Department of Infectious Diseases, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China.
Department of Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China.
BMC Public Health. 2024 Aug 9;24(1):2161. doi: 10.1186/s12889-024-19657-6.
The prevalence of non-alcoholic fatty liver disease (NAFLD) keeps increasing annually worldwide. Non-invasive assessment tools for evaluating the risk and severity of the disease are still limited. Insulin resistance (IR) and abdominal obesity (ABO) are closely related to NAFLD.
A retrospective large-scale, population-based study was conducted based on the data from the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES). Three ABO indices, namely lipid accumulation product (LAP), visceral obesity index (VAI), waist circumference-triglyceride index (WTI), and three IR indices, including triglyceride glucose index (TyG), homeostasis model assessment of insulin resistance (HOMA-IR) and metabolic score for insulin resistance (METS-IR), were analyzed and compared for their relationships with NAFLD based on weighted multivariable logistic regression, spearman correlation heatmap, smooth curve fittings. The area under the curve (AUC) of receiver-operating characteristic (ROC) curve was used to evaluate the diagnostic capability of these indices for NAFLD. Differences among the AUCs were calculated and compared by Delong test.
In total, 3095 participants were included in our study among which 1368 adults were diagnosed with NAFLD. All six indices presented positive associations with NAFLD. There was a claw-shaped curve between HOMA-IR, VAI, LAP and NAFLD while a smooth semi-bell curve was observed in TyG, METS-IR and WTI. LAP and HOMA-IR had the best diagnostic capability for NAFLD (LAP: AUC = 0.8, Youden index = 0.48; HOMA-IR: AUC = 0.798, Youden index = 0.472) while VAI (AUC = 0.728, Youden index = 0.361) showed the lowest predictive value. The correlation heat map indicated positive correlations between all six indices and liver function, hepatic steatosis and fibrosis severity. In the NAFLD group, IR indicators presented a stronger association with alanine aminotransferase (ALT) compared with ABO indices.
All six indices can screen NAFLD withLAP and HOMA-IR being possibly optimal predictors. IR indices may be more sensitive to identify acute hepatic injury in NAFLD patients than ABO indices.
非酒精性脂肪性肝病（NAFLD）的患病率在全球范围内呈逐年上升趋势。用于评估疾病风险和严重程度的非侵入性评估工具仍然有限。胰岛素抵抗（IR）和腹型肥胖（ABO）与 NAFLD 密切相关。
本研究基于 2017-2018 年全国健康和营养检查调查（NHANES）的数据进行了回顾性大规模人群研究。分析并比较了三种 ABO 指数（脂堆积产物（LAP）、内脏肥胖指数（VAI）、腰围-甘油三酯指数（WTI））和三种 IR 指数（甘油三酯葡萄糖指数（TyG）、胰岛素抵抗的稳态模型评估（HOMA-IR）和代谢评分胰岛素抵抗（METS-IR）），基于加权多变量逻辑回归、斯皮尔曼相关热图、平滑曲线拟合，探讨它们与 NAFLD 的关系。受试者工作特征（ROC）曲线下面积（AUC）用于评估这些指标对 NAFLD 的诊断能力。通过 Delong 检验计算和比较 AUC 之间的差异。
本研究共纳入 3095 名参与者，其中 1368 名成年人被诊断为 NAFLD。所有 6 项指标均与 NAFLD 呈正相关。HOMA-IR、VAI、LAP 与 NAFLD 之间呈爪形曲线，而 TyG、METS-IR 和 WTI 则呈平滑半钟形曲线。LAP 和 HOMA-IR 对 NAFLD 具有最佳的诊断能力（LAP：AUC=0.8，Youden 指数=0.48；HOMA-IR：AUC=0.798，Youden 指数=0.472），而 VAI（AUC=0.728，Youden 指数=0.361）则具有最低的预测值。相关热图表明，这 6 项指标与肝功能、肝脂肪变性和纤维化严重程度呈正相关。在 NAFLD 组中，IR 指标与丙氨酸氨基转移酶（ALT）的相关性强于 ABO 指标。
这 6 项指标均可筛查 NAFLD，LAP 和 HOMA-IR 可能是最佳预测指标。IR 指标在识别 NAFLD 患者急性肝损伤方面可能比 ABO 指标更敏感。
