Novel Surrogate Markers of Insulin Resistance in Patients With Metabolic Dysfunction-Associated Steatosis Liver Disease: Associations With Dietary and Lifestyle Inflammatory Scores in the Large Cross-Sectional Study Publisher Pubmed



Yilmaz Y ; Saeedian B ; Babajani N ; Ashtari S ; Ghorat F ; Taheri E
Source: Clinical Nutrition ESPEN Published:2025

Abstract

Background & aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a major global health challenge, with insulin resistance (IR) and inflammation being key pathophysiological drivers. Here, this study aimed to evaluate the associations between MASLD and novel IR markers, and to examine the interrelationships between dietary (DIS) and lifestyle (LIS) inflammatory scores and IR indices. Methods: This cross-sectional study was conducted among participants in the baseline phase of the Sabzevar Persian Cohort Study (SPCS). We studied 970 patients with MASLD and 961 age- and sex-matched controls. Eight distinct IR markers were assessed: triglyceride-glucose index (TyG), TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c), lipid accumulation product (LAP), visceral adiposity index (VAI), and metabolic score for insulin resistance (METS-IR). DIS was calculated from 19 dietary components, LIS from three lifestyle parameters, and a combined dietary and lifestyle inflammation score (DLIS) from both measures. Results: Patients with MASLD exhibited higher adiposity measures and comorbidity rates than controls. TyG-BMI demonstrated the strongest association with MASLD (area under the curve [AUC]: 0.994), followed by TyG-WC (AUC: 0.993) and METS-IR (AUC: 0.989). TyG-BMI demonstrated the highest specificity (96.74 %), indicating its strong ability to correctly identify individuals without the disease (true negatives), thereby minimizing false positives. In contrast, TyG-WC showed the highest sensitivity (97.31 %), reflecting its excellent capacity to correctly detect individuals with the disease (true positives), thus reducing the likelihood of false negatives. LIS correlated most strongly with TyG-BMI (r = 0.811, p < 0.001), whereas DLIS correlated best with METS-IR (r = 0.346, p < 0.001). Canonical correlation analysis revealed significant relationships between inflammatory scores and IR indices (r = 0.835, p < 0.001). Conclusions: Among novel IR markers, TyG-BMI represented the most robust surrogate marker associated with the risk of having MASLD. The strong correlation between LIS and TyG-BMI suggested the potential significant association of lifestyle-related inflammation and IR in MASLD pathophysiology that needs to be investigated in future interventional studies. © 2025 Elsevier B.V., All rights reserved.