Lipids & metabolic liver disease
Comparative performance of insulin resistance-related indices in predicting adverse cardiovascular events among individuals with non-alcoholic fatty liver disease (NAFLD) and MASLD: a multi-center cohort study
Authors' conclusion
Insulin Resistance-Related Indices demonstrate robust clinical utility in predicting CVD and mortality in NAFLD/MASLD across three distinct cohorts, with oxidative stress, inflammatory activation, and accelerated aging serving as potential mechanistic pathways.
Study context
- Population
- Individuals with MASLD/NAFLD from National Health and Nutrition Examination Survey (NHANES) (4693/3266), UK Biobank (74,173/67,864) and China Pudong cohort (7823/10,576)three cohorts
- Exposure
- Insulin resistance-related indices (triglyceride-glucose (TyG)-related indices, atherogenic index of plasma (AIP), cardiometabolic index (CMI)) for predicting adverse cardiovascular events under NAFLD and MASLD criteria
- Outcome
- Association of elevated TyG-WHTR with CVD mortality, MI and IS
Methodological detailsmulticentre, three cohorts (NHANES, UK Biobank, China Pudong)
- Multicentre
- Three cohorts (NHANES, UK Biobank, China Pudong)
Main finding
As reported in the abstract
- Cardiovascular disease (CVD) mortality, NAFLD, UK Biobank (UKB): HR
- 1.60, 1.38-1.84 (95% CI)
- CVD mortality, NAFLD, NHANES: HR
- 1.90, 1.34-2.70 (95% CI)
- CVD mortality, NAFLD, Pudong: HR
- 1.24, 1.10-1.40 (95% CI)
- CVD mortality, MASLD, UKB: HR
- 1.59, 1.38-1.82 (95% CI)
- CVD mortality, MASLD, NHANES: HR
- 1.86, 1.36-2.54 (95% CI)
- CVD mortality, MASLD, Pudong: HR
- 1.70, 1.43-2.03 (95% CI)
- Myocardial infarction (MI), NAFLD: HR
- 1.20, 1.09-1.33 (95% CI)
- MI, MASLD: HR
- 1.22, 1.11-1.34 (95% CI)
- Ischemic stroke (IS), NAFLD: HR
- 1.41, 1.24-1.61 (95% CI)
- IS, MASLD: HR
- 1.39, 1.23-1.57 (95% CI)
Observational data: associations, not effects.
Further findings
Structural neuroimaging: TyG-WC/TyG-WHTR and subcortical volumes
- Significant negative correlations between TyG-WC/TyG-WHTR and subcortical volumes
- P < 1 × 10-4
Mediation by oxidative stress, phenotypic aging and inflammatory markers
- Proportion of associations collectively accounted for
- 1.4-27%
Original publication
Comparative performance of insulin resistance-related indices in predicting adverse cardiovascular events among individuals with NAFLD and MASLD: a multi-center cohort study. Cardiovasc Diabetol. Published 4 July 2026. doi:10.
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