Association of the cholesterol-high-density lipoprotein glucose index with metabolic dysfunction-associated fatty liver disease and hepatic steatosis severity: a cross-sectional study based on health examination data

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a common metabolic liver disorder closely associated with abnormalities in glucose and lipid metabolism. The cholesterol-high-density lipoprotein glucose index (CHG), a composite marker integrating glucose and lipid metabolism parameters, may reflect the metabolic abnormalities associated with MAFLD. This study aimed to investigate the association between CHG and MAFLD, as well as hepatic steatosis severity. This cross-sectional study included 22,858 adults who underwent routine health examinations at the Health Management Center of the Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine. MAFLD was diagnosed based on abdominal ultrasonography findings and metabolic dysfunction criteria. Logistic regression models, restricted cubic spline analysis, receiver operating characteristic (ROC) curve analysis, and multinomial logistic regression were performed. Participants with MAFLD had significantly higher CHG levels than those without MAFLD (5.44 vs. 5.08, P < 0.001). After adjustment for age, sex, body mass index, alanine aminotransferase, aspartate aminotransferase, creatinine, and uric acid, each standard deviation increase in CHG was associated with higher odds of MAFLD (OR = 2.273, 95% CI: 2.161-2.390, P < 0.001). Restricted cubic spline analysis indicated a nonlinear association between CHG and prevalent MAFLD (P for overall association < 0.001; P for nonlinearity < 0.001). The AUCs for CHG and TyG were 0.801 and 0.829, respectively. CHG levels were also higher across categories of ultrasound-defined hepatic steatosis severity. In this cross-sectional health examination population, CHG was associated with prevalent MAFLD and showed discriminatory ability within the study sample, although its performance was lower than that of TyG. Further validation is required to determine the generalizability and clinical relevance of these findings.