The Role of the Triglyceride–Glucose Index and Its Derivatives in Predicting the Risk of Metabolic Dysfunction–Associated Steatotic Liver Disease and Hepatic Fibrosis

The Role of the Triglyceride–Glucose Index and Its Derivatives in Predicting the Risk of Metabolic Dysfunction–Associated Steatotic Liver Disease and Hepatic Fibrosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Role of the Triglyceride–Glucose Index and Its Derivatives in Predicting the Risk of Metabolic Dysfunction–Associated Steatotic Liver Disease and Hepatic Fibrosis Ayse Yazan Arslan, Asuman Okur This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9237501/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Metabolic dysfunction–associated steatotic liver disease (MASLD) has emerged as a major global health burden due to its increasing prevalence and its substantial contribution to liver-related morbidity and mortality. In primary care settings, simple, non-invasive, and cost-effective diagnostic biomarkers are needed to facilitate early detection. Methods This retrospective cross-sectional study included 408 adults attending a family medicine outpatient clinic between January 2023 and December 2024. Following the exclusion of secondary causes, MASLD was diagnosed in accordance with current diagnostic criteria and imaging findings. Liver fibrosis risk was evaluated using the Fibrosis-4 (FIB-4) index. The triglyceride–glucose (TyG) index and its composite derivatives—TyG × body mass index (TyG-BMI), TyG × waist circumference (TyG-WC), and TyG × waist-to-height ratio (TyG-WHtR)—were calculated. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed. Results MASLD was present in 50.5% of participants. All TyG-related indices demonstrated significant dose–response associations with MASLD (p < 0.001). In fully adjusted analyses, participants in the highest quartile of TyG-WC had a 14.46-fold higher odds of MASLD compared with the lowest quartile (95% CI: 6.85–30.56; p < 0.001). ROC analysis showed that TyG-WC had the highest discriminative performance (AUC: 0.761), followed by TyG-WHtR (AUC: 0.752) and TyG-BMI (AUC: 0.750). Subgroup analyses revealed stronger diagnostic performance in younger individuals and those without hypertension or diabetes. Conclusions TyG and its anthropometric derivatives, particularly TyG-WC, are independently associated with MASLD and show moderate diagnostic accuracy. These easily accessible indices may serve as practical screening tools for MASLD in primary care settings. MASLD liver fibrosis triglyceride–glucose index insulin resistance non-invasive diagnostics primary care ROC analysis Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 09 Apr, 2026 Editor invited by journal 30 Mar, 2026 Editor assigned by journal 27 Mar, 2026 Submission checks completed at journal 27 Mar, 2026 First submitted to journal 26 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9237501","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":621562603,"identity":"adcfa1ac-3257-4330-99fe-9f08228d358e","order_by":0,"name":"Ayse Yazan Arslan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIiWNgGAWjYNCDBwwMciD6wAOitSQwMBiDtSSQoiWxAcrACfhnpD98zFNTJ2/Ofvbxh4SaO+nzww4/BNpiJ6fbgF2LxI0cY2OeY2yGO3vSzSQSjj3L3Xg7zQCoJdnY7AAOa27ksEnzsPEwbjiQxsaQwHY4d+PsBJCWA4nbcGiRv5H+/DfPPwn7DeefMX9I+Hc43XB2+ge8WgxuJJgx87YZJG64kcYgkdh2OEFeOge/LYZn3hhLzu1LSN5w4xmbRGLfYcMN0jkFBxIMcPtF7nj6ww9vvtXZbjifxvzhw7fD8vKz0zd/+FBhJ4fT+wIJDEw8KE4FqzTAoRwE+A8wMP5AFpBvwKN6FIyCUTAKRiQAAFUMZ+1Hx25uAAAAAElFTkSuQmCC","orcid":"","institution":"Recep Tayyip Erdoğan University","correspondingAuthor":true,"prefix":"","firstName":"Ayse","middleName":"Yazan","lastName":"Arslan","suffix":""},{"id":621562604,"identity":"43a3a221-6fda-4e90-a52e-9f766e60ea2c","order_by":1,"name":"Asuman Okur","email":"","orcid":"","institution":"Giresun University","correspondingAuthor":false,"prefix":"","firstName":"Asuman","middleName":"","lastName":"Okur","suffix":""}],"badges":[],"createdAt":"2026-03-26 19:08:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9237501/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9237501/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107481828,"identity":"f3c0bc6d-113a-4054-be50-23c87a98c346","added_by":"auto","created_at":"2026-04-22 02:20:20","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":652094,"visible":true,"origin":"","legend":"","description":"","filename":"BMC.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9237501/v1_covered_0031b5a0-1fa5-4a6f-b587-1ab285b7cf6b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Role of the Triglyceride–Glucose Index and Its Derivatives in Predicting the Risk of Metabolic Dysfunction–Associated Steatotic Liver Disease and Hepatic Fibrosis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"MASLD, liver fibrosis, triglyceride–glucose index, insulin resistance, non-invasive diagnostics, primary care, ROC analysis","lastPublishedDoi":"10.21203/rs.3.rs-9237501/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9237501/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMetabolic dysfunction\u0026ndash;associated steatotic liver disease (MASLD) has emerged as a major global health burden due to its increasing prevalence and its substantial contribution to liver-related morbidity and mortality. In primary care settings, simple, non-invasive, and cost-effective diagnostic biomarkers are needed to facilitate early detection.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective cross-sectional study included 408 adults attending a family medicine outpatient clinic between January 2023 and December 2024. Following the exclusion of secondary causes, MASLD was diagnosed in accordance with current diagnostic criteria and imaging findings. Liver fibrosis risk was evaluated using the Fibrosis-4 (FIB-4) index. The triglyceride\u0026ndash;glucose (TyG) index and its composite derivatives\u0026mdash;TyG \u0026times; body mass index (TyG-BMI), TyG \u0026times; waist circumference (TyG-WC), and TyG \u0026times; waist-to-height ratio (TyG-WHtR)\u0026mdash;were calculated. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMASLD was present in 50.5% of participants. All TyG-related indices demonstrated significant dose\u0026ndash;response associations with MASLD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In fully adjusted analyses, participants in the highest quartile of TyG-WC had a 14.46-fold higher odds of MASLD compared with the lowest quartile (95% CI: 6.85\u0026ndash;30.56; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). ROC analysis showed that TyG-WC had the highest discriminative performance (AUC: 0.761), followed by TyG-WHtR (AUC: 0.752) and TyG-BMI (AUC: 0.750). Subgroup analyses revealed stronger diagnostic performance in younger individuals and those without hypertension or diabetes.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eTyG and its anthropometric derivatives, particularly TyG-WC, are independently associated with MASLD and show moderate diagnostic accuracy. These easily accessible indices may serve as practical screening tools for MASLD in primary care settings.\u003c/p\u003e","manuscriptTitle":"The Role of the Triglyceride–Glucose Index and Its Derivatives in Predicting the Risk of Metabolic Dysfunction–Associated Steatotic Liver Disease and Hepatic Fibrosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-16 19:48:54","doi":"10.21203/rs.3.rs-9237501/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-09T05:12:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-30T06:06:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-27T06:38:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-27T06:38:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2026-03-26T19:03:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a02f6628-7f55-4604-a6d5-8664aac10112","owner":[],"postedDate":"April 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-16T19:48:54+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-16 19:48:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9237501","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9237501","identity":"rs-9237501","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}