Associations Between Novel Lipid Indicators and the Risk of Nonalcoholic Fatty Liver Disease in Patients With Type 2 Diabetes

This study aimed to evaluate associations between emerging lipid parameters, including the ZJU index (ZJU), the hepatic steatosis index (HSI), the triglyceride-glucose index (TyG), the Framingham steatosis index (FSI) and the atherogenic index of plasma (AIP), and nonalcoholic fatty liver disease (NAFLD) risk in individuals with type 2 diabetes mellitus (T2DM) and assess their clinical utility for NAFLD prevention and diabetes management. Clinical data from 6378 participants were analyzed. Stepwise-adjusted multivariable logistic regression, restricted cubic splines (RCS), subgroup analysis, and sensitivity tests examined relationships between lipid parameters and NAFLD. Receiver operating characteristic (ROC) curves compared predictive performance. Among participants, 36.11% (2303/6378) had NAFLD. After full adjustment, each 1-unit increase in ZJU, HSI, TyG, FSI, and AIP conferred NAFLD odds ratios (95% CI) of 1.22 (1.14-1.31), 1.08 (1.05-1.11), 2.19 (1.82-2.63), 1.01 (1.00-1.02), and 4.75 (2.97-7.58), respectively. When divided into quartiles, the highest quartile of these parameters exhibited 2.13-fold, 2.86-fold, 2.04-fold, 1.80-fold, and 1.68-fold NAFLD risk compared to the lowest quartile. RCS revealed significant nonlinear relationships (p _overall < 0.001, p _nonlinear < 0.05). Sensitivity analysis confirmed robustness. ROC curves identified HSI as the strongest predictor (AUC = 0.709, 95% CI: 0.696-0.721). Elevated ZJU, HSI, TyG, FSI, and AIP were significantly associated with increased NAFLD risk in the T2DM population. HSI may demonstrate superior predictive performance for NAFLD in T2DM populations compared to other conventional lipid parameters.