Monocytes to Apolipoprotein A1 ratio is associated with metabolic dysfunction-associated fatty liver disease in type 2 diabetes mellitus

Abstract

The monocyte-to-Apolipoprotein A1 ratio (MAR) emerges as a potentially valuable inflammatory biomarker indicative of metabolic dysfunction-associated fatty liver disease (MASLD). Accordingly, this investigation primarily aims to assess the correlation between MAR and MASLD risk. A cohort comprising 957 individuals diagnosed with type 2 diabetes mellitus (T2DM) participated in this study. The relationship between MAR and MASLD was analyzed through binomial logistic regression analysis and restricted cubic splines (RCS). Furthermore, a comparative assessment of MAR and monocyte to high-density lipoprotein ratio (MHR) in identifying MASLD efficacy was conducted using receiver operating characteristic curve analysis. Remarkably, even after adjusting for metabolic parameters and hepatic functional markers, MAR stood out as an independent predictor for MASLD (OR 1.58, 95% CI 1.36-1.84; P < 0.001) and displayed a nonlinear positive association with MASLD risk according to RCS analysis (P for nonlinearity and overall < 0.001). Notably, MAR exhibited superior diagnostic accuracy for identifying MASLD compared to MHR (AUC: 0.772 vs 0.722, P < 0.001). In summary, MAR emerges as a promising inflammatory indicator for MASLD, demonstrating potential as a valuable screening tool to bolster the management of MASLD within the T2DM population.

Keywords: Inflammatory marker; Metabolic dysfunction-associated fatty liver disease; Monocyte to Apolipoprotein A ratio; Type 2 diabetes mellitus.

Fig. 1

The flowchart illustrates the process of study population enrollment.

Fig. 2

MASLD prevalence (A) and metabolic dysfunctions distribution (B) based on MAR quartile. MAR Monocytes to Apolipoprotein A1 ratio, MASLD Metabolic dysfunction-associated fatty liver disease.

Fig. 3

Correlation of MAR with CT_L−S and NFS. (A) the negative association between MAR and CT_L−S (r = − 0.369, P < 0.001). (B) the positive association between MAR and NFS (r = 0.158, P < 0.001). NFS Nonalcoholic fatty liver disease fibrosis score, MAR Monocytes to Apolipoprotein A1 ratio.

Fig. 4

The independent correlation of MAR with MASLD in different Models. Model 1: adjustment for age, gender, diabetic duration, and drinking. Model 2: further adjustment for waist circumference, body mass index, systolic blood pressure, diastolic blood pressure, hemoglobin A1c, triglycerides, high-density lipoprotein, homeostasis model assessment of insulin resistance, and uric acid based on Model 1. Model 3: additional adjustment for alanine aminotransferase and aspartate aminotransferase, as well as the usage of hypoglycemic agents like metformin, thiazolidinediones, sodium-glucose cotransporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists based on Model 2. MASLD Metabolic dysfunction-associated fatty liver disease, MAR Monocytes to Apolipoprotein A1 ratio.

Fig. 5

Restricted cubic spines analysis of the association between MAR and MASLD after accounting for full adjustments in Model 3. MASLD Metabolic dysfunction-associated fatty liver disease, MAR Monocytes to Apolipoprotein A1 ratio.

Fig. 6

ROC analysis for comparing MASLD identifying value between MAR and MHR. MASLD Metabolic dysfunction-associated fatty liver disease, MAR Monocytes to Apolipoprotein A1 ratio, MHR Monocytes to high-density lipoprotein, BMI Body mass index, WC Waist circumference, SBP Systolic blood pressure, DBP Diastolic blood pressure, HbA1c Glycated hemoglobin, TG Triglyceride, TC Total cholesterol, HDL-c High-density lipoprotein cholesterol, LDL-c Low-density lipoprotein cholesterol, APOA1 Apolipoprotein A1, UA Uric acid, ALT Alanine aminotransferase, AST Aspartate aminotransferase. HOMR-IR Homeostasis model assessment insulin resistance, MAR Monocyte to APOA1 ratio, MHR Monocyte to HDL-c ratio, MASLD Metabolic dysfunction-associated fatty liver disease.