Association of AGAHR with metabolic dysfunction-associated steatotic liver disease (MASLD)

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an increasing global health concern. This cross-sectional study aimed to evaluate the association between the AGAHR index [calculated as (alanine aminotransferase (ALT)×plasma fasting glucose (PFG)) to (aspartate aminotransferase (AST)×high-density lipoprotein cholesterol (HDL-C)) ratio] and MASLD.

Data from 2508 participants in the NHANES 2017-2020 cycle were analyzed. Weighted multivariable logistic regression, restricted cubic spline (RCS), receiver operating characteristic (ROC), and decision curve analysis (DCA) were performed. The findings were further assessed in an independent local cohort (n = 56).

After adjustment for potential confounders, AGAHR was positively associated with MASLD [odds ratio (OR): 1.17, 95% confidence interval (CI): 1.10-1.24, P < 0.001]. RCS analysis suggested a nonlinear association pattern. In the NHANES cohort, AGAHR demonstrated good discriminative ability [area under the curve (AUC): 0.752, 95% CI: 0.733-0.771], outperforming the PFG/HDL-C ratio (GHR) and ALT/AST ratio (AAR). These findings were consistent in the validation cohort (AUC: 0.756, 95% CI: 0.624-0.889). DCA indicated that AGAHR provided a greater net benefit across a range of threshold probabilities compared with the reference indicators.

AGAHR is significantly associated with MASLD and may serve as a simple indicator reflecting metabolic features related to hepatic steatosis. Further studies in larger and more diverse populations are warranted to confirm these findings.