Abstract

Background and Objectives: As the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) rises, identifying reliable biomarkers for risk prediction is essential. This study assessed baseline triglyceride glucose (TyG) index and TyG-derived parameters as predictors of future MASLD risk in older adults. Methods and Study Design: We analyzed data from 2,757 Chinese adults (60-91 years) undergoing annual health checks (2017-2023). Incident MASLD was detected using ultrasound after excluding baseline cases. Cox proportional hazards models (with parameters in quartiles) and time-dependent ROC curves quantified associations and time-varying predictive performance among TyG-related parameters. The predictive performance of TyG-BMI was also compared with the hepatic steatosis index (HSI) in ROC analysis. Results: Over a median six-year follow-up, 584 incident MASLD cases occurred. TyG-derived parameters showed stronger associations than TyG index. Specifically, triglyceride glucose-body mass index (TyG-BMI) demonstrated the highest risk, with an adjusted hazard ratio of 6.42 (95% CI: 5.33-7.73) for the highest versus lowest quartile. This association remained robust in sensitivity analysis. TyG-BMI demonstrated numerically higher AUC values than the HSI (Men: TyG-BMI 0.758 vs. HSI 0.747; Women: TyG-BMI 0.759 vs. HSI 0.756), with overlapping confidence intervals. Time-dependent ROC analysis confirmed TyG-BMI’s superior predictive accuracy over time. The optimal TyG-BMI cut-offs were 187.97 for men and 191.33 for women. Conclusions: TyG-BMI demonstrated superior predictive performance compared to TyG index itself, other TyG-derived parameters, and the HSI, supporting its utility as a practical screening tool in primary care.

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