A Cross-Sectional Study to Evaluate the Association of HbA1c and Triglycerates HDL Ratio as a Non Invasive Marker in Non Alcoholic Fatty Liver Disease in a Tertiary Center
Keywords:
NAFLD, HbA1c, diagnosis, Management, MASLDAbstract
Introduction
Non-alcoholic fatty liver disease (NAFLD) is distinguished by the presence of excess fat deposits within hepatic cells specifically when 5% or more of hepatocytes contain fat, by eliminating secondary causes such as excessive alcohol consumption or medications. It is a globally leading liver disease, affecting adults over 25%, with rising prevalence due to increasing obesity, type 2 diabetes mellitus and metabolic syndrome. This study explores HbA1c levels and the triglyceride-to-HDL ratio as non-invasive diagnostic markers.
Materials and Methods:
This cross-sectional study aims to correlate an association between HbA1c and the triglyceride to HDL ratio in the context of non-invasive NAFLD diagnosis. Conducted at a tertiary care center in Chengalpattu district, the study used a convenient sampling method with 85 participants aged 18–65 years, including those with comorbidities like diabetes, dyslipidemia, and hypertension. Data analysis was calculated with the help of SPSS version 21, and the chi-square test, utilized to assess the relationships between the variables
Results:
Participants mean age in this study was 53.57 ± 14.0. 31 patients were in the grade 1 and 27 patients in Grade 2 and 3 respectively. Most of the patients were having high TGL:HDL and grade III fatty liver (n=21). A significant association was noted among the TGL:HDL cholesterol ratio and grade of liver steatosis (p = 0.038). Higher level of HbA1c was associated with increased grading of fatty liver. 19 patients with HbA1c >6.5 were having grade III fatty liver, 16 patients with HbA1c 6.1-6.4 had grade II fatty liver. No significance was demonstrated between HbA1c and grade of fatty liver (p=0.692).
Conclusion:
The triglyceride to HDL-C ratio and HbA1c are potential non-invasive biomarker for NAFLD, linked to insulin resistance and lipid metabolism. It is accessible, easy to use, and aids early detection. Further more researches are needed to confirm its broader clinical applicability, while it may enhance early diagnosis and management
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References
Hepatology [Internet]. [cited 2025 Jan 28]. Available from: https://journals.lww.com/hep/abstract/2016/07000/global_epidemiology_of_nonalcoholic_fatty_liver.14.aspx
Nonalcoholic Fatty Liver Disease and Cardiovascular Risk: A Scientific Statement From the American Heart Association | Arteriosclerosis, Thrombosis, and Vascular Biology [Internet]. [cited 2025 Jan 28]. Available from: https://www.ahajournals.org/doi/full/10.1161/ATV.0000000000000153?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
Association between the triglyceride to high-density lipoprotein cholesterol ratio and type 2 diabetes mellitus in non-alcoholic fatty liver disease | Scientific Reports [Internet]. [cited 2025 Jan 28]. Available from: https://www.nature.com/articles/s41598-024-82116-0
Allen CL, Hooper GJ, Frampton CMA. Do Larger Femoral Heads Improve the Functional Outcome in Total Hip Arthroplasty? J Arthroplasty. 2014 Feb 1;29(2):401–4.
Fan N, Peng L, Xia Z, Zhang L, Song Z, Wang Y, et al. Triglycerides to high-density lipoprotein cholesterol ratio as a surrogate for nonalcoholic fatty liver disease: a cross-sectional study. Lipids Health Dis. 2019 Feb 2;18(1):39.
Paul J. Recent advances in non-invasive diagnosis and medical management of non-alcoholic fatty liver disease in adult. Egypt Liver J. 2020 Jul 28;10(1):37.
Ren XY, Shi D, Ding J, Cheng ZY, Li HY, Li JS, et al. Total cholesterol to high-density lipoprotein cholesterol ratio is a significant predictor of nonalcoholic fatty liver: Jinchang cohort study. Lipids Health Dis. 2019 Feb 11;18(1):47.
Ting YW, Jalaludin MY, Zaini AA, Mohamed R. Triglyceride to high-density lipoprotein cholesterol ratio is an independent predictor of liver fibrosis among pediatrics non-alcoholic fatty liver disease. Front Endocrinol. 2022 Dec 16;13:1071350.
Wang J, Li H, Wang X, Shi R, Hu J, Zeng X, et al. Association between triglyceride to high-density lipoprotein cholesterol ratio and nonalcoholic fatty liver disease and liver fibrosis in American adults: an observational study from the National Health and Nutrition Examination Survey 2017–2020. Front Endocrinol [Internet]. 2024 Jul 16 [cited 2025 Jan 28];15. Available from: https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1362396/full
Masroor M, Haque Z. HbA1C as a Biomarker of Non-alcoholic Fatty Liver Disease: Comparison with Anthropometric Parameters. J Clin Transl Hepatol. 2021 Feb 28;9(1):15–21.
Chen C, Zhu Z, Mao Y, Xu Y, Du J, Tang X, et al. HbA1c may contribute to the development of non-alcoholic fatty liver disease even at normal-range levels. Biosci Rep. 2020 Jan 31;40(1):BSR20193996
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