Relationship Between Six Insulin Resistance Surrogates and Nonalcoholic Fatty Liver Disease Among Older Adults: A Cross-Sectional Study

Figures & data

Table 1 Characteristics of the Participants with and without NAFLD

Characteristics	Total(n = 72,225)	Non-NAFLD (n =53,878)	NAFLD (n = 18,347)	P value
Sex, women, n (%)	37,937 (52.5)	27,053 (50.2)	10,884 (59.3)	<0.001
Age (years)	69.93 (6.72)	70.23 (6.94)	69.05 (5.95)	<0.001
Smoking, former or current smokers (%)	9329 (12.9)	7640 (14.2)	1689 (9.2)	<0.001
Marriage, living without partner (%)	10,401 (14.4)	8280 (15.4)	2121 (11.6)	<0.001
RHR (beats/min)	71.18 (11.79)	71.03 (11.89)	71.62 (11.51)	<0.001
FPG (mmol/L)	6.04 (1.98)	5.89 (1.88)	6.47 (2.20)	<0.001
TG (mmol/L)	1.46 (0.76)	1.36 (0.70)	1.76 (0.85)	<0.001
TC (mmol/L)	4.90 (1.65)	4.85 (1.73)	5.02 (1.40)	<0.001
ALT (mmol/L)	19.34 (16.73)	18.62 (16.92)	21.45 (15.97)	<0.001
AST (mmol/L)	23.26 (9.76)	23.17 (9.39)	23.55 (10.77)	<0.001
LDLC (mmol/L)	2.72 (1.96)	2.67 (2.01)	2.87 (1.77)	<0.001
HDLC (mmol/L)	1.42 (0.42)	1.45 (0.42)	1.34 (0.40)	<0.001
History of hypertension (%)	51,942 (71.9)	37,551 (69.7)	14,391 (78.4)	<0.001
History of diabetes (%)	18,096 (25.1)	11,617 (21.6)	6479 (35.3)	<0.001
History of CVDs (%)	7812 (10.8)	5659 (10.5)	2153 (11.7)	<0.001
BMI (kg/m^2)	25.57 (3.59)	24.67 (3.23)	28.19 (3.28)	<0.001
SBP (mmHg)	144.32 (20.33)	143.54 (20.47)	146.62 (19.71)	<0.001
DBP (mmHg)	84.12 (10.95)	83.60 (10.98)	85.64 (10.72)	<0.001
Drinking (%)				<0.001
Never	67,871 (94.0)	50,156 (93.1)	17,715 (96.6)
Occasionally	2456 (3.4)	1824 (3.4)	632 (3.4)
Frequently	688 (1.0)	688 (1.3)	0 (0.0)
Daily	1210 (1.7)	1210 (2.2)	0 (0.0)
Physical activity (%)				<0.001
Never	47,515 (65.8)	36,213 (67.2)	11,302 (61.6)
Occasionally	1214 (1.7)	894 (1.7)	320 (1.7)
More than once a week	2797 (3.9)	2014 (3.7)	783 (4.3)
Daily	20,699 (28.7)	14,757 (27.4)	5942 (32.4)
TyG	8.70 (0.58)	8.62 (0.55)	8.96 (0.58)	<0.001
TyG-BMI	223.04 (37.71)	212.92 (33.36)	252.77 (33.83)	<0.001
LAP	38.49 (25.93)	33.43 (22.74)	53.36 (28.85)	<0.001
VAI	1.82 (1.27)	1.65 (1.15)	2.33 (1.46)	<0.001
TG/HDLC	1.13 (0.75)	1.03 (0.68)	1.43 (0.87)	<0.001
METS-IR	37.70 (6.84)	35.94 (6.08)	42.86 (6.30)	<0.001
HSI	33.92 (7.82)	32.71 (7.98)	37.47 (6.05)	<0.001

Abbreviations: NAFLD, Non-alcoholic fatty liver disease; IR, Insulin Resistance; TyG, triglyceride-glucose index; TyG-BMI TyG, index with body mass index; LAP, lipid accumulation product; VAI, visceral adiposity index; TG/HDL-c, triglycerides/high-density lipoprotein cholesterol ratio; METS-IR, metabolic score for IR; HSI, hepatic steatosis index; BMI, body mass index; RHR, resting heart rate; FPG, fasting plasma glucose; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglyceride; HDL-c, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; ALT, alanine transaminase; AST, aspartate aminotransferase.

Table 2 Logistic Regression Analyses for the Association Between Six IR Surrogates and NAFLD

Variables	No. of Cases	ORs (95% CIs)
		Crude Model	Model 1	Model 2
TyG
Q1	1728	Ref.	Ref.	Ref.
Q2	2388	1.46 (1.36,1.56)	1.43 (1.34,1.53)	1.42 (1.32,1.52)
Q3	3321	2.2 (2.06,2.34)	2.13 (2,2.27)	2.11 (1.98,2.25)
Q4	4477	3.3 (3.11,3.51)	3.17 (2.98,3.37)	3.1 (2.92,3.3)
Q5	6433	5.91 (5.56,6.27)	5.6 (5.27,5.95)	5.48 (5.16,5.83)
TyG-BMI
Q1	428	Ref.	Ref.	Ref.
Q2	1383	3.47 (3.11,3.88)	3.38 (3.03,3.79)	3.33 (2.98,3.73)
Q3	2971	8.48 (7.65,9.42)	8.2 (7.4,9.11)	8.01 (7.23,8.91)
Q4	5101	17.88 (16.16,19.83)	17.16 (15.51,19.03)	16.7 (15.1,18.53)
Q5	8464	46.35 (41.92,51.38)	44.08 (39.86,48.88)	43.02 (38.89,47.72)
LAP
Q1	1032	Ref.	Ref.	Ref.
Q2	2154	2.28 (2.11,2.46)	2.28 (2.11,2.47)	2.25 (2.08,2.44)
Q3	3317	3.87 (3.6,4.17)	3.89 (3.61,4.2)	3.84 (3.57,4.14)
Q4	4845	6.54 (6.09,7.04)	6.58 (6.12,7.08)	6.47 (6.02,6.97)
Q5	6999	12.28 (11.44,13.19)	12.28 (11.42,13.21)	12.1 (11.25,13.02)
VAI
Q1	1637	Ref.	Ref.	Ref.
Q2	2714	1.81 (1.69,1.93)	1.81 (1.7,1.94)	1.8 (1.68,1.92)
Q3	3466	2.47 (2.32,2.63)	2.49 (2.33,2.65)	2.47 (2.32,2.64)
Q4	4429	3.46 (3.25,3.68)	3.47 (3.26,3.71)	3.47 (3.26,3.7)
Q5	6101	5.72 (5.38,6.08)	5.71 (5.36,6.09)	5.71 (5.35,6.09)
TG/HDL-c
Q1	1746	Ref.	Ref.	Ref.
Q2	2608	1.6 (1.5,1.71)	1.59 (1.49,1.7)	1.58 (1.48,1.69)
Q3	3501	2.33 (2.18,2.48)	2.3 (2.16,2.45)	2.29 (2.14,2.43)
Q4	4440	3.23 (3.04,3.43)	3.15 (2.96,3.35)	3.15 (2.96,3.35)
Q5	6052	5.25 (4.94,5.57)	5.08 (4.79,5.4)	5.06 (4.77,5.38)
METS-IR
Q1	514	Ref.	Ref.	Ref.
Q2	1574	3.31 (2.99,3.67)	3.27 (2.95,3.62)	3.21 (2.9,3.56)
Q3	2987	7.07 (6.42,7.79)	6.9 (6.27,7.61)	6.7 (6.08,7.39)
Q4	4990	14.3 (13.03,15.74)	13.94 (12.69,15.34)	13.45 (12.25,14.81)
Q5	8282	36.42 (33.19,40.05)	35.57 (32.41,39.13)	34.49 (31.41,37.95)
HSI
Q1	518	Ref.	Ref.	Ref.
Q2	1727	3.65 (3.3,4.04)	3.61 (3.26,4)	3.53 (3.19,3.91)
Q3	3129	7.43 (6.76,8.19)	7.32 (6.66,8.07)	7.11 (6.46,7.84)
Q4	5113	14.73 (13.42,16.2)	14.44 (13.15,15.89)	13.85 (12.61,15.24)
Q5	7860	32.09 (29.25,35.28)	31.42 (28.61,34.58)	30.23 (27.53,33.28)

Notes: Model 1: unadjusted; Model 2: adjusted for age and sex; Model 3: adjusted for age, sex, marital status, smoking, physical exercise, SBP, RHR.

Abbreviations: OR, odd ratio; CI, confidential interval; NAFLD, Non-alcoholic fatty liver disease; IR, Insulin Resistance; TyG, triglyceride-glucose index; TyG-BMI, TyG index with body mass index; LAP, lipid accumulation product; VAI, visceral adiposity index; TG/HDL-c, triglycerides/high-density lipoprotein cholesterol ratio; METS-IR, metabolic score for IR; HSI, hepatic steatosis index.

Figure 1 Relationship of TyG, TyG-BMI, LAP, VAI, TG/HDL-C and METS-IR with the risk of NAFLD for all participants. ORs are adjusted for age, sex, marital status, smoking, physical exercise, SBP, RHR.

Abbreviations: NAFLD, Non-alcoholic fatty liver disease; IR, Insulin Resistance; OR, odd ratio; TyG, triglyceride-glucose index; TyG-BMI, TyG index with body mass index; LAP, lipid accumulation product; VAI, visceral adiposity index; TG/HDL-c, triglycerides/high-density lipoprotein cholesterol ratio; METS-IR, metabolic score for IR; RHR, resting heart rate; SBP, systolic blood pressure.

Table 3 AUCs for Insulin Resistance Surrogates in Relation to NAFLD

Variables	AUC (95% CI)	Specificity	Sensitivity	Youden
TyG-BMI+ other factors	0.8059 (0.8025,0.8094)	0.704796	0.756200	0.460996
METS-IR+ other factors	0.7959 (0.7923,0.7994)	0.667824	0.775822	0.443645
HSI+ other factors	0.7763 (0.7726,0.78)	0.664353	0.747534	0.411886
LAP+ other factors	0.7313 (0.7272,0.7354)	0.646813	0.697335	0.344148
TyG + other factors	0.6901 (0.6857,0.6944)	0.594807	0.687742	0.282549
TG/HDL-c+ other factors	0.6781 (0.6737,0.6825)	0.647463	0.610236	0.257699
VAI+ other factors	0.6742 (0.6697,0.6786)	0.633617	0.621682	0.255299

Notes: Other factors: age, sex, marital status, smoking, physical exercise, SBP, RHR.

Abbreviations: AUC, area under the curve; NAFLD, Non-alcoholic fatty liver disease; IR, Insulin Resistance; TyG, triglyceride-glucose index; TyG-BMI, TyG index with body mass index; LAP, lipid accumulation product; VAI, visceral adiposity index; TG/HDL-c, triglycerides/high-density lipoprotein cholesterol ratio; METS-IR, metabolic score for IR; HSI, hepatic steatosis index; SBP, systolic blood pressure; RHR, resting heart rate.

Figure 2 The receiver operating characteristic curve of insulin resistance surrogates and HSI after adjusting for age, sex, marital status, smoking, physical exercise, SBP, RHR.

Abbreviations: HIS, hepatic steatosis index; TyG, triglyceride-glucose index; TyG-BMI, TyG index with body mass index; LAP, lipid accumulation product; VAI, visceral adiposity index; TG/HDL-c, triglycerides/high-density lipoprotein cholesterol ratio; METS-IR, metabolic score for IR; RHR, resting heart rate; SBP, systolic blood pressure.