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Background <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusions <p>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.</p>

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Personalized MASLD and liver fibrosis risk assessment for adults: glycemic status determines optimal choice of non-invasive indices

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月22日

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  • Yuan Zhao,
  • Dongyu Hu,
  • Jiacheng Cheng,
  • Huili Cao,
  • Xiaojuan Wang,
  • Junhua He,
  • Yikun Zhu,
  • Jin Li

摘要

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.