Analysis of the Association Between TG/HDL, TyG, TyG-BMI, and ZJU Indices with Metabolic Dysfunction-Associated Fatty Liver Disease in Patients with Type 2 Diabetes

Yunyi Yang,1,* Hongping Wang,2,* Yanming He,1 Xiaoli He,1 Zheng Yao,1 Hongjie Yang1 1Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, People’s Republic of China; 2Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hongjie Yang, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, People’s Republic of China, Email [email protected] Zheng Yao, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, People’s Republic of China, Email [email protected]: TG/HDL, TyG, TyG-BMI, and ZJU indices are associated with metabolic syndrome and cardiovascular diseases. This study aims to evaluate the relationships between these indices and metabolic dysfunction-associated fatty liver disease (MAFLD) in patients with type 2 diabetes (T2DM).Methods: We analyzed 598 T2DM patients, with MAFLD diagnosed based on abdominal ultrasound and clinical manifestations. Clinical characteristics and laboratory results were collected. Correlation analysis assessed the relationship between insulin resistance (IR) indicators and MAFLD. Logistic regression and restrictive cubic spline (RCS) analyses were performed to evaluate associations, and ROC curve analysis identified the most effective IR indicator for MAFLD.Results: Among the IR indices, the strongest association with MAFLD was observed for TyG-BMI (p < 0.001). Logistic regression analysis indicated a significant relationship between TyG-BMI and the diagnosis of MAFLD (P = 0.006). RCS curve analysis showed distinct trends: TG/HDL-C (J-shaped), TyG (inverted U-shaped), and TyG-BMI (linear), with TyG-BMI showing the most robust relationship. ROC curve analysis identified TyG-BMI as the most effective diagnostic indicator. Subgroup analysis revealed that TG/HDL, TyG, and the ZJU index had stronger effects in females, with TG/HDL being the most effective.Conclusion: TyG-BMI is a significant determinant for the diagnosis of MAFLD in T2DM patients, while TG/HDL is more effective for screening in female patients.Keywords: TG/HDL, TyG, TyG-BMI, ZJU, T2DM, MAFLD