Associations between cardiometabolic indices and the onset of metabolic dysfunction-associated steatotic liver disease as well as its progression to liver fibrosis: a cohort study
Abstract Background This study sought to examine the associations between cardiometabolic indices and the onset of metabolic dysfunction-associated steatotic liver disease (MASLD) as well as its progression to liver fibrosis. Methods This study comprised 25,366 subjects aged 18 years and older, free...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-04-01
|
| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-025-02716-6 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849764941999898624 |
|---|---|
| author | Ziping Song Xinlei Miao Shuang Liu Manling Hu Xiaoling Xie Yuting Sun Song Leng |
| author_facet | Ziping Song Xinlei Miao Shuang Liu Manling Hu Xiaoling Xie Yuting Sun Song Leng |
| author_sort | Ziping Song |
| collection | DOAJ |
| description | Abstract Background This study sought to examine the associations between cardiometabolic indices and the onset of metabolic dysfunction-associated steatotic liver disease (MASLD) as well as its progression to liver fibrosis. Methods This study comprised 25,366 subjects aged 18 years and older, free of MASLD at baseline, from the Dalian Health Management Cohort (DHMC). Cardiometabolic indices include cardiometabolic index (CMI), atherogenic index of plasma (AIP), triglyceride glucose (TyG), triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC) and triglyceride glucose-waist height ratio (TyG-WHtR). All participants were categorized into quartile groups based on cardiometabolic indices. Cox proportional hazards regression models and restricted cubic splines were employed to examine the relationship between cardiometabolic indices and the incidence of MASLD as well as its progression to liver fibrosis, and analyses were performed between different subgroups. Mediation analysis was employed to explore how obesity and inflammation serve as mediators in the connection between cardiometabolic indices and MASLD. To evaluate the predictive ability of cardiometabolic indices for the onset of MASLD, the time-dependent receiver operating characteristic (ROC) curve was utilized. Results A total of 5378 (21.2%) individuals developed MASLD during the follow-up period of 82,445 person-years. Multivariates Cox regression analyses showed that participants in the highest quartile of cardiometabolic indices had greater risk of MASLD than those in the lowest quartile (CMI: HR = 6.11, 95% CI 5.45–6.86; AIP: HR = 4.58, 95% CI 4.11–5.10; TyG: HR = 3.55, 95% CI 3.21–3.92; TyG-BMI: HR = 13.55, 95% CI 11.80–15.57; TyG-WC: HR = 12.52, 95% CI 10.93–14.34; TyG-WHtR: HR = 11.37, 95% CI 9.96–12.98). TyG-BMI (HR = 1.36, 95% CI 1.18–1.57), but not other cardiometabolic indices, was associated with liver fibrosis. Mediation analysis indicated that BMI mediated 40.4%, 33.2%, 36.5%, − 10.4%, 37.4%, 48.5% of the associations between CMI, AIP, TyG, TyG-BMI, TyG-WC, TyG-WHtR and MASLD. Time-dependent ROC curves demonstrated that TyG-BMI had a superior predictive ability for MASLD onset compared to other indicators. Conclusions The risk of developing MASLD increases as the level of cardiometabolic indices increases. Obesity may serve as a mediating factor in the aforementioned association. TyG-BMI showed the strongest association with the onset of MASLD and its progression to liver fibrosis, proved to be outperformed other cardiometabolic indicators, and could be the best clinical non-invasive biomarker for early screening of MASLD and liver fibrosis. |
| format | Article |
| id | doaj-art-4752d4aa62a24ee49ebce440316cdc01 |
| institution | DOAJ |
| issn | 1475-2840 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj-art-4752d4aa62a24ee49ebce440316cdc012025-08-20T03:04:59ZengBMCCardiovascular Diabetology1475-28402025-04-0124111210.1186/s12933-025-02716-6Associations between cardiometabolic indices and the onset of metabolic dysfunction-associated steatotic liver disease as well as its progression to liver fibrosis: a cohort studyZiping Song0Xinlei Miao1Shuang Liu2Manling Hu3Xiaoling Xie4Yuting Sun5Song Leng6Health Management Center, The Second Hospital of Dalian Medical UniversityHealth Management Center, The Second Hospital of Dalian Medical UniversitySchool of Public Health, Dalian Medical UniversityDepartment of Gastroenterology, The Second Hospital of Dalian Medical UniversitySchool of Public Health, Dalian Medical UniversityDepartment of Gastroenterology, The Second Hospital of Dalian Medical UniversityHealth Management Center, The Second Hospital of Dalian Medical UniversityAbstract Background This study sought to examine the associations between cardiometabolic indices and the onset of metabolic dysfunction-associated steatotic liver disease (MASLD) as well as its progression to liver fibrosis. Methods This study comprised 25,366 subjects aged 18 years and older, free of MASLD at baseline, from the Dalian Health Management Cohort (DHMC). Cardiometabolic indices include cardiometabolic index (CMI), atherogenic index of plasma (AIP), triglyceride glucose (TyG), triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC) and triglyceride glucose-waist height ratio (TyG-WHtR). All participants were categorized into quartile groups based on cardiometabolic indices. Cox proportional hazards regression models and restricted cubic splines were employed to examine the relationship between cardiometabolic indices and the incidence of MASLD as well as its progression to liver fibrosis, and analyses were performed between different subgroups. Mediation analysis was employed to explore how obesity and inflammation serve as mediators in the connection between cardiometabolic indices and MASLD. To evaluate the predictive ability of cardiometabolic indices for the onset of MASLD, the time-dependent receiver operating characteristic (ROC) curve was utilized. Results A total of 5378 (21.2%) individuals developed MASLD during the follow-up period of 82,445 person-years. Multivariates Cox regression analyses showed that participants in the highest quartile of cardiometabolic indices had greater risk of MASLD than those in the lowest quartile (CMI: HR = 6.11, 95% CI 5.45–6.86; AIP: HR = 4.58, 95% CI 4.11–5.10; TyG: HR = 3.55, 95% CI 3.21–3.92; TyG-BMI: HR = 13.55, 95% CI 11.80–15.57; TyG-WC: HR = 12.52, 95% CI 10.93–14.34; TyG-WHtR: HR = 11.37, 95% CI 9.96–12.98). TyG-BMI (HR = 1.36, 95% CI 1.18–1.57), but not other cardiometabolic indices, was associated with liver fibrosis. Mediation analysis indicated that BMI mediated 40.4%, 33.2%, 36.5%, − 10.4%, 37.4%, 48.5% of the associations between CMI, AIP, TyG, TyG-BMI, TyG-WC, TyG-WHtR and MASLD. Time-dependent ROC curves demonstrated that TyG-BMI had a superior predictive ability for MASLD onset compared to other indicators. Conclusions The risk of developing MASLD increases as the level of cardiometabolic indices increases. Obesity may serve as a mediating factor in the aforementioned association. TyG-BMI showed the strongest association with the onset of MASLD and its progression to liver fibrosis, proved to be outperformed other cardiometabolic indicators, and could be the best clinical non-invasive biomarker for early screening of MASLD and liver fibrosis.https://doi.org/10.1186/s12933-025-02716-6Triglyceride-glucoseCardiometabolic indexMetabolic dysfunction-associated steatotic liver diseaseLiver fibrosisInsulin resistance |
| spellingShingle | Ziping Song Xinlei Miao Shuang Liu Manling Hu Xiaoling Xie Yuting Sun Song Leng Associations between cardiometabolic indices and the onset of metabolic dysfunction-associated steatotic liver disease as well as its progression to liver fibrosis: a cohort study Cardiovascular Diabetology Triglyceride-glucose Cardiometabolic index Metabolic dysfunction-associated steatotic liver disease Liver fibrosis Insulin resistance |
| title | Associations between cardiometabolic indices and the onset of metabolic dysfunction-associated steatotic liver disease as well as its progression to liver fibrosis: a cohort study |
| title_full | Associations between cardiometabolic indices and the onset of metabolic dysfunction-associated steatotic liver disease as well as its progression to liver fibrosis: a cohort study |
| title_fullStr | Associations between cardiometabolic indices and the onset of metabolic dysfunction-associated steatotic liver disease as well as its progression to liver fibrosis: a cohort study |
| title_full_unstemmed | Associations between cardiometabolic indices and the onset of metabolic dysfunction-associated steatotic liver disease as well as its progression to liver fibrosis: a cohort study |
| title_short | Associations between cardiometabolic indices and the onset of metabolic dysfunction-associated steatotic liver disease as well as its progression to liver fibrosis: a cohort study |
| title_sort | associations between cardiometabolic indices and the onset of metabolic dysfunction associated steatotic liver disease as well as its progression to liver fibrosis a cohort study |
| topic | Triglyceride-glucose Cardiometabolic index Metabolic dysfunction-associated steatotic liver disease Liver fibrosis Insulin resistance |
| url | https://doi.org/10.1186/s12933-025-02716-6 |
| work_keys_str_mv | AT zipingsong associationsbetweencardiometabolicindicesandtheonsetofmetabolicdysfunctionassociatedsteatoticliverdiseaseaswellasitsprogressiontoliverfibrosisacohortstudy AT xinleimiao associationsbetweencardiometabolicindicesandtheonsetofmetabolicdysfunctionassociatedsteatoticliverdiseaseaswellasitsprogressiontoliverfibrosisacohortstudy AT shuangliu associationsbetweencardiometabolicindicesandtheonsetofmetabolicdysfunctionassociatedsteatoticliverdiseaseaswellasitsprogressiontoliverfibrosisacohortstudy AT manlinghu associationsbetweencardiometabolicindicesandtheonsetofmetabolicdysfunctionassociatedsteatoticliverdiseaseaswellasitsprogressiontoliverfibrosisacohortstudy AT xiaolingxie associationsbetweencardiometabolicindicesandtheonsetofmetabolicdysfunctionassociatedsteatoticliverdiseaseaswellasitsprogressiontoliverfibrosisacohortstudy AT yutingsun associationsbetweencardiometabolicindicesandtheonsetofmetabolicdysfunctionassociatedsteatoticliverdiseaseaswellasitsprogressiontoliverfibrosisacohortstudy AT songleng associationsbetweencardiometabolicindicesandtheonsetofmetabolicdysfunctionassociatedsteatoticliverdiseaseaswellasitsprogressiontoliverfibrosisacohortstudy |