Comparative Diagnostic Performance of Atherogenic Indices and the Fatty Liver Index for Metabolic Dysfunction-Associated Fatty Liver Disease in a Korean Population

Background: Lipid metabolism abnormalities are a major risk factor for metabolic dysfunction-associated fatty liver disease (MAFLD) and cardiovascular disease.The atherogenic combined index (ACI) has been proposed as a novel predictor of coronary artery disease.We compared the diagnostic performance of ACI, cardiometabolic index (CMI), and atherogenic index of plasma (AIP), and fatty liver index (FLI) for MAFLD.Methods: This study included 22,703 Korean adults who underwent abdominal ultrasonography and biochemical testing at a comprehensive health promotion center.Diagnostic performance and associations with MAFLD were evaluated by area under receiver operating characteristic curve (AUROC) and multivariable logistic regression analysis.Results: Of 22,703 individuals, 32.1% (n=7,287) had MAFLD.CMI, AIP, ACI, and FLI were higher in the MAFLD group than in the controls (all P <0.0001).FLI demonstrated the highest diagnostic performance for MAFLD (AUROC, 0.883), followed by CMI (0.826) and AIP (0.800), whereas ACI showed the lowest performance (0.781).All indices were independently associated with MAFLD: CMI (odds ratio [ OR], 1.636; 95% confidence interval [ CI], 1.546-1.732),AIP (OR, 1.770; 95% CI, 1.684-1.862),ACI (OR, 1.909; 95% CI, 1.806-2.018),and FLI (OR, 1.698; 95% CI, 1.576-1.829)(all P < 0.0001).Conclusions: CMI, AIP, ACI, and FLI were independently associated with MAFLD.ACI had the lowest discriminative performance, whereas FLI had the highest.To the author's knowledge, this is the first study to compare ACI with other atherogenic indices and FLI for MAFLD in a Korean population.