Association between triglyceride glucose-body mass index and non-alcoholic fatty liver disease in the non-obese Chinese population with normal blood lipid levels: a secondary analysis based on a prospective cohort study

Abstract

Background: Both triglyceride glucose-body mass index (TyG-BMI) and non-alcoholic fatty liver disease (NAFLD) are linked to insulin resistance (IR). Prospective studies linking TyG-BMI to NAFLD have been limited by short follow-up. This study investigated the longitudinal association between TyG-BMI and NAFLD occurrence in the non-obese Chinese individuals.

Methods: This study determined TyG-BMI at baseline and the incidence of NAFLD at follow-up and performed a post hoc analysis of a prospective cohort study that involved assessing the risk of NAFLD in non-obese Chinese residents from January 2010 to December 2014. The incidence of NAFLD during the 5-year follow-up was identified as the endpoint. Cox proportional hazards regression analysis was used to evaluate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the incidence of NAFLD. Receiver operating characteristic (ROC) curve analysis was conducted to estimate the predictive power of TyG-BMI and its components for NAFLD. Subgroup analysis was performed to better understand other factors that may affect the association between TyG-BMI and NAFLD to identify potential special populations.

Results: During the follow-up period, 841 (8.61%) of 9767 non-obese subjects who met the screening criteria were diagnosed with NAFLD. After confounding factors were fully adjusted for, the HR of NAFLD was 3.09 (95% CI 2.63-3.63) per standard deviation (SD) increase in TyG-BMI. Furthermore, TyG-BMI had a strong predictive value (area under ROC = 0.85; 95% CI 0.84-0.86) for the incidence of NAFLD, with a specificity of 0.73 and sensitivity of 0.82. Additionally, in the male population, each SD increase in TyG-BMI was linked to an increased risk of NAFLD (HR = 2.85, 95% CI 2.30-3.53), but the risk was higher in the female population (HR = 3.58, 95% CI 2.80-4.60). Gender and TyG-BMI interacted significantly with NAFLD incidence (P < 0.0001).

Conclusion: In the normolipidaemic and non-obese subset of the Chinese population, an increase in TyG-BMI is related to an increased incidence of NAFLD. TyG-BMI may have clinical significance in identifying groups at high risk of NAFLD.

Keywords: Association; Body mass index; Fasting plasma glucose; Insulin resistance; Non-alcoholic fatty liver disease; Secondary analysis; Triglyceride; Triglyceride glucose body mass index.

Fig. 1

Flow chart

Fig. 2

ROC curves for NAFLD

Fig. 3

Kaplan-Meier analysis of NAFLD incidence according to TyG-BMI quartiles (P < 0.0001)

Fig. 4

Subgroup analysis of the association between TyG-BMI and NAFLD. The HR (95% CI) was derived from the Cox regression model. (Sex, age, DBP, SBP, LDL-C, HDL-C, TG, UA, Cr, GLB, ALB, AST, ALP, GGT, ALT, FPG, and DBIL were adjusted)