ArticleDiabetology & metabolic syndrome2025
Personalized MASLD and liver fibrosis risk assessment for adults: glycemic status determines optimal choice of non-invasive indices.
Article in Diabetology & metabolic syndrome, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Exploratory mediation analysis of body roundness index in the nonlinear association between CHG index and metabolic dysfunction-associated steatotic liver disease among non-diabetic adults.Frontiers in nutrition · 2026Article
- The effects of ketogenic diet and calorie-restricted diet on metabolic dysfunction-associated steatotic liver disease: a retrospective study.Frontiers in nutrition · 2026Article
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Abstract
backgroundMetabolic 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.
methodsCross-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.
resultsMASLD 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.
conclusionsGlycemic 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.
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