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. 2022 Sep 2:13:951689.
doi: 10.3389/fendo.2022.951689. eCollection 2022.

Potential screening indicators for early diagnosis of NAFLD/MAFLD and liver fibrosis: Triglyceride glucose index-related parameters

Yan Xue  1 , Jiahui Xu  2 , Man Li  1 , Yueqiu Gao  1
Affiliations

Potential screening indicators for early diagnosis of NAFLD/MAFLD and liver fibrosis: Triglyceride glucose index-related parameters

Yan Xue et al. Front Endocrinol (Lausanne). .

Abstract

Importance: Homeostatic model assessment for insulin resistance (HOMA-IR) and triglyceride glucose (TyG) index-related parameters [TyG index, triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-waist-to-height ratio (TyG-WHtR), and triglyceride glucose-body mass index (TyG-BMI)] are gradually considered as convenient and alternative indicators for insulin resistance in various metabolic diseases, but the specific diagnostic capacity and the comparison of the parameters in non-alcoholic fatty liver disease (NAFLD), metabolic-associated fatty liver disease (MAFLD), and liver fibrosis remain uncertain.

Objective: To comprehensively assess and compare the diagnostic accuracy of the above parameters in NAFLD, MAFLD, and liver fibrosis and identify the appropriate indicators.

Methods: A total of 1,727 adults were enrolled from the 2017-2018 National Health and Nutrition Examination Surveys. Logistic regressions were used to identify the parameters significantly associated with NAFLD, MAFLD, and liver fibrosis; receiver operating characteristic (ROC) curves were used to evaluate and compare their diagnostic capacity. Subgroup analyses were conducted to validate the concordance, and the optimal cutoff values were determined according to the Youden's indexes.

Results: Significant differences were observed between quartile-stratified HOMA-IR and TyG index-related parameters across the NAFLD, MAFLD, and liver fibrosis (P < 0.05). All variables were significantly predictive of different disease states (P < 0.05). The top three AUC values are TyG-WC, TyG-WHtR, and TyG-BMI with AUCs of 0.815, 0.809, and 0.804 in NAFLD. The optimal cutoff values were 822.34, 4.94, and 237.77, respectively. Similar values and the same trend of the above three indexes could be observed in MAFLD and liver fibrosis. Subgroup analyses showed consistent results with the primary research, despite some heterogeneity.

Conclusions: TyG-WC, TyG-WHtR, and TyG-BMI can be used for early screening of NAFLD and MAFLD. These three parameters and HOMA-IR were more suitable for assessing metabolic risks and monitoring disease progression in patients with NAFLD.

Keywords: MAFLD; NAFLD; NHANES; ROC curves; TyG index–related parameters.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of subject inclusion and exclusion in the 2017–2018 U.S. National Health and Nutrition Examination Survey.
Figure 2
Figure 2
Association of the five parameters with non-alcoholic fatty liver disease (NAFLD). (A) Association of TyG index with NAFLD. (B) Association of HOMA-IR score with NAFLD. (C) Association of TyG-WHtR with NAFLD. (D) Association of TyG-BMI with NAFLD. (E) Association of TyG-WC with NAFLD.Model 1: Adjusted for age and gender.Model 2: Adjusted for age, gender, PIR, education level, smoking status, diabetes, hypertension, and obesity or overweight.Note: Q1–4 = quartiles 1–4; specific values are as follows:Age Q1 < 36 years, 36 ≥ Age Q2 ≤ 53 years, 53 > Age Q3 ≤ 65 years, Age Q4 > 65 years;TYG Q1 < 8.02, 8.02 ≥ TYG Q2 < 8.50, 8.5 ≥ TYG Q2 < 8.96, TYG Q4 ≥ 8.96;HOMA-IR Q1 < 1.38, 1.38 ≥ HOMA-IR Q2 < 2.24, 2.24 ≥ HOMA-IR Q2 < 3.84, HOMA-IR Q4 ≥ 3.84;TyG-WHtR Q1 < 4.34, 4.34 ≥ TyG-WHtR Q2 < 5.05, 5.05 ≥ TyG-WHtR Q2 < 5.81, TyG-WHtR Q4 ≥ 5.81;TyG-BMI Q1 < 203.68, 203.68 ≥ TyG-BMI Q2 < 240.41, 240.41 ≥ TyG-BMI Q2 < 287.39, TyG-BMI Q4 ≥ 287.39.TyG-WC Q1 < 720.71, 720.71 ≥ TyG-WC Q2 < 838.50, 838.50 ≥ TyG-WC Q2 < 959.81, TyG-WC Q4 ≥ 959.81.
Figure 3
Figure 3
Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) values of the five parameters (TyG index, HOMA-IR score, TyG-WHtR, TyG-BMI, and TyG-WC) in diagnosing NAFLD, metabolic-associated fatty liver disease (MAFLD), liver fibrosis, and moderate-to-advanced fibrosis. (A) Five parameters were assessed to identify NAFLD. (B) Five parameters were assessed to identify MAFLD. (C) Five parameters were assessed to identify liver fibrosis. (D) Five parameters were evaluated to identify moderate-to-advanced fibrosis.
Figure 4
Figure 4
ROC curves and the area under the ROC curve (AUC) values of TyG index, HOMA-IR score, TyG-WHtR, TyG-BMI, and TyG-WC for NAFLD. (A) Subgroup analyses based on age. (B) Subgroup analyses based on gender. (C) Subgroup analyses based on smoking status. (D) Subgroup analyses based on diabetes. (E) Subgroup analyses based on overweight or obesity. (F) Subgroup analyses based on hypertension.
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