Diagnostic Utility of Lipid Indices for Detecting MASLD in Patients with Metabolic Syndrome
Eunice Susan Thomson *
Department of General Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Akash Thomas Oommen
Department of General Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a prevalent hepatic manifestation of metabolic syndrome and is emerging as a leading cause of chronic liver disease globally. Early detection is essential for effective risk stratification and intervention. Lipid abnormalities – especially elevated triglycerides - are central to MASLD pathophysiology and may serve as cost-effective, non-invasive diagnostic indicators.
Objectives: To evaluate the clinical utility of lipid parameters and lipid-derived indices in predicting the presence and severity of MASLD in adults with metabolic syndrome.
Methodology: A prospective observational study was conducted at a tertiary care hospital in 2024. A total of 110 adult patients with metabolic syndrome were enrolled. Anthropometric data, fasting lipid profiles, liver enzymes, glucose metabolism markers and derived indices (TG/HDL, TG/LDL, TG/Total Cholesterol, HDL/LDL and TyG index) were assessed. Abdominal ultrasonography was used to classify MASLD severity. Statistical analyses included ROC curves, Pearson correlation, t-tests and chi-square tests were done.
Results: Triglyceride levels were significantly higher in patients with MASLD (median 112.00 vs. 92.00 mg/dL, p = 0.0001), whereas HDL, LDL and total cholesterol showed no significant differences. ROC analysis indicated that the TG/Total Cholesterol ratio had the highest discriminative power (AUC = 0.70, p < 0.001), followed by TG/HDL (AUC = 0.64, p = 0.010), TyG index (AUC = 0.64, p = 0.007) and TG/LDL (AUC = 0.63, p = 0.016). The HDL/LDL ratio was not predictive (AUC = 0.46, p = 0.484).
Conclusion: Triglyceride-based indices- especially TG/Total Cholesterol and TG/HDL, demonstrate strong potential as non-invasive predictors of MASLD. These markers may complement imaging tools and support early screening in metabolic syndrome patients, enhancing timely intervention and clinical outcomes.
Keywords: MASLD, nonalcoholic fatty liver disease, triglycerides, lipid profile, TG/HDL ratio, TyG index, ultrasound, metabolic syndrome, ROC curve, predictive biomarkers