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. 2024 Dec 23:15:1384059.
doi: 10.3389/fendo.2024.1384059. eCollection 2024.

Triglycerides to apolipoprotein A1 ratio: an effective insulin resistance-associated index in identifying metabolic dysfunction-associated fatty liver disease in type 2 diabetes mellitus

Wei Wang  1 , Yang Chen  1 , Mei Tu  1 , Hang Ju Chen  1
Affiliations

Triglycerides to apolipoprotein A1 ratio: an effective insulin resistance-associated index in identifying metabolic dysfunction-associated fatty liver disease in type 2 diabetes mellitus

Wei Wang et al. Front Endocrinol (Lausanne). .

Abstract

Background: The triglycerides to Apolipoprotein A1 ratio (TG/APOA1) holds promise to be a more valuable index of insulin resistance for the diagnosis of metabolic dysfunction-associated fatty liver disease (MAFLD) in type 2 diabetes mellitus (T2DM). This study aims to evaluate the correlation between TG/APOA1 and MAFLD, as well as compare the efficacy of TG/APOA1 with triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-c) and triglyceride-glucose (TyG) index in identifying MAFLD among individuals with T2DM.

Method: This study consecutively recruited 779 individuals with T2DM for the investigation. The unenhanced abdominal CT scans were conducted to measure CT liver-spleen attenuation measurement (CTL-S). The CTL-S less than 1.0 and without other liver comorbidities were considered to be MAFLD. The binomial logistic regression analysis and restricted cubic spines (RCS) were employed to evaluate the association between TG/APOA1 and MAFLD. The receiver operating characteristic (ROC) curve analysis was performed to compare the efficacy of TG/APOA1 with TG/HDL-c and TyG index identifying MAFLD.

Results: The TG/APOA1 exhibited a substantial increase in the MAFLD group (P<0.05). Even after adjustments for potential confounding factors, TG/APOA1 exhibited significant associations with nonalcoholic fatty liver disease fibrosis score (β=0.266, P<0.001), fibrosis-4 index (β=0.123, P=0.029), aspartate aminotransferase-to-platelet ratio index (β=0.113, P=0.037), and CTL-S (β=-0.225, P<0.001). Meanwhile, TG/APOA1 contributed to an independent variable for MAFLD, the odds ratio with a 95% CI was 2.092 (1.840-2.380) in the total population, 2.123 (1.810-2.511) in men, and 2.162 (1.824-2.587) in women. Additionally, the results also revealed a nonlinear association between elevated TG/APOA1 and higher MAFLD risk according to the RCS analysis whether in the total population, men, or women (P for nonlinearity and overall <0.001). Furthermore, TG/APOA1 had higher AUC level compared to TG/HDL-c and TyG index in the total population (0.769 vs 0.742, P=0.025; 0.769 vs 0.694, P < 0.001), men (0.776 vs 0.744, P=0.044; 0.776 vs 0.709, P < 0.001), and women (0.762 vs 0.728, P=0.041; 0.762 vs 0.674, P < 0.001).

Conclusion: TG/APOA1 serves as an effective index of insulin resistance in identifying MAFLD, offering advantages in the screening of MAFLD in T2DM.

Keywords: insulin resistance; metabolic dysfunction-associated fatty liver disease; triglyceride glucose index; triglycerides to apolipoprotein A1 ratio; triglycerides to high-density lipoprotein cholesterol ratio; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flowchart visually depicts the process of enrolling the study population.
Figure 2
Figure 2
The increased prevalence of MAFLD across TG/APOA1 quartiles (A). The distribution of 1 metabolic dysfunction to 7 metabolic dysfunctions in the TG/APOA quartile groups (B). MAFLD, metabolic dysfunction-associated fatty liver disease; TG/APOA1, triglycerides to Apolipoprotein A1 ratio.
Figure 3
Figure 3
The advanced liver fibrosis risk based on the nonalcoholic fatty liver disease fibrosis score (A), the fibrosis-4 index (B), and the aspartate aminotransferase-to-platelet ratio index (C) index and the severity of fatty liver based on CT liver-spleen attenuation measurement (D).
Figure 4
Figure 4
Univariate correlations between TG/APOA1 and NFS (A), FIB-4 (B), APRI (C), and CTL-S (D). TG/APOA1, triglycerides to Apolipoprotein A1 ratio; NFS, nonalcoholic fatty liver disease fibrosis score; FIB-4, fibrosis-4 index (B). APRI, AST-to-platelet ratio index; CTL-S, CT liver-spleen attenuation measurement.
Figure 5
Figure 5
The correlation of TG/APOA1 with MAFLD after adjusting for different models in the total population (A), men (B), and women (C). model 1: adjustments for age, sex, diabetic duration, smoking, and drinking. model 2: further adjustments for metabolic dysfunctional indicators like body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, glycated hemoglobin A1c, uric acid, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol based on model 1. model 3: further adjusting for liver functional indicators like aminotransferase, aspartate aminotransferase albumin, albumin, and platelets based on model 2. MAFLD, metabolic dysfunction-associated fatty liver disease; TG/APOA1, triglycerides to Apolipoprotein A1 ratio.
Figure 6
Figure 6
Restricted cubic spines analysis of the correlation between TG/APOA1 and MAFLD after adjusting for model 3 in the total population (A), men (B), and women (C). model 3: adjustments for age, sex, diabetic duration, smoking, drinking, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, glycated hemoglobin A1c, uric acid, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and liver functional indicators like aminotransferase, aspartate aminotransferase albumin, albumin, and platelets MAFLD, metabolic dysfunction-associated fatty liver disease; TG/APOA1, triglycerides to Apolipoprotein A1 ratio.
Figure 7
Figure 7
Comparison of MAFLD identifying value between TG/APOA1 and TG/HDL-c, TyG index in the total population (A), men (B), and women (C). MAFLD, metabolic dysfunction-associated fatty liver disease; TG/APOA1, triglycerides to Apolipoprotein A1 ratio; TG/HDL-c, triglycerides to high-density lipoprotein cholesterol ratio; TyG index, triglyceride-glucose index.
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