Chen Xiaoli, Du Leilei, Peng Jia
Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.
J Glob Health. 2025 Aug 4;15:04249. doi: 10.7189/jogh.15.04249.
Metabolic dysfunction-associated steatotic liver disease (MASLD), primarily driven by insulin resistance (IR), is emerging as a significant public health concern. While the estimated glucose disposal rate (eGDR), a novel marker of IR, could be useful in predicting adverse outcomes in diabetes, its role in MASLD remains unclear.
We used data from the National Health and Nutrition Examination Survey (NHANES) collected from 1999 to 2018, and combined cross-sectional and cohort study designs to explore the associations between eGDR, cardiovascular disease (CVD) outcomes in US adults with MASLD. Here, MASLD was defined using the fatty liver index or hepatic steatosis index along with cardiometabolic risk factors. We applied survey-weighted logistic regression to evaluate CVD prevalence and used Cox proportional hazards models to assess mortality risk. We analysed nonlinear associations between eGDR, CVD, and mortality outcomes using restricted cubic splines. Lastly, we compared the predictive performance of eGDR with traditional IR markers, including the triglyceride-glucose (TyG) index and HOMA-IR, via C-statistics.
Logistic regression and Cox proportional hazards models showed that lower eGDR levels were consistently associated with increased risks of CVD prevalence (P < 0.001) and mortality (P < 0.001), even after adjusting for potential confoundersin both MASLD models. eGDR also outperformed TyG and HOMA-IR in predicting all-cause and CVD mortality (P < 0.001), underscoring its superior prognostic value in MASLD populations (P < 0.001). Moreover, incorporating eGDR into the baseline model significantly enhanced predictive accuracy and reclassification (P < 0.001), further validating its potential to improve risk prediction.
Lower eGDR levels are associated with higher risks of CVD and mortality in MASLD. The eGDR outperforms traditional IR markers in predicting all-cause mortality and improves risk prediction models, highlighting its potential usefulness for clinical risk stratification in MASLD.
代谢功能障碍相关脂肪性肝病（MASLD）主要由胰岛素抵抗（IR）驱动，正成为一个重大的公共卫生问题。虽然估计葡萄糖处置率（eGDR）作为一种新的IR标志物，可能有助于预测糖尿病的不良结局，但其在MASLD中的作用仍不清楚。
我们使用了1999年至2018年美国国家健康与营养检查调查（NHANES）的数据，并结合横断面和队列研究设计，探讨eGDR与美国患有MASLD的成年人心血管疾病（CVD）结局之间的关联。在这里，MASLD是使用脂肪肝指数或肝脂肪变性指数以及心脏代谢危险因素来定义的。我们应用调查加权逻辑回归来评估CVD患病率，并使用Cox比例风险模型来评估死亡风险。我们使用受限立方样条分析eGDR、CVD和死亡结局之间的非线性关联。最后，我们通过C统计量比较了eGDR与传统IR标志物（包括甘油三酯-葡萄糖（TyG）指数和HOMA-IR）的预测性能。
逻辑回归和Cox比例风险模型显示，即使在两个MASLD模型中对潜在混杂因素进行调整后，较低的eGDR水平也始终与CVD患病率增加（P < 0.001）和死亡风险增加（P < 0.001）相关。在预测全因死亡率和CVD死亡率方面，eGDR也优于TyG和HOMA-IR（P < 0.001），强调了其在MASLD人群中的优越预后价值（P < 0.001）。此外，将eGDR纳入基线模型显著提高了预测准确性和重新分类能力（P < 0.001），进一步验证了其改善风险预测的潜力。
较低的eGDR水平与MASLD患者较高的CVD和死亡风险相关。在预测全因死亡率方面，eGDR优于传统IR标志物，并改善了风险预测模型，突出了其在MASLD临床风险分层中的潜在有用性。
