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Abstract：
BACKGROUND: The prevalence of non-alcoholic fatty liver disease (NAFLD) keeps increasing annually worldwide. Non-invasive assessment tools for evaluating the risk and severity of the disease are still limited. Insulin resistance (IR) and abdominal obesity (ABO) are closely related to NAFLD.
METHODS: A retrospective large-scale, population-based study was conducted based on the data from the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES). Three ABO indices, namely lipid accumulation product (LAP), visceral obesity index (VAI), waist circumference-triglyceride index (WTI), and three IR indices, including triglyceride glucose index (TyG), homeostasis model assessment of insulin resistance (HOMA-IR) and metabolic score for insulin resistance (METS-IR), were analyzed and compared for their relationships with NAFLD based on weighted multivariable logistic regression, spearman correlation heatmap, smooth curve fittings. The area under the curve (AUC) of receiver-operating characteristic (ROC) curve was used to evaluate the diagnostic capability of these indices for NAFLD. Differences among the AUCs were calculated and compared by Delong test.
RESULTS: In total, 3095 participants were included in our study among which 1368 adults were diagnosed with NAFLD. All six indices presented positive associations with NAFLD. There was a claw-shaped curve between HOMA-IR, VAI, LAP and NAFLD while a smooth semi-bell curve was observed in TyG, METS-IR and WTI. LAP and HOMA-IR had the best diagnostic capability for NAFLD (LAP: AUC = 0.8, Youden index = 0.48; HOMA-IR: AUC = 0.798, Youden index = 0.472) while VAI (AUC = 0.728, Youden index = 0.361) showed the lowest predictive value. The correlation heat map indicated positive correlations between all six indices and liver function, hepatic steatosis and fibrosis severity. In the NAFLD group, IR indicators presented a stronger association with alanine aminotransferase (ALT) compared with ABO indices.
CONCLUSIONS: All six indices can screen NAFLD withLAP and HOMA-IR being possibly optimal predictors. IR indices may be more sensitive to identify acute hepatic injury in NAFLD patients than ABO indices.
METHODS: A retrospective large-scale, population-based study was conducted based on the data from the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES). Three ABO indices, namely lipid accumulation product (LAP), visceral obesity index (VAI), waist circumference-triglyceride index (WTI), and three IR indices, including triglyceride glucose index (TyG), homeostasis model assessment of insulin resistance (HOMA-IR) and metabolic score for insulin resistance (METS-IR), were analyzed and compared for their relationships with NAFLD based on weighted multivariable logistic regression, spearman correlation heatmap, smooth curve fittings. The area under the curve (AUC) of receiver-operating characteristic (ROC) curve was used to evaluate the diagnostic capability of these indices for NAFLD. Differences among the AUCs were calculated and compared by Delong test.
RESULTS: In total, 3095 participants were included in our study among which 1368 adults were diagnosed with NAFLD. All six indices presented positive associations with NAFLD. There was a claw-shaped curve between HOMA-IR, VAI, LAP and NAFLD while a smooth semi-bell curve was observed in TyG, METS-IR and WTI. LAP and HOMA-IR had the best diagnostic capability for NAFLD (LAP: AUC = 0.8, Youden index = 0.48; HOMA-IR: AUC = 0.798, Youden index = 0.472) while VAI (AUC = 0.728, Youden index = 0.361) showed the lowest predictive value. The correlation heat map indicated positive correlations between all six indices and liver function, hepatic steatosis and fibrosis severity. In the NAFLD group, IR indicators presented a stronger association with alanine aminotransferase (ALT) compared with ABO indices.
CONCLUSIONS: All six indices can screen NAFLD withLAP and HOMA-IR being possibly optimal predictors. IR indices may be more sensitive to identify acute hepatic injury in NAFLD patients than ABO indices.
摘要：
背景：非酒精性脂肪性肝病（NAFLD）的患病率在全球范围内逐年增加。用于评估疾病风险和严重程度的非侵入性评估工具仍然有限。胰岛素抵抗(IR)和腹型肥胖(ABO)与NAFLD密切相关。
方法：回顾性大规模，基于人群的研究是根据国家健康和营养检查调查(NHANES)2017-2018年周期的数据进行的.三个ABO指数，即脂质积累产物(LAP)，内脏肥胖指数（VAI），腰围-甘油三酯指数（WTI），和三个IR指数，包括甘油三酯葡萄糖指数（TyG），胰岛素抵抗的稳态模型评估（HOMA-IR）和胰岛素抵抗的代谢评分（METS-IR），基于加权多变量逻辑回归分析和比较它们与NAFLD的关系，斯皮尔曼相关热图，平滑曲线拟合。使用受试者工作特征（ROC）曲线的曲线下面积（AUC）来评估这些指标对NAFLD的诊断能力。通过Delong检验计算并比较AUC之间的差异。
结果：总计，我们的研究包括3095名参与者，其中1368名成年人被诊断为NAFLD。所有六个指标均与NAFLD呈正相关。HOMA-IR之间有一条爪形曲线，VAI,LAP和NAFLD在TyG中观察到平滑的半钟形曲线，METS-IR和WTI。LAP和HOMA-IR对NAFLD的诊断能力最好(LAP:AUC=0.8,Youden指数=0.48;HOMA-IR:AUC=0.798,Youden指数=0.472),而VAI(AUC=0.728,Youden指数=0.361)的预测值最低。相关热图显示6项指标与肝功能呈正相关,肝脂肪变性和纤维化严重程度。在NAFLD组中，与ABO指数相比，IR指标与丙氨酸转氨酶（ALT）的相关性更强。
结论：所有六个指标都可以筛查NAFLD，而LAP和HOMA-IR可能是最佳预测因子。IR指数可能比ABO指数更敏感地识别NAFLD患者的急性肝损伤。
方法：回顾性大规模，基于人群的研究是根据国家健康和营养检查调查(NHANES)2017-2018年周期的数据进行的.三个ABO指数，即脂质积累产物(LAP)，内脏肥胖指数（VAI），腰围-甘油三酯指数（WTI），和三个IR指数，包括甘油三酯葡萄糖指数（TyG），胰岛素抵抗的稳态模型评估（HOMA-IR）和胰岛素抵抗的代谢评分（METS-IR），基于加权多变量逻辑回归分析和比较它们与NAFLD的关系，斯皮尔曼相关热图，平滑曲线拟合。使用受试者工作特征（ROC）曲线的曲线下面积（AUC）来评估这些指标对NAFLD的诊断能力。通过Delong检验计算并比较AUC之间的差异。
结果：总计，我们的研究包括3095名参与者，其中1368名成年人被诊断为NAFLD。所有六个指标均与NAFLD呈正相关。HOMA-IR之间有一条爪形曲线，VAI,LAP和NAFLD在TyG中观察到平滑的半钟形曲线，METS-IR和WTI。LAP和HOMA-IR对NAFLD的诊断能力最好(LAP:AUC=0.8,Youden指数=0.48;HOMA-IR:AUC=0.798,Youden指数=0.472),而VAI(AUC=0.728,Youden指数=0.361)的预测值最低。相关热图显示6项指标与肝功能呈正相关,肝脂肪变性和纤维化严重程度。在NAFLD组中，与ABO指数相比，IR指标与丙氨酸转氨酶（ALT）的相关性更强。
结论：所有六个指标都可以筛查NAFLD，而LAP和HOMA-IR可能是最佳预测因子。IR指数可能比ABO指数更敏感地识别NAFLD患者的急性肝损伤。
