Associations between non-insulin-based insulin resistance surrogate markers and liver-related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort study in South Korea
Abstract Background Insulin resistance (IR) is a crucial mechanism in the pathogenesis and clinical progression of metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to examine the relationship between non-insulin-based IR surrogate markers and the incidence of liver-...
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2025-04-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-025-03877-0 |
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| author | Sang Yi Moon Minkook Son Yeo Wool Kang Myeongseok Koh Jong Yoon Lee Yang Hyun Baek |
| author_facet | Sang Yi Moon Minkook Son Yeo Wool Kang Myeongseok Koh Jong Yoon Lee Yang Hyun Baek |
| author_sort | Sang Yi Moon |
| collection | DOAJ |
| description | Abstract Background Insulin resistance (IR) is a crucial mechanism in the pathogenesis and clinical progression of metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to examine the relationship between non-insulin-based IR surrogate markers and the incidence of liver-related outcomes in individuals with MASLD in a nationwide Korean cohort. Methods A total of 66,334 individuals with MASLD who underwent a health examination between 1 January 2009 and 31 December 2010 were included in the study and followed until 31 December 2019, with a median follow-up period of 9.4 years. Hepatic steatosis was defined as a fatty liver index ≥ 30. The triglyceride-glucose (TyG) index, triglyceride-to-high-density lipoprotein cholesterol (TG/HDL) ratio, and metabolic score of IR (METS-IR) were employed as non-insulin-based IR surrogate markers. The MASLD groups were divided into four groups based on the non-insulin-based IR surrogate markers quartiles. The primary outcome was liver-related outcomes, as a composite of hepatocellular carcinoma and decompensated liver cirrhosis. Results The MASLD group was 64.4% male (average age, 59.0 years). Using the lowest quartile (Q1) of the three non-insulin-based IR surrogate markers as a reference, a decrease in the adjusted hazard ratio for liver-related outcomes was observed from Q2 to Q4: (TyG: Q2 0.90 [95% confidence interval [CI]: 0.79–1.02], Q3 0.80 [95% CI: 0.70–0.91], Q4 0.80 [95% CI: 0.69–0.92]; TG/HDL: Q2 0.85 [95% CI: 0.75–0.97], Q3 0.81 [95% CI: 0.71–0.92], Q4 0.81 [95% CI: 0.71–0.93]; METS-IR: Q2 0.83 [95% CI: 0.73–0.95], Q3 0.80 [95% CI: 0.70–0.91], Q4 0.80 [95% CI: 0.70–0.92]). Conclusions A lower non-insulin-based IR surrogate marker in the MASLD group may be associated with an increased risk of liver-related outcomes. In the course of monitoring MASLD, metabolic alterations must be meticulously observed. |
| format | Article |
| id | doaj-art-6fc185ca86ea4d789b5d06aa1318aa53 |
| institution | DOAJ |
| issn | 1471-230X |
| language | English |
| publishDate | 2025-04-01 |
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| spelling | doaj-art-6fc185ca86ea4d789b5d06aa1318aa532025-08-20T03:18:38ZengBMCBMC Gastroenterology1471-230X2025-04-0125111110.1186/s12876-025-03877-0Associations between non-insulin-based insulin resistance surrogate markers and liver-related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort study in South KoreaSang Yi Moon0Minkook Son1Yeo Wool Kang2Myeongseok Koh3Jong Yoon Lee4Yang Hyun Baek5Department of Internal Medicine, Dong-A University College of MedicineDepartment of Data Sciences Convergence, Dong-A University Interdisciplinary ProgramDepartment of Internal Medicine, Dong-A University College of MedicineDepartment of Internal Medicine, Dong-A University College of MedicineDepartment of Internal Medicine, Dong-A University College of MedicineDepartment of Internal Medicine, Dong-A University College of MedicineAbstract Background Insulin resistance (IR) is a crucial mechanism in the pathogenesis and clinical progression of metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to examine the relationship between non-insulin-based IR surrogate markers and the incidence of liver-related outcomes in individuals with MASLD in a nationwide Korean cohort. Methods A total of 66,334 individuals with MASLD who underwent a health examination between 1 January 2009 and 31 December 2010 were included in the study and followed until 31 December 2019, with a median follow-up period of 9.4 years. Hepatic steatosis was defined as a fatty liver index ≥ 30. The triglyceride-glucose (TyG) index, triglyceride-to-high-density lipoprotein cholesterol (TG/HDL) ratio, and metabolic score of IR (METS-IR) were employed as non-insulin-based IR surrogate markers. The MASLD groups were divided into four groups based on the non-insulin-based IR surrogate markers quartiles. The primary outcome was liver-related outcomes, as a composite of hepatocellular carcinoma and decompensated liver cirrhosis. Results The MASLD group was 64.4% male (average age, 59.0 years). Using the lowest quartile (Q1) of the three non-insulin-based IR surrogate markers as a reference, a decrease in the adjusted hazard ratio for liver-related outcomes was observed from Q2 to Q4: (TyG: Q2 0.90 [95% confidence interval [CI]: 0.79–1.02], Q3 0.80 [95% CI: 0.70–0.91], Q4 0.80 [95% CI: 0.69–0.92]; TG/HDL: Q2 0.85 [95% CI: 0.75–0.97], Q3 0.81 [95% CI: 0.71–0.92], Q4 0.81 [95% CI: 0.71–0.93]; METS-IR: Q2 0.83 [95% CI: 0.73–0.95], Q3 0.80 [95% CI: 0.70–0.91], Q4 0.80 [95% CI: 0.70–0.92]). Conclusions A lower non-insulin-based IR surrogate marker in the MASLD group may be associated with an increased risk of liver-related outcomes. In the course of monitoring MASLD, metabolic alterations must be meticulously observed.https://doi.org/10.1186/s12876-025-03877-0Fatty liverFibrosisHepatocellular carcinomaLiver cirrhosisIncidence |
| spellingShingle | Sang Yi Moon Minkook Son Yeo Wool Kang Myeongseok Koh Jong Yoon Lee Yang Hyun Baek Associations between non-insulin-based insulin resistance surrogate markers and liver-related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort study in South Korea BMC Gastroenterology Fatty liver Fibrosis Hepatocellular carcinoma Liver cirrhosis Incidence |
| title | Associations between non-insulin-based insulin resistance surrogate markers and liver-related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort study in South Korea |
| title_full | Associations between non-insulin-based insulin resistance surrogate markers and liver-related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort study in South Korea |
| title_fullStr | Associations between non-insulin-based insulin resistance surrogate markers and liver-related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort study in South Korea |
| title_full_unstemmed | Associations between non-insulin-based insulin resistance surrogate markers and liver-related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort study in South Korea |
| title_short | Associations between non-insulin-based insulin resistance surrogate markers and liver-related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort study in South Korea |
| title_sort | associations between non insulin based insulin resistance surrogate markers and liver related outcomes in metabolic dysfunction associated steatotic liver disease a nationwide cohort study in south korea |
| topic | Fatty liver Fibrosis Hepatocellular carcinoma Liver cirrhosis Incidence |
| url | https://doi.org/10.1186/s12876-025-03877-0 |
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