The Triglyceride/HDL Ratio as a Non-Invasive Marker for Early-Stage NAFLD: A Retrospective Cross-Sectional Study of 2588 Patients

<b>Background</b>: Non-alcoholic fatty liver disease (NAFLD) is a global public health issue. Although liver biopsy remains the gold standard for diagnosing hepatosteatosis, its invasiveness, high cost, and associated risks limit its widespread use. Therefore, there is a need for reliable, non-invasive, and cost-effective biomarkers to aid in the early detection of NAFLD. Our objective was to determine the utility of the triglyceride (TG)-to-high-density-lipoprotein (HDL) ratio in predicting non-alcoholic fatty liver disease. <b>Methods</b>: This retrospective cross-sectional study included 2588 patients who met the inclusion criteria. Demographic data and laboratory results were collected from electronic health records. Experienced radiologists performed abdominal ultrasonography to assess fatty liver according to the EASL 2021 criteria. The TG/HDL ratio and other non-invasive scores (APRI, FIB-4, ALT/AST, TG/glucose) were calculated. Early-stage disease was defined as grade 1 or grade 2 hepatosteatosis. <b>Results</b>: The TG/HDL ratio was significantly higher in NAFLD patients (AUROC: 0.682) and outperformed the other non-invasive indices. At the optimal cut-off value of 1.86, the sensitivity was 80.7%, and the specificity was 45.5%. The TG/HDL ratio correlated positively with markers of glycemic control, inflammation, and liver enzymes. <b>Conclusions</b>: The TG/HDL ratio is an accessible and valuable parameter for predicting non-alcoholic fatty liver disease. It offers a non-invasive alternative to liver biopsy and potentially prevents complications from non-alcoholic fatty liver disease or diagnostic approaches.