Comparison of Triglyceride-Glucose Index Indices and Fatty Liver Index in Predicting Metabolic Dysfunction-Associated...

Background and Aims: Metabolic dysfunction-associated fatty liver disease (MAFLD) is increasingly prevalent and linked to liver and cardiometabolic complications. Although liver biopsy remains the diagnostic gold standard, its invasiveness limits routine use, and imaging modalities show variable accuracy. Non-invasive indices such as triglyceride-glucose (TyG), triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC), and the fatty liver index (FLI) are recommended for screening, yet their performance in Vietnam remains unclear. This study evaluated and compared these indices in Vietnamese adults. Methods: A cross-sectional study was conducted at the Health Screening Department, University Medical Center Ho Chi Minh City (September 2024-January 2025). After exclusions, 290 adults undergoing routine check-ups with abdominal ultrasound were included. Clinical and laboratory data were collected to calculate TyG, TyG-BMI, TyG-WC, and FLI, and their diagnostic performance for MAFLD was compared using logistic regression and receiver operating characteristic (ROC) analysis, with area under the ROC curve (AUROC) and 95% confidence intervals (CIs). Results: Of 290 participants, 32.76% were diagnosed with MAFLD. Patients with MAFLD were older, more frequently male, and had higher body mass index (BMI), waist circumference (WC), blood pressure (BP), metabolic comorbidities, and abnormal biochemical parameters compared with non-MAFLD. The highest diagnostic performance was observed with TyG-BMI and FLI, both showing area under the receiver operating characteristic curve (AUROC) = 0.89, followed by TyG-WC (0.88) and TyG (0.82). In gender-stratified analysis, indices performed better in females; TyG-BMI achieved the highest AUROC of 0.91, comparable to FLI (0.90). Conclusions: TyG, TyG-BMI, TyG-WC, and FLI demonstrated excellent and comparable diagnostic accuracy for MAFLD, with superior performance in women. These indices represent practical, non-invasive tools for MAFLD screening in both clinical and community settings.