/HDL-C was associated with higher odds of steatosis (adjusted odds ratio, 2.23; 95% CI, 1.22-4.08; p = 0.0090). TG/HDL-C showed moderate discrimination for steatosis (area under the curve, 0.763; 95% confidence interval, 0.632-0.868), with an exploratory optimal threshold of 2.17 (79.0% sensitivity and 66.7% specificity). In contrast, TG/HDL-C was not associated with fibrosis after adjustment (adjusted odds ratio, 0.84; 95% confidence interval, 0.63-1.10; p = 0.209) and showed no discriminatory ability for fibrosis (area under the curve, 0.494). CONCLUSIONS: TG/HDL-C was independently associated with ultrasonographically detected hepatic steatosis and showed moderate discriminatory performance in patients with severe obesity undergoing evaluation for metabolic and bariatric surgery. However, it was not associated with fibrosis assessed by elastography. These findings support TG/HDL-C as a potential low-cost adjunct for identifying steatosis, but not as a substitute for fibrosis-specific assessment.