Prediction of MAFLD and NAFLD using different screening indexes: A cross-sectional study in U.S. adults

Central obesity and its association with benign prostatic hyperplasia: insights from a cross-sectional study of NHANES 2001-2008

BACKGROUND

Benign prostatic hyperplasia (BPH) is a common condition that affects elderly men, but its relationship with central obesity in the American population has not been adequately elucidated.

METHODS

In this study, we included a total of 4,625 participants from the National Health and Nutrition Examination Survey (NHANES) database spanning from 2001 to 2008. We calculated indices related to central obesity for each participant and then employed univariate logistic regression, multivariate logistic regression, restricted cubic splines (RCS), and Akaike's Information Criterion (AIC) analysis.

RESULTS

we found that the indices of Weight, Waist Circumference (WC), waist-to-Height Ratio (WHtR), and Body Roundness Index (BRI) were significantly elevated in the BPH group. In terms of dietary intake, we found that the intake of total fat, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, and cholesterol was significantly higher in the BPH group, with polyunsaturated fatty acids and cholesterol meeting the criteria for both univariate and multivariate regression analyses.

CONCLUSION

Weight, WC, WHtR, and BRI can effectively improve the prediction of BPH, which may be associated with the high intake of polyunsaturated fatty acids and cholesterol. Appropriately adjusting the types and total amount of fat intake may prevent the occurrence of prostatic hyperplasia.

Triglyceride glucose waist circumference and non alcoholic fatty liver disease: a systematic review and meta analysis

BACKGROUND

Insulin resistance (IR) plays a noticeable role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). The triglyceride glucose-waist circumference (TyG-WC) index, a novel measure for assessing IR, may hold significant predictive value for NAFLD. However, the relationship between TyG-WC and the risk of NAFLD remains elusive. To investigate this association, this comprehensive meta-analysis was conducted.

METHODS

A systematic electronic search was conducted using the PubMed, Embase, and Web of Science databases from their inception until July 2024 to identify observational studies assessing the relationship between TyG-WC and the risk of NAFLD. Joanna Briggs Institute's critical appraisal checklist was utilized to evaluate the quality of cross-sectional studies, while the Newcastle-Ottawa Scale (NOS) score was used to assess cohort studies. The principal summary outcomes included the mean difference (MD) and the corresponding 95% confidence interval (CI).

RESULTS

In total, 10 studies comprising 38,518 participants were included in this meta-analysis, of whom 37% were diagnosed with NAFLD. The analysis revealed a significant MD between NAFLD and non-NAFLD cases (MD, 137.41; [95% CI, 121.52-153.31]).

CONCLUSION

A significant MD was identified between NAFLD and non-NAFLD cases. The TyG-WC index was found to be positively correlated with the risk of NAFLD, suggesting that it may serve as a potential indicator for NAFLD.

Frequency and risk factors of metabolic associated fatty liver disease among medical students in Egypt

Metabolic (dysfunction) associated fatty liver disease (MAFLD) is a growing global concern. This study assessed the frequency of hepatic steatosis and MAFLD, alongside their associated risk factors, among medical students at Suez University, Egypt. A cross-sectional study was conducted from November 2022 to April 2023 among 84 medical students aged ≥ 18 years. Data on anthropometric parameters, body composition, and lifestyle were collected through self-administered questionnaires, InBody analysis, and FibroScan. MAFLD diagnosis required steatosis (≥ 238 dB/m) with obesity, metabolic dysfunction, or both. Statistical analyses included chi-square tests, ANOVA, and logistic regression. Hepatic steatosis was present in 25% of participants, while MAFLD frequency was 13.1%. Participants with MAFLD exhibited higher body weight (82.34 ± 10.78 kg vs. 65.84 ± 10.61 kg, p < 0.001), BMI (29.05 ± 3.66 vs. 22.90 ± 3.23 kg/m2, p < 0.001), waist circumference (88.73 ± 8.73 cm vs. 78.10 ± 7.96 cm, p < 0.001), BMR (1566.09 ± 27.37 vs. 1429.86 ± 93.44 kcal/day, p < 0.001), and fat mass (32.74 ± 7.25% vs. 23.91 ± 8.60%, p < 0.001). Binary regression analysis revealed increased body weight, BMI, waist circumference, and BMR as significant risk factors for MAFLD. An elevated fat mass percentage with a reduced muscle mass percentage highlighted the sarcopenic obesity role in MAFLD progression. Extreme weight reduction can exacerbate hepatic fat accumulation. Poor sleep quality, a sedentary lifestyle, and an unhealthy diet are also significant predictors. The widespread frequency of steatosis and MAFLD highlights the pressing need to tackle this silent epidemic among young Egyptian adults.

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a predictor of NAFLD prevalence and steatosis severity

Altered lipid metabolism is a crucial jeopardy cause for developing non-alcoholic fatty liver disease (NAFLD). Among various lipid metrics, the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) has recently emerged as a promising indicator showing significant potential in predicting the prevalence of NAFLD. This study aimed to provide novel insights for the prevention of NAFLD by examining the relationship between NHHR and the prevalence of NAFLD. To identify the connection between NHHR and NAFLD, this study utilized descriptive analysis, multivariate logistic regression, and restricted cubic spline regression to investigate data collected by the National Health and Nutrition Examination Survey performed from 2017 to 2020. Furthermore, the connection between NHHR and the controlled attenuation parameter (CAP) was assessed using multiple linear regression, smoothed curve fitting, and threshold effect analysis. The NAFLD group showed higher NHHR levels than the non-NAFLD group (2.990 vs 2.240, P < 0.001). Multiple logistic and linear regression analyses indicated significant positive associations between NHHR and its quartiles with both the prevalence of NAFLD and CAP levels. Additionally, NHHR was positively associated with the prevalence of NAFLD in a linear dose-response relationship. Furthermore, smoothed curve fitting demonstrated a positive relationship between NHHR and CAP, with a threshold effect at an inflection point of 3.398. Higher NHHR levels were significantly associated with the prevalence of NAFLD and steatosis, and maintaining NHHR in the appropriate range may reduce these conditions.

Machine learning-based disease risk stratification and prediction of metabolic dysfunction-associated fatty liver disease using vibration-controlled transient elastography: Result from NHANES 2021-2023

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a common chronic liver disease and represents a significant public health issue. Nevertheless, current risk stratification methods remain inadequate. The study aimed to use machine learning in the identification of significant features and the development of a predictive model to determine its usefulness in discrimination of MAFLD's risk stratification (low, moderate, and high) in adults.

METHODS

The data of the 2021-2023 NHANES database were analyzed. Vibration-controlled transient elastography measurements, including controlled attenuation parameter for the evaluation of steatosis and liver stiffness for the evaluation of fibrosis, were used for risk stratification. The participants were grouped into low-risk, moderate-risk, and high-risk groups based on specific criteria. Feature selection was conducted through Least Absolute Shrinkage and Selection Operator (LASSO) regression and random forest classification.

RESULTS

A total of 4,227 participants were included in the study. There were 16 significant predictors identified by LASSO regression, among which the top 10 predictors were demographic (age, gender, race, hypertension history), clinical (body mass index, waist circumference, hemoglobin, glycohemoglobin, lymphocyte count), and education level. The area under the receiver operating characteristic curve (AUC) of the random forest model in the validation set was 0.80, and the individual AUC was 0.83, 0.66 and 0.79 for the low-, moderate-, and high-risk groups, respectively.

CONCLUSION

Our machine learning model has excellent performance in stratification of risk for MAFLD with readily available clinical and demographic parameters. This model could be employed as a valuable screening tool to refer high-risk patients for further hepatological evaluation.

The association of advanced lung cancer inflammation index with non-alcoholic fatty liver disease in NHANES 2017-2020

Background

The advanced lung cancer inflammation index (ALI) is a composite index that combines inflammation and nutritional status, and non-alcoholic fatty liver disease (NAFLD) is associated with inflammation, nutritional status, and obesity. This study aimed to investigate the possible relationship between ALI and NAFLD.

Methods

We extracted cohort datasets from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) for the study. Weighted analyses and multivariate linear regression models were applied to assess the association between ALI and NAFLD. Fitted curves and threshold effects analyses were used to characterize nonlinear relationships.

Results

A total of 6,595 adults aged 18-80 years were included in this study. In multivariate linear regression analysis, there was a significant positive association between ALI and NAFLD [OR: 1.02, 95% CI (1.01, 1.02)]. In subgroup analyses, this positive association was maintained in females [OR: 1.02, 95% CI (1.01, 1.02)] and not in males. In addition, we found that the association between ALI and NAFLD was nonlinear, with an L-shaped relationship and an inflection point of 32.47. ALI showed a U-shaped association with NAFLD in the male population, with an inflection point of 40.65, and an L-shaped association in the female population, with an inflection point of 30.61.

Conclusion

Our study suggests that there is a significant positive association between high ALI levels and NAFLD prevalence in the US adult population. However, more clinical cohort studies are needed to confirm this finding.

The role of Triglyceride Glucose-Waist Circumference (TyG_WC) in predicting metabolic dysfunction-associated steatotic liver disease among individuals with hyperuricemia

BACKGROUND/AIMS

The incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) among individuals with hyperuricemia is significantly high. The aim of this study was to identify effective biomarkers for the detection of MASLD among patients with hyperuricemia.

METHOD

We conducted an analysis involving 3424 participants with hyperuricemia from the National Health and Nutrition Examination Survey (1999-2020). To identify potential significant variables, we employed Boruta's algorithm, SHapley Additive exPlanations (SHAP) and random forests. Multivariable logistic regression models were utilized to assess the odds ratio (OR) of developing MASLD. To evaluate the accuracy and clinical value of our prediction model, we employed receiver operating characteristic (ROC) curves and decision curve analysis (DCA) curves.

RESULTS

Among the study population of 3424 participants (mean [SD] age, 54 [20] years, 1788 [52.22%] males) with hyperuricemia, 1670 participants had MASLD. Using Boruta's algorithm, SHAP and random forests, our analysis suggested that Triglyceride Glucose-Waist Circumference (TyG_WC) was one of the most significant variables in predicting MASLD risk, with an area under the receiver operating characteristic (AUROC) of 0.865. The restricted curve spline (RCS) revealed a positive association between the odds ratio of TyG_WC and MASLD, when compared with lowest quantile of TyG_WC, the risk of MASLD for highest quantile was 137.96 times higher. The predictive strategy incorporating TyG_WC notably enhanced the clinical model, with threshold probabilities spanning from approximately 0% to 100%, resulting in a significant improvement of the net benefit.

CONCLUSIONS

Our analysis found that TyG_WC was one of the most significant variables in predicting MASLD risk among individuals with hyperuricemia.

Association between cumulative average triglyceride glucose-body mass index and the risk of CKD onset

Background

Chronic kidney disease (CKD) has become a significant global public health challenge, which was reported to be highly correlated with the triglyceride glucose-body mass index (TyG-BMI). Nevertheless, literature exploring the association between changes in the TyG-BMI and CKD incidence is scant, with most studies focusing on individual values of the TyG-BMI. We aimed to investigate whether cumulative average in the TyG-BMI were associated with CKD incidence.

Methods

Data in our study were obtained from the China Health and Retirement Longitudinal Study (CHARLS), which is an ongoing nationally representative prospective cohort study. The exposure was the cumulative average TyG-BMI from 2011 to 2015. The TyG-BMI was calculated by the formula ln [TG (mg/dl) × FBG (mg/dl)/2] × BMI (kg/m2), and the cumulative average TyG-BMI was calculated as follows: (TyG-BMI2011+ TyG-BMI2015)/2. Logistic regressions were used to determine the association between different quartiles of cumulative average TyG-BMI and CKD incidence. Meanwhile, restricted cubic spline was applied to examine the potential nonlinear association of the cumulative average TyG-BMI and CKD incidence. In addition, subgroup analysis was used to test the robustness of results.

Results

Of the 6117 participants (mean [SD] age at baseline, 58.64 [8.61] years), 2793 (45.7%) were men. During the 4 years of follow-up, 470 (7.7%) incident CKD cases were identified. After adjusting for potential confounders, compared to the participants in the lowest quartile of cumulative average TyG-BMI, participants in the 3rd and 4th quartile had a higher risk of CKD onset. The ORs and 95%CIs were [1.509(1.147, 1.990)] and [1.452(1.085, 1.948)] respectively. In addition, restricted cubic spline showed the cumulative average TyG-BMI had a liner association (p-nonlinear = 0.139).

Conclusions

The cumulative average in the TyG-BMI was independently associated with the risk of CKD in middle-aged and older adults. Monitoring long-term changes in the TyG-BMI may assist with the early identification of individuals at high risk of CKD.

Serum manganese and its association with non-alcoholic fatty liver disease: findings from NHANES

Objective

This study examines the link between serum manganese (Mn) levels and non-alcoholic fatty liver disease (NAFLD), with a focus on gender differences.

Methods

Utilizing data from the NHANES 2017-2018, we included participants aged 18 and older, excluding those without ultrasonic liver assessment, serum Mn data, or with hepatitis or significant alcohol use. The final analysis comprised 4,294 individuals, with 2,708 in the NAFLD group and 1,586 in the non-NAFLD group. Serum Mn was quantified via inductively coupled plasma mass spectrometry. We compared demographic and health-related variables between groups using appropriate statistical tests and categorized participants into quartiles based on Mn levels. Multivariate logistic regression and spline regression analyses were conducted to evaluate the association between serum Mn and NAFLD risk by gender.

Results

Serum Mn was significantly elevated in the NAFLD group compared to non-NAFLD individuals (9.06 vs. 9.33 μg/L, Z = 2.815, p = 0.005). After adjustments, males in the third Mn quartile showed a higher NAFLD risk (OR = 1.575; 95% CI: 1.193-2.087), while females in the fourth quartile also had increased risk (OR = 1.725; 95% CI: 1.313-2.269), both compared to the first quartile (p < 0.01). A positive dose-response relationship was found for both genders (P for trend <0.01), with nonlinear associations in males (P for nonlinearity <0.01) and linear associations in females (P for nonlinearity = 0.818). Significant interactions with ethnicity in males and hypertension in females were also noted.

Conclusion

Higher serum Mn levels are significantly associated with increased NAFLD risk in both genders, highlighting the need for gender-specific considerations in future studies and clinical practices.

Association between the indicators of insulin resistance and periodontitis: a study using data from the National Health and Nutrition Examination Survey 2009-2014

BACKGROUND

The rising obesity rates are accompanied by an increasing prevalence of insulin resistance (IR) associated with obesity. To ascertain the best index for replacing IR, this study aimed to investigate the possible association between IR, which was assessed using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and the triglyceride-glucose (TyG) index and its derived indexes and periodontitis.

METHODS

The association between the indicators of IR and periodontitis was assessed via multivariate-adjusted logistic regression analyses using data from the National Health and Nutrition Examination Survey (NHANES) 2009-2014. In addition, subgroup analyses and receiver operating characteristic curve analyses were conducted to explore possible influencing factors.

RESULTS

Our study encompassed 1,588 participants, and 41.0% were diagnosed with periodontitis. Based on the multivariate logistic regression analysis, a higher TyG-waist-to-height ratio (WHtR) (odds ratio [OR] = 1.14, 95% confidence interval [CI]: 1.02-1.27, P = 0.0244) and HOMA-IR score (OR = 1.00, 95% CI: 1.00-1.00, P = 0.0028) were associated with an increased risk of periodontitis. Conversely, the TyG index, TyG-adjusted for body mass index, and TyG-adjusted for waist circumference (WC) were not associated with periodontitis. According to further subgroup analyses and interaction result analyses, sex affected the association between the TyG index, TyG-WC, and TyG-WHtR and periodontitis (P < 0.05 for interaction). Moreover, the influence of age regulated the association between periodontitis and both TyG and HOMA-IR score. In terms of diagnostic accuracy, the area under the receiver operating characteristic curve analysis revealed that HOMA-IR score and TyG-WHtR slightly outperformed the TyG index, TyG-body mass index, and TyG-WC. Thus, they can be robust markers for assessing IR-related periodontitis risk.

CONCLUSION

A consistent and positive association was found between HOMA-IR score and TyG-WHtR and the odds of periodontitis prevalence. Hence, HOMA-IR score and TyG-WHtR were significantly associated with periodontitis in this cross-sectional study. However, prospective studies are needed to determine whether higher TyG-waist-to-height ratio and HOMA-IR score can predict the occurrence of periodontitis.

Expression and clinical significance of serum lncRNA H19 in patients with metabolic dysfunction-associated fatty liver disease

Long non-coding RNA H19 (lncRNA H19) plays an important role in lipid metabolism, however, its relationship with metabolic dysfunction-associated fatty liver disease (MAFLD) remains unclear. The aim of this study is to investigate the expression and clinical significance of serum lncRNA H19 in patients with MAFLD. This study enrolled patients with MAFLD and a control group of healthy subjects from January 2023 to March 2024. The serum levels of lncRNA H19 were quantified using real-time quantitative polymerase chain reaction. The serum levels of lncRNA H19 in patients with MAFLD were significantly higher compared to the control group (P < .05). Moreover, there was a positive correlation between serum lncRNA H19 and body mass index, triglyceride, total cholesterol (TC), low-density lipoprotein cholesterol, fasting blood glucose and uric acid (all P < .05). Conversely, a negative correlation was observed between serum lncRNA H19 and high-density lipoprotein cholesterol (HDL-C; P = .009). Additionally, significant positive associations were found between serum lncRNA H19 and alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase and liver stiffness measurement(all P < .05). The optimal cutoff value of serum lncRNA H19 for diagnosing MAFLD was 1.15, with an area under the curve of the receiver operating characteristic curve of 0.83, and the sensitivity and specificity were observed to be 87.7% and 72.5%, respectively. The lncRNA H19 exhibits associations with metabolic risk factors, liver function, and liver fibrosis, and can serve as a potential diagnostic biomarker for MAFLD.

The Value of TyG-Related Indices in Evaluating MASLD and Significant Liver Fibrosis in MASLD

Background: Triglyceride glucose (TyG) and its related index (TyG-body mass index, TyG-BMI) are recognized as markers for nonalcoholic fatty liver disease (NAFLD), but their associations with metabolic dysfunction-associated steatotic liver disease (MASLD) and significant liver fibrosis (SLF) risk are less studied. Therefore, this study explores the effectiveness of these indices in assessing MASLD and SLF risk in the U.S. population. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional study involving 5520 participants from the general population was performed. This research measured demographic, anthropometric, biochemical, comorbid, and lifestyle characteristics, all of which are considered risk factors for MASLD/SLF. Results: Upon controlling for confounding variables, only the TyG-BMI was found to have a consistent positive association with the risk of MASLD and SLF. Specifically, for each standard deviation increase, the odds ratio (OR) and 95% confidence interval (CI) were 4.44 (3.64-9.26, p for trend < 0.001) for MASLD and 2.48 (2.15-2.87, p for trend < 0.001) for SLF. Significant interactions were identified among age, sex, and the risk of MASLD associated with the TyG-BMI. The TyG-BMI also had a significant threshold effect on the risk of MASLD at a cutoff point of 180.71. Furthermore, the area under the receiver operating characteristic curve (AUC) revealed that the TyG-BMI better predicted the risk of MASLD and SLF (AUC 0.820, 95% CI 0.810-0.831; AUC 0.729, 95% CI 0.703-0.756, respectively). In addition, the integrated discrimination improvement (IDI), decision curve analysis (DCA), and net reclassification index (NRI) also demonstrated the satisfactory predictive ability of the TyG-BMI. Conclusions: Within this large dataset, the TyG-BMI was independently associated with both the MASLD score and the SLF in the MASLD cohort. Its predictive efficacy consistently surpassed that of TyG and other noninvasive models, indicating that TyG-BMI has potential for the early identification of MASLD and SLF risk.

There is a linear negative correlation between lipoprotein(a) and non-alcoholic fatty liver disease

This study aimed to investigate the relationship between lipoprotein(a) [Lp(a)] levels and non-alcoholic fatty liver disease (NAFLD), and to analyze its linear association and subgroup differences. This cross-sectional analysis was based on data from 2308 participants in the National Health and Nutrition Examination Survey (NHANES) III. Multivariate logistic regression models were used to assess the association between Lp(a) and NAFLD, adjusting for demographic factors, lifestyle behaviors, comorbidities, and biomarkers. Subgroup analyses were conducted based on age, sex, body mass index (BMI), diabetes, and hypertension. Restricted cubic spline (RCS) regression model was used to explore the nonlinear relationship between Lp(a) and NAFLD. Higher Lp(a) levels were significantly associated with a lower risk of NAFLD. In the fully adjusted model, compared to the lowest quartile group (Q1), the third and fourth quartiles (Q3 and Q4) had significantly reduced risks of NAFLD [Q3: OR = 0.701, 95% CI 0.511, 0.961; P = 0.027; Q4: OR = 0.605, 95% CI 0.438, 0.835; P = 0.002]. Subgroup analysis showed that the association between higher Lp(a) levels and reduced NAFLD risk was significant in individuals aged 50 years and older, those with BMI ≥ 30 kg/m2, non-diabetics, and those with hypertension. RCS analysis further confirmed a linear negative association between Log10Lp(a) and NAFLD risk (P = 0.029, P nonlinearity = 0.888). There is a significant linear negative association between Lp(a) levels and the risk of NAFLD, suggesting that Lp(a) may serve as a potential biomarker for assessing NAFLD risk.

Triglyceride/Glucose Index combined with Anthropometric Parameters: A Promising Tool for Screening NAFLD in Patients with Psoriasis

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is one of the most frequent causes of liver disease in our region, with a strong association with metabolic factors, such as obesity and diabetes. Recent studies reported that NAFLD was 1.5-3 times more common in psoriatic patients.

OBJECTIVES

To calculate the diagnostic validity parameters of the triglyceride/glucose (TyG) index, and its combination with anthropometric parameters [body mass index (BMI), waist circumference (WC), and waist-to-heigh ratio (WHR)], as a non-invasive method for detecting NAFLD in patients with moderate-to-severe psoriasis.

METHODS

We conducted a cross-sectional and single-center study with 149 patients with moderate-to-severe psoriasis. The ROC curves and the area under the curve (AUC) were calculated for the TyG index along with different anthropometric measures, using transient elastography as the reference test. The optimal cut-off point was calculated using Youden's index.

RESULTS

The prevalence of NAFLD was 64%. A total of 18% of these patients had significant liver fibrosis. The TyG index with anthropometric parameters showed a significant association with liver steatosis (P<.001). The TyG-BMI, TyG-WC, and TyG-WHR indices all showed an AUC>.83, while the TyG-BMI showed the highest AUC (0.852). Results were consistent in sex-based analyses.

CONCLUSIONS

The TyG index with anthropometric parameters -especially BMI- is an effective method for the initial screening of NAFLD in psoriatic patients.

Association Between Triglyceride-Glucose Related Index and Endometriosis Varies According to Educational Level

BACKGROUND

The association between the triglyceride-glucose (TyG) level, its obesity-related derivatives, and the occurrence of endometriosis (EMS) remains ambiguous, particularly in individuals with higher levels of education. This study sought to explore the relationship between TyG, its obesity-related derivatives, and EMS across various educational backgrounds.

METHODS

This study utilized a substantial dataset obtained from four cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2006. To explore the relationship between TyG, its obesity-related derivatives, and EMS, we employed a variety of analytical methods, including multivariable logistic regression models, smooth curve fitting, threshold effect analysis, and subgroup analysis, which were applied to participants with varying educational levels.

RESULTS

Among the 2347 participants, 203 (8.65%) were diagnosed with EMS. In the overall population, only the TyG, TyG-waist-to-height ratio (TyG-WHtR), and TyG-waist circumference (TyG-WC) variables demonstrated a positive association with EMS. However, within the group with high educational attainment, TyG, TyG-WHtR, TyG-WC, and TyG-body mass index (TyG-BMI) all exhibited positive correlations with EMS. These associations remained robust after adjustment for multiple potential confounding variables. The subgroup analysis demonstrated that these associations were consistent across different subgroups (p > 0.05). Furthermore, both linear and nonlinear relationships were observed between TyG and its obesity-related derivatives and EMS, as evidenced by the smooth curve fittings and threshold effect analyses. In contrast, no significant associations were identified in the group with lower levels of education.

CONCLUSIONS

Our study suggests that there is variation in the association between TyG and its obesity-related derivatives and EMS across different educational levels, warranting further investigation. In individuals with higher education, elevated levels of TyG and its obesity-related derivatives were associated with a higher prevalence of EMS. Conversely, this correlation was not observed among those with lower educational levels.

Development and validation of machine learning models for MASLD: based on multiple potential screening indicators

Background

Multifaceted factors play a crucial role in the prevention and treatment of metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to utilize multifaceted indicators to construct MASLD risk prediction machine learning models and explore the core factors within these models.

Methods

MASLD risk prediction models were constructed based on seven machine learning algorithms using all variables, insulin-related variables, demographic characteristics variables, and other indicators, respectively. Subsequently, the partial dependence plot(PDP) method and SHapley Additive exPlanations (SHAP) were utilized to explain the roles of important variables in the model to filter out the optimal indicators for constructing the MASLD risk model.

Results

Ranking the feature importance of the Random Forest (RF) model and eXtreme Gradient Boosting (XGBoost) model constructed using all variables found that both homeostasis model assessment of insulin resistance (HOMA-IR) and triglyceride glucose-waist circumference (TyG-WC) were the first and second most important variables. The MASLD risk prediction model constructed using the variables with top 10 importance was superior to the previous model. The PDP and SHAP methods were further utilized to screen the best indicators (including HOMA-IR, TyG-WC, age, aspartate aminotransferase (AST), and ethnicity) for constructing the model, and the mean area under the curve value of the models was 0.960.

Conclusions

HOMA-IR and TyG-WC are core factors in predicting MASLD risk. Ultimately, our study constructed the optimal MASLD risk prediction model using HOMA-IR, TyG-WC, age, AST, and ethnicity.

Association between the triglyceride-glucose index and liver fibrosis in adults with metabolism-related fatty liver disease in the United States: a cross-sectional study of NHANES 2017-2020

OBJECTIVE

This study aimed to examine the association between the triglyceride-glucose (TyG) index and liver fibrosis (LF) in U.S. adults with Metabolic Dysfunction-Associated Steatotic Liver Disease (MAFLD).

METHODS

Using data from the 2017 to 2020 National Health and Nutrition Examination Survey (NHANES) database, we conducted a population-based cross-sectional study with 1,324 participants. MAFLD was defined as a controlled attenuation parameter (CAP) score ≥ 248 dB/m accompanied by metabolic dysfunction. A median liver stiffness measurement ≥ 8.2 kPa was used to identify significant fibrosis (≥ F2). Multivariable logistic regression was employed to assess the impact of the TyG index on LF outcomes. A restricted cubic spline (RCS) model was used to explore nonlinear effects, and receiver operating characteristic (ROC) curves were applied to evaluate the effectiveness in predicting.

RESULTS

Among the participants, 716 were men and 608 were women, aged 20 to 80 years, representing various racial groups. Significant fibrosis was observed in 137 out of 1,324 participants. After adjusting for confounding factors, a higher TyG index was significantly associated with an increased incidence of MAFLD-related LF (OR = 2.18, 95% CI, 1.14-4.18; p < 0.05). Elevated TyG levels showed a positive correlation with significant fibrosis, with an odds ratio (OR) exceeding 1 when the TyG index was above 8.054. Subgroup analyses stratified by sex, age, and body mass index (BMI) revealed differences after adjusting for confounders. The association was stronger in women (OR = 2.53, 95% CI, 1.16-5.53) than in men (OR = 1.95, 95% CI, 0.81-4.72). A significant correlation was also found between TyG levels and obesity status (overweight: OR = 4.80, 95% CI, 1.27-18.2; obese: OR = 2.26, 95% CI, 1.20-5.53). In MAFLD patients aged 40-59, TyG was strongly associated with LF (OR = 2.85, 95% CI, 1.16-6.79). Furthermore, the area under the ROC curve (AUC) for the TyG index in predicting significant fibrosis in MAFLD patients was 0.73 (95% CI, 0.68-0.78), indicating moderate predictive ability.

CONCLUSIONS

In the general U.S. population, elevated TyG index levels were positively associated with an increased risk of LF in MAFLD patients.

Evaluating body roundness index and systemic immune inflammation index for mortality prediction in MAFLD patients

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a major cause of liver-related morbidity and mortality, contributing to both cardiovascular and non-cardiovascular deaths. The Body Roundness Index (BRI) and Systemic Immune-Inflammation Index (SII) have emerged as predictors of adverse outcomes in metabolic diseases. This study investigates the association between BRI, SII, and mortality risk in MAFLD patients. A nationwide retrospective cohort study was conducted using data from the NHANES database (January 1999-December 2018), including patients diagnosed with MAFLD. BRI and SII were calculated at baseline. Cox proportional hazards models assessed the association between these indices and all-cause, cardiovascular, and non-cardiovascular mortality, adjusting for confounders. Among 12,435 participants diagnosed with MAFLD, 3,381 (27.2%) were classified into the low BRI and low SII group, 2,889 (23.2%) into the low BRI and high SII group, 2,802 (22.5%) into the high BRI and low SII group, and 3,363 (27.1%) into the high BRI and high SII group. Compared to the low BRI and low SII group, the high BRI and high SII group demonstrated significantly higher all-cause mortality, with an adjusted hazard ratio (HR) of 1.89. For cardiovascular mortality, the HR was 2.31, while for non-cardiovascular mortality, the HR was 1.78. The high BRI and high SII cohort exhibited the highest risk of all-cause mortality, cardiovascular mortality, and non-cardiovascular mortality. BRI and SII are independent predictors of mortality in MAFLD patients, and their combined use enhances risk stratification. Integrating these indices into clinical practice could improve personalized management strategies and outcomes in this high-risk population.

Correlation analysis of the triglyceride-glucose index and related parameters in metabolic dysfunction-associated fatty liver disease

This study aimed to investigate the correlation and predictive value of TyG and related parameters with metabolic dysfunction-associated fatty liver disease (MAFLD) MAFLD. This study retrospectively included individuals who underwent health examinations and abdominal ultrasound from July 2021 to June 2024 at the Affiliated Hospital of Southwest Medical University, Sichuan Province, China. A total of 71,299 subjects' clinical and laboratory data were extracted, the correlation between TyG and related parameters and MAFLD was analyzed via univariate and multivariate logistic regression methods, and the nonlinear relationship between the TyG index and the risk of MAFLD was explored via restricted cubic spline (RCS) analysis. The predictive value of TyG and related parameters for MAFLD was assessed using the receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). TyG and related parameters were positively correlated with MAFLD, and the results remained unchanged after adjustment for the corresponding parameters. RCS analysis revealed a significant dose‒response relationship between TyG and related parameters and MAFLD. ROC curve analysis revealed AUC values of 0.83 (0.82-0.83), 0.92 (0.91-0.92), 0.90 (0.90-0.91), and 0.87 (0.87-0.88) for TyG, TyG-BMI, TyG-WC, and TyG-WHR, respectively. Subgroup analyses revealed that the TyG index and related parameters had greater predictive value in the female, younger, and BMI < 23.7 populations.

Synergistic Beneficial Effects of Flaxseed (Linum usitatissimum L.) Oil and Olive (Olea europaea L.) Oil Against Metabolic Dysfunction Associated Fatty Liver and Its Complications

Flaxseed and olive oil effectively treat numerous diseases and health conditions, particularly metabolic disorders. Traditional medicine has used both oils for managing cardiovascular disease, diabetes, gastrointestinal dysfunctions, metabolic-dysfunction-associated fatty liver disease (MAFLD), obesity, and more. This review explores the bioactive and polyphenolic compounds in flaxseed and olive oils that provide anti-inflammatory, antioxidant, anti-microbial, hepatoprotective, cardioprotective, antidiabetic, and gastroprotective benefits. Flaxseed oil contains beneficial compounds like alpha-linolenic acid (ALA), lignans, ferulic acid, p-coumaric acid, and phytosterols. It contributes to its therapeutic effects on fatty liver disease and other conditions. Olive oil contains phenolic compounds, including oleic acid, hydroxytyrosol, and tocopherols, which are similarly linked to metabolic health benefits, especially in managing MAFLD. The purpose of this review is to elucidate the mechanisms of action of these bioactive compounds, highlighting their potential in managing various metabolic diseases.

Diagnostic accuracy of Fatty Liver Index (FLI) for detecting Metabolic Associated Fatty Liver Disease (MAFLD) in adults attending a tertiary care hospital, a cross-sectional study

BACKGROUND

Metabolic-associated fatty liver disease (MAFLD) is a major public health problem worldwide. This study aimed to determine the prevalence of MAFLD and evaluate the diagnostic accuracy of the Fatty Liver Index (FLI) compared to ultrasonography for detecting fatty liver in adults attending a tertiary care hospital in Gujarat, India.

METHODS

This cross-sectional study included 500 adults visiting the outpatient department between January 2023 and December 2023. MAFLD was diagnosed on ultrasound. FLI was calculated using body mass index, waist circumference, triglycerides, and gamma-glutamyl transpeptidase levels. FLI ≥ 60 indicated fatty liver. Logistic regression analysis identified factors associated with fatty liver.

RESULTS

MAFLD prevalence was 32.2% on ultrasound. High FLI (≥ 60) was present in 26.2%. Male sex, higher BMI, waist circumference, night shift work, diabetes, and triglycerides were independent predictors of fatty liver. FLI showed excellent diagnostic accuracy with a sensitivity of 96%, specificity of 92.5%, and AUC of 0.92 for detecting fatty liver on ultrasound.

CONCLUSION

MAFLD prevalence among adults was high in this hospital-based sample. FLI can serve as an accurate non-invasive tool for identifying individuals with a high probability of MAFLD. These findings emphasize the need for larger population-based studies and the implementation of regular MAFLD screening programs in high-risk groups.

The Different Predictive Effects of Multiple Body Fat Indexes on Metabolic Dysfunction-Associated Fatty Liver Disease

Purpose

The aim of this study was to comprehensively compare the predictive effect of 10 body fat indexes on MAFLD in different sex, age and BMI subgroups.

Patients and Methods

A total of 5403 physical examination data were included and divided into the MAFLD group (N=2632) and non-MAFLD group (N=2771). The differences and correlation of 10 promising indicators between the two groups were compared, including fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation product (LAP), visceral fat index (VAI), cardiometabolic index (CMI), body adiposity index (BAI), and triglyceride-glucose index (TyG), waist circumference index (WC), body mass index (BMI), waist to height ratio (WHtR). Logistic regression was used to analyze the risk of MAFLD under different adjustment conditions. The operating characteristic curve of different genders, BMI levels and age subgroups was plotted.

Results

Male gender, smoking, alcohol drinking, and higher age are risk factors for MAFLD. In addition to BAI, the other 9 indicators had a high correlation with MAFLD, the area under the curve (AUC) value was >0.7, and the prediction effect was better in females, BMI<24 kg/m2, age <35 years subgroup, among which FLI (AUC: 0.912, 95% CI: 0.905-0.920), LAP (AUC: 0.894, 95% CI: 0.8866-0.903), and HSI (AUC: 0.881, 95% CI: 0.872-0.890) have better prediction effects.

Conclusion

Our study confirmed the accuracy of body fat-related indexes in predicting MAFLD in people of different sexes, ages, and BMI levels. Among them, FLI, LAP and HSI have high predictive value and can be utilized as simple and cost-effective tools for screening MAFLD in clinical settings.

Lipid accumulation product, poverty income ratio, and bone mineral density in U.S. adults: a mediation analysis based on NHANES (2009-2020)

Objective

This study aims to investigate the relationship between the lipid accumulation product (LAP) index and total femur bone mineral density (BMD), while also examining the mediating role of the poverty-income ratio (PIR).

Methods

Using the most recent data from the National Health and Nutrition Examination Survey (NHANES) spanning 2009 to 2020, multivariate logistic regression models were employed in this study to investigate the relationship between the LAP index and total femur BMD. Saturation effects and potential non-linear associations were examined using a smooth curve-fitting approach to determine saturation levels. Interaction tests and subgroup analyses were also performed. Additionally, a mediation analysis was conducted to explore the mediating role of PIR.

Results

Three thousand two hundred and twenty three participants aged 20 years or older were recruited for this study. Multivariate regression analysis demonstrated a greater total femur BMD in individuals with a high LAP index. Additionally, analysis of the saturation effect and smooth curve fitting identified a clear saturation effect between the LAP index and total femur BMD. A saturation value of 16.05 was determined when investigating the relationship between the LAP index and total femur BMD. Subgroup analysis revealed no significant interaction effects after adjusting for covariates. Moreover, mediation analysis indicated that the LAP index had a substantial direct effect on total femur BMD (p < 0.0001), with PIR partially mediating this relationship (1.115%, p = 0.0280).

Conclusion

The results of this investigation demonstrated a saturation effect between the LAP index and total femur BMD, which may have been mediated by PIR.

Association between severe headache or migraine and lipid accumulation product and visceral adiposity index in adults: a cross-sectional study from NHANES

BACKGROUND

Existing literature on the impact of lipid accumulation product (LAP) and visceral adiposity index (VAI) on severe headache or migraine is limited. This study aims to elucidate the association between LAP and VAI and the prevalence of migraine.

METHODS

Data for this study were sourced from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). A database-self-administered questionnaire was used to assess severe headache or migraine. A weighted logistic regression model was employed to assess the relationship between LAP and VAI with migraine prevalence. Complementary analytical approaches included subgroup analysis, restricted cubic spline (RCS), and threshold effect analysis to validate the findings.

RESULTS

In the end, 4572 people were recruited for the research, including 880 with migraine and 3692 without migraine. Following adjustment for the relevant covariables, weighted logistic regression analysis (OR = 1.409, 95% CI: 1.054, 1.883, P = 0.022; OR = 1.288, 95% CI: 1.010, 1.642, P = 0.042) revealed significantly elevated odds of migraine prevalence in participants within the highest tertile (T3) of LAP and VAI than those in the lowest tertile (T1). The nonlinear association between migraine prevalence and both VAI and LAP was further elucidated through a restricted cubic spline. The threshold analysis pinpointed 2.142 (log-likelihood ratio = 0.016) as the critical inflection point for VAI. Subgroup analysis and interaction testing revealed the significant association was independent in different subgroup factors.

CONCLUSIONS

The data indicate a robust association between higher levels of LAP and VAI and an increased prevalence of migraine.

Development and validation of a machine learning-based framework for assessing metabolic-associated fatty liver disease risk

BACKGROUND

The existing predictive models for metabolic-associated fatty liver disease (MAFLD) possess certain limitations that render them unsuitable for extensive population-wide screening. This study is founded upon population health examination data and employs a comparison of eight distinct machine learning (ML) algorithms to construct the optimal screening model for identifying high-risk individuals with MAFLD in China.

METHODS

We collected physical examination data from 5,171,392 adults residing in the northwestern region of China, during the year 2021. Feature selection was conducted through the utilization of the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Additionally, class balancing parameters were incorporated into the models, accompanied by hyperparameter tuning, to effectively address the challenges posed by imbalanced datasets. This study encompassed the development of both tree-based ML models (including Classification and Regression Trees, Random Forest, Adaptive Boosting, Light Gradient Boosting Machine, Extreme Gradient Boosting, and Categorical Boosting) and alternative ML models (specifically, k-Nearest Neighbors and Artificial Neural Network) for the purpose of identifying individuals with MAFLD. Furthermore, we visualized the importance scores of each feature on the selected model.

RESULTS

The average age (standard deviation) of the 5,171,392 participants was 51.12 (15.00) years, with 52.47% of the participants being females. MAFLD was diagnosed by specialized physicians. 20 variables were finally included for analyses after LASSO regression model. Following ten rounds of cross-validation and parameter optimization for each algorithm, the CatBoost algorithm exhibited the best performance, achieving an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.862. The ranking of feature importance indicates that age, BMI, triglyceride, fasting plasma glucose, waist circumference, occupation, high density lipoprotein cholesterol, low density lipoprotein cholesterol, total cholesterol, systolic blood pressure, diastolic blood pressure, ethnicity and cardiovascular diseases are the top 13 crucial factors for MAFLD screening.

CONCLUSION

This study utilized a large-scale, multi-ethnic physical examination data from the northwestern region of China to establish a more accurate and effective MAFLD risk screening model, offering a new perspective for the prediction and prevention of MAFLD.

Association between different triglyceride glucose index-related indicators and depression in premenopausal and postmenopausal women: NHANES, 2013-2016

BACKGROUND AND AIM

The association between the Triglyceride-glucose (TyG) index and depression has been observed, yet its confirmation within peri- and postmenopausal demographics remains elusive. Consequently, the principal aim of this investigation is to explore the nexus between TyG-related indicators and depressive symptoms among pre- and postmenopausal women.

METHODS

The data utilized in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) conducted from 2013 to 2016. The patients were divided into three groups based on TyG, Triglyceride-Glucose-Body Mass Index (TyG-BMI), Triglyceride-Glucose-Waist Circumference (TyG-WC), and Triglyceride-Glucose-Waist-to-Height Ratio (TyG-WHtR): Q1 (1st quintile), Q2 (2nd quintile), and Q3 (3rd quintile). Further exploration of the differences between these groups was conducted. Employing logistic regression, stratified analysis, restricted cubic splines, and subgroup analyses, we scrutinized the correlation between TyG-related indicators and depressive symptoms in both premenopausal and postmenopausal women. Furthermore, sensitivity analyses were conducted to assess the durability and uniformity of this relationship.

RESULTS

In premenopausal women, there was a consistent independent positive correlation between TyG-BMI, TyG-WC, and TyG-WHtR with depressive symptoms across all three models, while TyG itself did not show a significant association. In Models 1 and 2, TyG-BMI exhibited a higher odds ratio (OR) value than the other two indicators [Model 1, Q3 OR (95 % confidence interval, CI) = 3.37 (1.91-5.94); Model 2, Q3 OR (95 % CI) = 3.03 (1.67-5.52)]. In Models 3, TyG-WHtR demonstrates a more significant association with depressive symptoms [Model 3, Q3 OR (95 % CI) = 2.85 (1.55-5.27)]. This correlation does not manifest in menopausal women.

CONCLUSIONS

In premenopausal women, TyG-BMI, TyG-WC, and TyG-WHtR exhibited a positive and linear relationship with depressive symptoms. Furthermore, the analysis revealed that the combined measures of TyG-BMI, TyG-WC, and TyG-WHtR offered greater precision and sensitivity in assessing this association compared to TyG alone.

Association between serum selenium and non-alcoholic fatty liver disease: Results from NHANES: An observational study

Non-alcoholic fatty liver disease (NAFLD) encompasses a broad spectrum of diseases and stands as the second most prevalent liver disorder in the 21st century. Advanced hepatic fibrosis (AHF) is a crucial indicator of the progression of NAFLD. Selenium (Se) is an indispensable trace element for human physiology; however, excessive intake can lead to poisoning and detrimental effects. Notably, males exhibit significantly higher serum Se levels compared to females. To investigate the correlation between serum Se levels and the prevalence of NAFLD and AHF across different genders. Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, 7271 participants were included. Through descriptive analysis, multivariable logistic regression, subgroup analysis, interaction, and restricted cubic spline regression analysis, the relationship between serum Se levels and the prevalence of NAFLD and AHF was investigated. serum Se levels were significantly higher in both male and female NAFLD groups compared to the non-NAFLD groups (Males: 187.570 vs 183.300, Z = -16.169, P < .001; Females: 184.780 vs 180.130, Z = -4.102, P < .001). After adjusting for confounders, an increase in one quartile of serum Se was associated with a 17.60% increase in NAFLD prevalence in males (OR, 1.176; 95% CI: 1.052-1.315) and a 38.50% decrease in AHF prevalence (OR, 0.615; 95% CI: 0.479-0.789). In females, each quartile increase in serum Se was associated with a 29.10% increase in NAFLD prevalence (OR,1.291;95%CI: 1.155-1.442) and a 51.60% decrease in AHF prevalence (OR, 0.484; 95% CI: 0.344-0.682). serum Se levels are positively correlated with the prevalence of NAFLD and negatively correlated with the prevalence of AHF in both males and females.

Predictive Value of the Chinese Visceral Adiposity Index for Metabolic Dysfunction-Associated Fatty Liver Disease and Elevated Alanine Aminotransferase Levels in Nonobese Chinese Adults: A Cross-Sectional Study

PURPOSE

It is unclear how the Chinese Visceral Adiposity Index (cVAI) relates to metabolic dysfunction-associated fatty liver disease (MAFLD) and alanine aminotransferase (ALT) in nonobese individuals. In this study, we evaluated the ability of the cVAI to predict MAFLD and elevated ALT in nonobese participants.

METHODS

This cross-sectional study recruited 541 nonobese subjects from March 2019 to January 2022 with the age range of 18-80 years. Hepatic steatosis was diagnosed by ultrasound. Participants were divided into four groups according to cVAI quartiles. To assess the associations between cVAI and MAFLD and elevated ALT, multivariate logistic regression was used. Receiver operating characteristic (ROC) curves were generated to evaluate the ability of the cVAI to predict MAFLD and elevated ALT.

RESULTS

Compared to the group with the lowest cVAI, the group with the highest cVAI was positively associated with nonobese MAFLD [16.173 (4.082-64.073), P < 0.001] and elevated ALT [8.463 (2.859-25.049), P < 0.001]. The area under the ROC curve (AUC) of the cVAI was greater than that of WC, waist-to-height ratio, or BMI for predicting nonobese MAFLD in the male, female, > 38 and ≤ 38 years old subgroups (P < 0.05), respectively. In addition, the ability of the cVAI to predict MAFLD was better in females, young individuals, and individuals with a higher education level (P < 0.05). The cVAI also had good predictive ability for elevated ALT levels [0.655 (0.602-0.708)], particularly in females, young people, and highly educated participants. Furthermore, the cVAI was strongly positively correlated with the liver fibrosis score (P < 0.05) and was also a strong indicator of concomitant metabolic syndrome in nonobese MAFLD patients [AUC = 0.688 (0.612-0.763)].

CONCLUSION

The cVAI was strongly related to nonobese MAFLD and elevated ALT. The cVAI may be a reliable and accessible predictor of nonobese MAFLD and elevated ALT.

The effects of Atractylodes macrocephala extract BZEP self-microemulsion based on gut-liver axis HDL/LPS signaling pathway to ameliorate metabolic dysfunction-associated fatty liver disease in rats

OBJECTIVES

To elucidate the therapeutic effects and mechanisms of Atractylodes macrocephala extract crystallize (BZEP) and BZEP self-microemulsion (BZEPWR) on metabolic dysfunction-associated fatty liver disease (MAFLD) induced by "high sugar, high fat, and excessive alcohol consumption" based on the gut-liver axis HDL/LPS signaling pathway.

METHODS

In this study, BZEP and BZEPWR were obtained via isolation, purification, and microemulsification. Furthermore, an anthropomorphic MAFLD rat model of "high sugar, high fat, and excessive alcohol consumption" was established. The therapeutic effects of BZEPWR and BZEP on the model rats were evaluated in terms of liver function, lipid metabolism (especially HDL-C), serum antioxidant indexes, and liver and intestinal pathophysiology. To determine the lipoproteins in the serum sample, the amplitudes of a plurality of NMR spectra were derived via deconvolution of the composite methyl signal envelope to yield HDL-C subclass concentrations. The changes in intestinal flora were detected via 16 S rRNA gene sequencing. In addition, the gut-liver axis HDL/LPS signaling pathway was validated using immunohistochemistry, immunofluorescence, and western blot.

RESULTS

The findings established that BZEPWR and BZEP improved animal signs, serum levels of liver enzymes (ALT and AST), lipid metabolism (TC, TG, HDL-C, and LDL-C), and antioxidant indexes (GSH, SOD, and ROS). In addition, pathological damage to the liver, colon, and ileum was ameliorated, and the intestinal barrier function of the model rats was restored. At the genus level, BZEPWR and BZEP exerted positive effects on beneficial bacteria, such as Lactobacillus and norank_f__Muribaculaceae, and inhibitory effects on harmful bacteria, such as unclassified_f__Lachnospiraceae and Blautia. Twenty HDL-C subspecies were detected, and their levels were differentially increased in both BZEPWR and BZEP groups, with BZEPWR exhibiting a stronger elevating effect on specific HDL-C subspecies. Also, the gut-liver axis HDL/LPS signaling pathway was studied, which indicated that BZEPWR and BZEP significantly increased the expressions of ABCA1, LXR, occludin, and claudin-1 proteins in the gut and serum levels of HDL-C. Concomitantly, the levels of LPS in the serum and TLR4, Myd88, and NF-κB proteins in the liver were decreased.

CONCLUSION

BZEPWR and BZEP exert restorative and reversal effects on the pathophysiological damage to the gut-liver axis in MAFLD rats, and the therapeutic mechanism may be related to the regulation of the intestinal flora and the HDL/LPS signaling pathway.

Prognostic effect of triglyceride glucose-related parameters on all-cause and cardiovascular mortality in the United States adults with metabolic dysfunction-associated steatotic liver disease

BACKGROUNDS

Insulin resistance (IR) plays a vital role in the pathogenesis of the metabolic dysfunction-associated steatotic liver disease (MASLD). However, it remains unclear whether triglyceride-glucose (TyG) related parameters, which serve as useful biomarkers to assess IR, have prognostic effects on mortality outcomes of MASLD.

METHODS

Participants in the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2018 years were included. TyG and its related parameters [TyG-waist circumference (TyG-WC) and TyG-waist to height ratio (TyG-WHtR)] were calculated. Kaplan-Meier curves, Cox regression analysis, and restricted cubic splines (RCS) were conducted to evaluate the association between TyG-related indices with the all-cause and cardiovascular mortality of adults with MASLD. The concordance index (C-index) was used to evaluate the prediction accuracy of TyG-related indices.

RESULTS

A total of 8208 adults (4209 men and 3999 women, median age 49.00 years) with MASLD were included in this study. Multivariate-adjusted Cox regression analysis revealed that high quartile levels of TyG-related indices were significantly associated with the all-cause mortality of participants with MASLD [TyGadjusted hazard ratio (aHR) = 1.25, 95% confidence interval (CI) 1.05-1.50, P = 0.014; TyG-WCaHR for all-cause mortality = 1.28, 95% CI 1.07-1.52, P = 0.006; TyG-WHtRaHR for all-cause mortality = 1.50, 95% CI 1.25-1.80, P < 0.001; TyG-WCaHR for cardiovascular mortality = 1.81, 95% CI 1.28-2.55, P = 0.001; TyG-WHtRaHR for cardiovascular mortality = 2.22, 95% CI 1.55-3.17, P < 0.001]. The C-index of TyG-related indices for predicting all-cause mortality was 0.563 for the TyG index, 0.579 for the TyG-WC index, and 0.585 for the TyG-WHtR index, respectively. Regarding cardiovascular mortality, the C-index was 0.561 for the TyG index, 0.607 for the TyG-WC index, and 0.615 for the TyG-WHtR index, respectively. Nonlinear trends were observed between TyG and TyG-WC indices with all-cause mortality of MASLD (P < 0.001 and = 0.012, respectively). A non-linear relationship was observed between the TyG index and cardiovascular mortality of MASLD (P = 0.025). Subgroup analysis suggested that adults aged < 65 years old and those without comorbidities were more sensitive to the mortality prediction of TyG-related indices.

CONCLUSION

Findings of this study highlight the predictive value of TyG-related indices, especially the TyG-WHtR index, in the mortality outcomes of adults with MASLD. TyG-related indices would be surrogate biomarkers for the clinical management of MASLD.

Association of the triglyceride-glucose index and its related parameters with frailty

BACKGROUND

Frailty is a dynamic geriatric condition. Limited studies have examined the association of the triglyceride-glucose (TyG) index and its related indicators [TyG index, triglyceride glucose-waist to height ratio (TyG-WHtR), triglyceride glucose-waist circumference (TyG-WC), and triglyceride glucose-body mass index (TyG-BMI)] with frailty, and the potential links among them remain unclear. On the basis of data from the National Health and Nutrition Examination Survey (NHANES), this study investigated the potential relationships of the TyG index and its related indices with frailty.

METHODS

This research included 7,965 participants from NHANES 2003-2018. The relationship of the TyG index and its related indices with frailty was investigated with binary logistic regression analyses, restricted cubic spline (RCS), and receiver operating characteristic (ROC) curve. Potential influences were further investigated through stratified analyses and interaction tests.

RESULTS

The prevalence of frailty in the participants of this study was 25.59%, with a average frailty index of 0.16 (0.00). In the three regression analysis models, the continuous TyG index and its associated indices were positively associated with frailty. In addition, quartiles of TyG, TyG-WC, TyG-WHtR, and TyG-BMI were significantly associated with increased frailty prevalence in the fully adjusted models (TyG Q4 vs. Q1, OR = 1.58, 95% CI: 1.19, 2.09, P = 0.002; TyG-WC Q4 vs. Q1, OR = 2.40, 95% CI: 1.90, 3.04, P < 0.001; TyG-WHtR Q4 vs. Q1, OR = 2.26, 95% CI: 1.82, 2.81, P < 0.001; TyG- BMI Q4 vs. Q1, OR = 2.16, 95% CI: 1.76, 2.64, P < 0.001). According to RCS analysis, TyG, TyG-WC, TyG-WHtR, and TyG-BMI were linearly and positively associated with frailty. ROC curves revealed that TyG-WHtR (AUC: 0.654) had greater diagnostic value for frailty than TyG (AUC: 0.604), TyG-BMI (AUC: 0.621), and TyG-WC (AUC: 0.629). All of the stratified analyses and interaction tests showed similar results.

CONCLUSIONS

Elevated TyG and its associaed indices are associated with an increased prevalence of frailty. Reasonable control of blood glucose and blood lipids, and avoidance of obesity, may aid in reducing the occurrence of frailty in middle-aged and older adults.

Positive association between insulin resistance and fatty liver disease in psoriasis: evidence from a cross-sectional study

Background

Fatty liver disease (FLD) is a common comorbidity of psoriasis and is often referred to as non-alcoholic fatty liver disease (NAFLD). However, the role of inflammation or insulin resistance (IR) in FLD is inconclusive. The study aims to explore whether FLD in psoriasis patients is more related to insulin resistance or systemic inflammation level.

Methods

Data for this study were collected from the Shanghai Psoriasis Effectiveness Evaluation Cohort, a prospective cohort that examines psoriasis characteristics in the Chinese population. IR was assessed using the triglyceride glucose (TyG) and TyG-body mass index (TyG-BMI) indicators. Systemic non-specific inflammation was assessed using the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), and systemic immune inflammation index (SII).

Results

The analysis included a total of 647 patients. Subsequent logistic regression analysis revealed that NLR, dNLR, and SII were not significantly associated with FLD in psoriasis patients, while TyG and TyG-BMI showed significant associations with FLD. Subgroup analysis indicated that in the majority of subgroups, TyG and TyG-BMI were significantly associated with FLD, particularly TyG-BMI. Excluding individuals with methotrexate and acitretin resulted in consistent findings with the main analysis. Further analysis revealed a significantly higher diagnosis rate of metabolic-associated fatty liver disease (MAFLD) compared to NAFLD.

Conclusions

Metabolic factors play a crucial role in FLD in patients with psoriasis, and TyG and TyG-BMI are potential predictors of FLD. Therefore, MAFLD can be recommend as a term to describe FLD in psoriasis patients.

Trial registration

https://www.chictr.org.cn/showproj.html?proj=58256, identifier ChiCTR2000036186. A multi-center clinical study of systemic treatment strategies for psoriasis in Chinese population. Registered 31 August 2020.

Association between obstructive sleep apnea and visceral adiposity index and lipid accumulation product: NHANES 2015-2018

BACKGROUND

Obesity refers to a significant contributor to the development of obstructive sleep apnea (OSA). Early prediction of OSA usually leads to better treatment outcomes, and this study aims to employ novel metabolic markers, visceral adiposity index (VAI), and lipid accumulation product (LAP) to evaluate the relationship to OSA.

METHODS

The data used in the current cross-sectional investigation are from the National Health and Nutrition Examination Survey (NHANES), which was carried out between 2015 and 2018. To examine the correlation between LAP and VAI levels and OSA, multivariate logistic regression analysis was adopted. In addition, various analytical methods were applied, including subgroup analysis, smooth curve fitting, and threshold effect analysis.

RESULTS

Among totally 3932 participants, 1934 were included in the OSA group. The median (Q1-Q3) values of LAP and VAI for the participants were 40.25 (21.51-68.26) and 1.27 (0.75-2.21), respectively. Logistic regression studies indicated a positive correlation between LAP, VAI, and OSA risk after adjusting for potential confounding variables. Subgroup analysis revealed a stronger correlation between LAP, VAI levels, and OSA among individuals aged < 60 years. Through smooth curve fitting, specific saturation effects of LAP, VAI, and BMD were identified, with inflection points at 65.684 and 0.428, respectively.

CONCLUSION

This study demonstrates that elevated levels of LAP and VAI increase the risk of OSA, suggesting their potential as predictive markers for OSA and advocating for dietary and exercise interventions to mitigate OSA risk in individuals with high LAP and VAI levels.

NAFLD in the 21st Century: Current Knowledge Regarding Its Pathogenesis, Diagnosis and Therapeutics

Non-alcoholic fatty liver disease (NAFLD) is a major public health issue worldwide. It is the most common liver disease in Western countries, andits global prevalence is estimated to be up to 35%. However, its diagnosis may be elusive, because liver biopsy is relatively rarely performed and usually only in advanced stages of the disease. Therefore, several non-invasive scores may be applied to more easily diagnose and monitor NAFLD. In this review, we discuss the various biomarkers and imaging scores that could be useful in diagnosing and managing NAFLD. Despite the fact that general measures, such as abstinence from alcohol and modulation of other cardiovascular disease risk factors, should be applied, the mainstay of prevention and management is weight loss. Bariatric surgery may be suggested as a means to confront NAFLD. In addition, pharmacological treatment with GLP-1 analogues or the GIP agonist tirzepatide may be advisable. In this review, we focus on the utility of GLP-1 analogues and GIP agonists in lowering body weight, their pharmaceutical potential, and their safety profile, as already evidenced inanimal and human studies. We also elaborate on other options, such as the use of vitamin E, probiotics, especially next-generation probiotics, and prebiotics in this context. Finally, we explore future perspectives regarding the administration of GLP-1 analogues, GIP agonists, and probiotics/prebiotics as a means to prevent and combat NAFLD. The newest drugs pegozafermin and resmetiron, which seem to be very promising, arealso discussed.

The combination of body mass index and fasting plasma glucose is associated with type 2 diabetes mellitus in Japan: a secondary retrospective analysis

Background

Body mass index (BMI) and fasting plasma glucose (FPG) are known risk factors for type 2 diabetes mellitus (T2DM), but data on the prospective association of the combination of BMI and FPG with T2DM are limited. This study sought to characterize the association of the combination of BMI and FPG (ByG) with T2DM.

Methods

The current study used the NAGALA database. We categorized participants by tertiles of ByG. The association of ByG with T2DM was expressed with hazard ratios (HRs) with 95% confidence intervals (CIs) after adjustment for potential risk factors.

Results

During a median follow-up of 6.19 years in the normoglycemia cohort and 5.58 years in the prediabetes cohort, the incidence of T2DM was 0.75% and 7.79%, respectively. Following multivariable adjustments, there were stepwise increases in T2DM with increasing tertiles of ByG. After a similar multivariable adjustment, the risk of T2DM was 2.57 (95% CI 2.26 - 2.92), 1.97 (95% CI 1.53 - 2.54) and 1.50 (95% CI 1.30 - 1.74) for a per-SD change in ByG in all populations, the normoglycemia cohort and the prediabetes cohort, respectively.

Conclusion

ByG was associated with an increased risk of T2DM in Japan. The result reinforced the importance of the combination of BMI and FPG in assessing T2DM risk.

Association between combined exposure to dioxins and arthritis among US adults: a cross-sectional study

Dioxins and dioxin-like compounds (DLCs) are common pollutants hazardous to human health. We applied 12 dioxins and DLCs data of 1851 participants (including 484 arthritis patients) from National Health Examination Survey (NHANES) 2001-2004 and quadrupled them into rank variables. Multivariate logistic regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models were used to explore the relationship between individual or mixed exposure to the pollutants and arthritis after adjusting for multiple covariates. In multivariable logistic regression with an individual dioxin or DLC, almost every chemical was significantly positively associated with arthritis, except PCB66 (polychlorinated biphenyl 66) and 1,2,3,4,6,7,8-heptachlorodibenzofuran (hpcdf). The WQS model indicated that the combined exposure to the 12 dioxins and DLCs was positively linked to arthritis (OR: 1.884, 95% CI: 1.514-2.346), with PCB156 (weighted 0.281) making the greatest contribution. A positive trend between combined exposure and arthritis was observed in the BKMR model, with a posterior inclusion probability (PIP) of 0.987 for PCB156, which was also higher than the other contaminants.

Positive association between different triglyceride glucose index-related indicators and psoriasis: evidence from NHANES

Background

Psoriasis is a chronic inflammatory skin disease with effects that extend beyond the skin. Insulin resistance (IR) has been associated with psoriasis, but it remains unclear how indicators related to the triglyceride glucose (TyG) index, which were associate with IR, are associated with the condition.

Objective

The purpose of this study was to investigate the association between psoriasis and three TyG-related indicators: triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist to height ratio (TyG-WHtR), and triglyceride glucose-waist circumference (TyG-WC).

Methods

Data from adults aged 20 to 80 years in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2006 and 2009 to 2014 were utilized. Institutional Review Board approval and documented written consent was obtained from participants by NHANES (Protocol #2005-06). The patients were divided into three groups based on TyG-BMI, TyG-WC, and TyG-WHtR: Q1 (1st quintile), Q2 (2nd-3rd quintiles), and Q3 (4th-5th quintiles). Differences between the groups were further explored. Multivariate logistic regressions were used to investigate the correlation between these three indicators and psoriasis, with results expressed as odds ratios (OR) and 95% confidence intervals (CI). Subgroup analysis and supplementary analysis was further conducted to explore potential influencing factors.

Results

The study included 9,291 participants, of which 260 had psoriasis. Compared Q2 and Q3 of TyG-BMI, TyG-WC, and TyG-WHtR to Q1, there were significantly associate with psoriasis. Among the three indicators, TyG-WC consistently had the highest OR values in Models 1 and 2 (Model 1: Q3 OR (95% CI) = 2.155 (1.442-3.220); Model 2: Q3 OR (95% CI) = 2.029 (1.341-3.069)). While in Model 3, the TyG-BMI shows more significant relationship with psoriasis (Model 3 of TyG-BMI: Q3 OR (95% CI) = 1.948 (1.300-3.000)). Similar results were observed in the majority of subgroups and in supplementary analysis.

Conclusion

This study identified a stable and strong positive association between TyG-related indicators (TyG-BMI, TyG-WC, and TyG-WHtR) and psoriasis. This association persisted even after adjusting for multiple factors. It is suggested that high IR is significantly associated with psoriasis.

Markers of insulin resistance associated with non-alcoholic fatty liver disease in non-diabetic population

Insulin resistance (IR) plays an important role in the development of non-alcoholic fatty liver disease (NAFLD). IR markers are divided into two types: (1) insulin-based IR marker, homeostatic model assessment of IR (HOMA-IR); and (2) non-insulin-based IR markers, such as triglyceride-glucose (TyG) index, TyG index with body mass index (TyG-BMI), triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c), and metabolic score for IR (METS-IR). The non-insulin-based IR markers are often associated with lipids. The aim of this study was to analyse the association between IR markers and NAFLD in non-diabetic population. Baseline data of NAFLD and non-NAFLD groups were compared. Logistic regression was used to evaluate the relationship between five IR markers and NAFLD risk. The odds ratios (ORs) and 95% confidence intervals (CIs) of IR markers were calculated. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were used to evaluate the ability of different IR markers to detect NAFLD. Subgroup analyses were performed in obese and non-obese subgroups. This study found a positive correlation between NAFLD risk and elevation in five IR markers (HOMA-IR, TyG, TyG-BMI, TG/HDL-c, and METS-IR). In non-obese subjects, the AUC of TyG-BMI was larger than that of the other four IR markers to detect NAFLD. The AUC of HOMA-IR was larger than that of the other four IR markers to detect NAFLD in obese subjects. In non-diabetic population, the five IR markers are associated with the risk of NAFLD, including non-obese and obese NAFLD. TyG-BMI and HOMA-IR can be used to detect non-obese and obese NAFLD, respectively, with better detection ability compared with the other IR markers.

Associations of Combined Lifestyle Factors with MAFLD and the Specific Subtypes in Middle-Aged and Elderly Adults: The Dongfeng-Tongji Cohort Study

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the crucial pathogenesis for intra-hepatic and extra-hepatic diseases, especially in elderly adults. Lifestyle management may be a modifiable cost-effective measure for MAFLD prevention, but the evidence is limited. A total of 23,408 middle-aged and elderly individuals were included in a longitudinal study from 2008 to 2018. Combined lifestyle scores (range 0-6) were evaluated by BMI, smoking, drinking, diet, physical activity, and sleep. Logistic regression models were used to calculate ORs for the risks of MAFLD and specific subtypes. The mean age of participants was 61.7 years, and 44.5% were men. Compared with poor lifestyle (scores 0-2), ORs (95% CIs) of the ideal lifestyle (scores 5-6) were 0.62 (0.57-0.68) for MAFLD, 0.31 (0.28-0.34) for MAFLD with excess weight and obesity, 0.97 (0.75-1.26) for MAFLD with diabetes, and 0.56 (0.51-0.62) for MAFLD with metabolic dysregulation. Additionally, lifestyle improvement was associated with lower risks of MAFLD (OR, 0.76; 95% CI, 0.68-0.86), MAFLD with excess weight and obesity (OR, 0.72; 95% CI, 0.63-0.81), MAFLD with diabetes (OR, 0.74; 95% CI, 0.54-1.02) and MAFLD with metabolic dysregulation (OR, 0.49; 95% CI, 0.43-0.55), respectively. Our findings suggest that adherence to a combined healthy lifestyle was associated with lower risks of MAFLD, particularly in excess weight/obese individuals or those with metabolic dysregulation.

Diagnostic value of triglyceride-glucose index and related parameters in metabolism-associated fatty liver disease in a Chinese population: a cross-sectional study

OBJECTIVE

Our study aimed to explore the diagnostic value of triglyceride-glucose (TyG) and its related parameters in metabolism-associated fatty liver disease (MAFLD).

DESIGN

A cross-sectional study of residents who attended medical checkups at the First Hospital of Nanping City, Fujian Medical University, between 2015 and 2017.

SETTING

One participation centre.

PARTICIPANTS

2605 subjects met the inclusion-exclusion criteria and were grouped according to whether they had MAFLD.

RESULTS

The TyG index and its associated parameters are positively associated with the risk of developing MAFLD (p<0.001). Restriction cube spline analysis showed a significant dose-response relationship between the TyG index and MAFLD. The risk of developing MAFLD increases significantly with a higher TyG index. After adjusting for confounders, this relationship remains (OR: 4.89, 95% CI 3.98 to 6.00). The areas under the receiver operating characteristic curves of the TyG index for MAFLD detection were 0.793 (0.774 to 0.812). The areas under the curve (AUC) of TyG-related parameters were improved, among which TyG-waist circumference (TyG-WC) showed the largest AUC for MAFLD detection (0.873, 95% CI 0.860 to 0.887). In addition, the best cut-off value of the TyG-WC was 716.743, with a sensitivity and specificity of 88.7% and 71.4%, respectively.

CONCLUSION

The TyG index effectively identifies MAFLD, and the TyG-related parameters improved the identification and diagnosis of MAFLD, suggesting that TyG-related parameters, especially TyG-WC, may be a useful marker for diagnosing MAFLD.

Comparison of the diagnostic performance of twelve noninvasive scores of metabolic dysfunction-associated fatty liver disease

BACKGROUND

The absence of distinct symptoms in the majority of individuals with metabolic dysfunction-associated fatty liver disease (MAFLD) poses challenges in identifying those at high risk, so we need simple, efficient and cost-effective noninvasive scores to aid healthcare professionals in patient identification. While most noninvasive scores were developed for the diagnosis of nonalcoholic fatty liver disease (NAFLD), consequently, the objective of this study was to systematically assess the diagnostic ability of 12 noninvasive scores (METS-IR/TyG/TyG-WC/TyG-BMI/TyG-WtHR/VAI/HSI/FLI/ZJU/FSI/K-NAFLD) for MAFLD.

METHODS

The study recruited eligible participants from two sources: the National Health and Nutrition Examination Survey (NHANES) 2017-2020.3 cycle and the database of the West China Hospital Health Management Center. The performance of the model was assessed using various metrics, including area under the receiver operating characteristic curve (AUC), net reclassification index (NRI), integrated discrimination improvement (IDI), decision curve analysis (DCA), and subgroup analysis.

RESULTS

A total of 7398 participants from the NHANES cohort and 4880 patients from the Western China cohort were included. TyG-WC had the best predictive power for MAFLD risk in the NHANES cohort (AUC 0.863, 95% CI 0.855-0.871), while TyG-BMI had the best predictive ability in the Western China cohort (AUC 0.903, 95% CI 0.895-0.911), outperforming other models, and in terms of IDI, NRI, DCA, and subgroup analysis combined, TyG-WC remained superior in the NAHANES cohort and TyG-BMI in the Western China cohort.

CONCLUSIONS

TyG-BMI demonstrated satisfactory diagnostic efficacy in identifying individuals at a heightened risk of MAFLD in Western China. Conversely, TyG-WC exhibited the best diagnostic performance for MAFLD risk recognition in the United States population. These findings suggest the necessity of selecting the most suitable predictive models based on regional and ethnic variations.