Fasting insulin to HDL-C ratio is correlated with MASLD severity in Chinese overweight/obesity: a cross-sectional analysis

The fasting insulin to high-density lipoprotein cholesterol ratio (FINS/HDL-C) is a newly identified insulin resistance (IR) marker. And the correlation between FINS/HDL-C and metabolic dysfunction-associated steatotic liver disease (MASLD) has not yet been explored, our study investigated the association between FINS/HDL-C and MASLD severity. This cross-sectional study included 330 participants with overweight/obesity and MASLD. Demographic information and biochemical indicators were collected, and IR markers including FINS/HDL-C, homeostatic model assessment for insulin resistance (HOMA-IR), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), and triglyceride glucose index (TyG), were calculated. MASLD severity was assessed using the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) determined by FibroScan. The relationship between FINS/HDL-C and MASLD severity was evaluated and compared with that of other IR markers. Participants with higher CAP and LSM exhibited significantly higher FINS/HDL-C ( P < 0.05). Even in the fully adjusted linear regression model, FINS/HDL-C remains positively correlated with CAP (β = 0.28, 95% CI 0.03 ~ 0.53, P = 0.030) and LSM (β = 1.71, 95% CI 0.33 ~ 3.09, P = 0.015). And FINS/HDL‑C was the only biomarker that showed elevated CAP at Quartile 2. Exploratory analysis suggested that BMI might be involved in the association between FINS/HDL-C and CAP and LSM. FINS/HDL-C had the highest area under the receiver operating characteristic curve for severe hepatic steatosis, at 0.699 (95% CI: 0.639 ~ 0.758). Our findings suggest that FINS/HDL-C is associated with MASLD severity in overweight/obese individuals. It might serve as a valuable biomarker for MASLD risk stratification.