Application of TG/HDL-C Combined with Liver Function Indexes to Predict Metabolic-Associated Fatty Liver Disease

IA Jun-xiang, ZHAO Yan-hua, HE He, LIANG Shan-shan, GAN Wei, LI Gui-xing

Abstract

To study the application of triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) combined with liver function indexes to predict metabolic-associated fatty liver disease (MAFLD).   Methods  A total of 2971 outpatients diagnosed with MAFLD and 2794 healthy controls were enrolled, and their relevant data were collected. Two-sample Mann-Whitney U test and binary logistic regression analysis were conducted to study the relationship between TG/HDL-C and MAFLD and to construct combined diagnosis models of MAFLD. The area under the curve (AUC) of receiver operating characteristic (ROC) was used to pick out the optimal model.   Results  The TG/HDL-C of MAFLD patients was significantly higher than that of healthy controls. In multivariate analysis, after adjusting for body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, triglycerides, high-density lipoprotein cholesterol, uric acid and creatinine, the odds ratio of TG/HDL-C was 2.356 (95% confidence interval [CI]: 1.028-5.400). Therefore, TG/HDL-C was an independent risk factor for MAFLD. ROC curve analysis showed that the AUC of using TG/HDL-C to predict MAFLD was 0.795 (95% CI: 0.784-0.807), and when the cut-off value was 1.09, the sensitivity was 0.679 and the specificity was 0.755. The AUC of the diagnosis model established by a combined use of TG/HDL-C, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin (ALB) was 0.890 (95% CI: 0.882-0.898), and when the cut-off value was 0.47, the sensitivity and specificity were 0.792 and 0.839, respectively.   Conclusion  TG/HDL-C is an independent risk factor for MAFLD. TG/HDL-C can well predict MAFLD when it is used in combination with ALT, AST, and ALB.

 

Keywords: Metabolic-associated fatty liver disease, TG/HDL-C, Diagnosis model

 

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References


ESLAM M， NEWSOME P N， SARIN S K， et al. A new defifinition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol，2020，73(1): 202–209.

YILMAZ Y， BYRNE C D， MUSSO G. A single-letter change in an acronym: Signals, reasons, promises, challenges, and steps ahead for moving from NAFLD to MAFLD. Expert Rev Gastroenterol Hepatol， 2021，15(4): 345–352.

YOUNOSSI Z M， KOENIG A B， ABDELATIF D， et al. Global epidemiology of nonalcoholic fatty liver disease--Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology，2016， 64(1): 73–84.

SANCHEZ-MUNOZ D， CASTELLANO-MEGIAS V M， ROMERO-GOMEZ M. Histologic features of steatohepatitis in patients with a clinical diagnosis of autoimmune cholestasis. Dig Dis Sci，2004， 49(11/12): 1957–1960.

AMPUERO J， ALLER R， GALLEGO-DURAN R， et al. The effects of metabolic status on non-alcoholic fatty liver disease-related outcomes, beyond the presence of obesity. Aliment Pharmacol Ther，2018， 48(11/12): 1260–1270.

PIROLA C J， SOOKOIAN S. Multiomics biomarkers for the prediction of nonalcoholic fatty liver disease severity. World J Gastroenterol，2018， 24(15): 1601–1615.

LIU D C， GUAN L， ZHAO Y， et al. Association of triglycerides to high-density lipoprotein-cholesterol ratio with risk of incident hypertension. Hypertens Res，2020，43(9): 948–955.

CHEN Z K， CHEN G Z， QIN H L， et al. Higher triglyceride to high-density lipoprotein cholesterol ratio increases cardiovascular risk: 10-year prospective study in a cohort of Chinese adults. J Diabetes Investig，2020， 11(2): 475–481.

CAI Z F， CHEN Z K， FANG W， et al. Triglyceride to high-density lipoprotein cholesterol ratio variability and incident diabetes: A 7-year prospective study in a Chinese population. J Diabetes Investig，2021， 12(10): 1864–1871.

FIGUEIREDO N， QUEIROZ M D O， LOPES K L S， et al. Triglyceride-to-high-density-lipoprotein-cholesterol ratio as a predictor for metabolic syndrome according to obesity onset in women with severe obesity. Metabolism， 2021， 116: 154649[2021-08-08]. https://doi.org/10.1016/j. metabol.2020.154649.

LIU X Y， WU Q Y， CHEN Z H， et al. Elevated triglyceride to high-density lipoprotein cholesterol (TG/HDL-c) ratio increased risk of hyperuricemia: A 4-year cohort study in China. Endocrine，2020，68(1): 71–80.

WEN J， CHEN Y Y， HUANG Y， et al. Association of the TG/HDL-C and Non-HDL-C/HDL-C ratios with chronic kidney disease in an adult Chinese population. Kidney Blood Press Res，2017，42(6): 1141–1154.

XUE J， WANG Y X， LI B， et al. Triglycerides to high-density lipoprotein cholesterol ratio is superior to triglycerides and other lipid ratios as an indicator of increased urinary albumin-to-creatinine ratio in the general population of China: A cross-sectional study. Lipids Health Dis，2021， 20(1): 13.

LIN D Z， QI Y Q， HUANG C L， et al. Associations of lipid parameters with insulin resistance and diabetes: A population-based study. Clin Nutr，2018，37(4): 1423–1429.

HUANG J F， TSAI P C， YEH M L， et al. Risk stratification of non-alcoholic fatty liver disease across body mass index in a community basis. J Formos Med Assoc，2020，119(1): 89–96.

FUKUDA Y， HASHIMOTO Y， HAMAGUCHI M， et al. Triglycerides to high-density lipoprotein cholesterol ratio is an independent predictor of incident fatty liver; A population-based cohort study. Liver Int，2016， 36(5): 713–720.

FAN N G， PENG L， XIA Z H， et al. Triglycerides to high-density lipoprotein cholesterol ratio as a surrogate for nonalcoholic fatty liver disease: A cross sectional study. Lipids Health Dis，2019，18(1): 39.

COTTER T G， RINELLA M. Nonalcoholic fatty liver disease 2020: The state of the disease. Gastroenterology，2020，158(7): 1851–1864.

RADA P， GONZALEZ-RODRIGUEZ A， GARCIA-MONZON C， et al. Understanding lipotoxicity in NAFLD pathogenesis: Is CD36 a key driver? Cell Death Dis，2020，11(9): 802.

GONZALEZ-CANTERO J， MARTIN-RODRIGUEZ J L， GONZALEZ-CANTERO A， et al. Insulin resistance in lean and overweight non-diabetic Caucasian adults: Study of its relationship with liver triglyceride content， waist circumference and BMI. PLoS One， 2018， 13(2): e0192663[2021-08-15]. https://doi.org/10.1371/journal.pone.0192663.

BILIC-CURCIC I， BERKOVIC M C， VIROVIC-JUKIC L， et al. Shifting perspectives--Interplay between non-alcoholic fatty liver disease and insulin resistance in lean individuals. World J Hepatol，2021，13(1): 80–93.

LIM S， KIM J W， TARGHER G. Links between metabolic syndrome and metabolic dysfunction-associated fatty liver disease. Trends Endocrinol Metab，2021，32(7): 500–514.

LUCERO D， MIKSZTOWICZ V， MACRI V， et al. Overproduction of altered VLDL in an insulin-resistance rat model: Influence of SREBP-1c and PPAR-alpha. Clin Investig Arterioscler，2015，27(4): 167–174.

CHRISTOU G A， KIORTSIS D N. Adiponectin and lipoprotein metabolism. Obes Rev，2013，14(12): 939–949.

CHEN Z K， QIN H L， QIN S B， et al. Correlation of triglyceride to high-density lipoprotein cholesterol ratio with nonalcoholic fatty liver disease among the non-obese Chinese population with normal blood lipid levels: A retrospective cohort research. Lipids Health Dis，2019，18(1): 162.

WU K T， KUO P L， SU S B， et al. Nonalcoholic fatty liver disease severity is associated with the ratios of total cholesterol and triglycerides to high-density lipoprotein Cholesterol. J Clinical Lipidol，2016，10(2): 420–425.

PACIFICO L， BONCI E， ANDREOLI G， et al. Association of serum triglyceride-to-HDL cholesterol ratio with carotid artery intima-media thickness, insulin resistance and nonalcoholic fatty liver disease in children and adolescents. Nutr Metab Cardiovasc Dis，2014，24(7): 737–743.


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