Metabolic score for insulin resistance is associated with metabolic dysfunction-associated steatotic liver disease among adults with hypertension: a cross-sectional secondary analysis of a Chinese single-center health check-up population
TL;DR
Among adults with hypertension in a Chinese single-center health check-up population, higher METS-IR was associated with a higher likelihood of prevalent MASLD and showed a graded, mildly non-linear pattern.
Abstract
Background Metabolic dysfunction-associated steatotic liver disease (MASLD; formerly termed non-alcoholic fatty liver disease) and hypertension frequently coexist within the same cardiometabolic context. The metabolic score for insulin resistance (METS-IR), which is derived from body mass index, fasting blood glucose, triglycerides, and high-density lipoprotein cholesterol without requiring insulin measurement, may serve as a practical auxiliary indicator of metabolic dysfunction. Objective This study investigated the association between METS-IR and MASLD among adults with hypertension and evaluated the dose-response pattern, non-linear features, discrimination, and effect modification. Methods This secondary cross-sectional analysis used publicly available data from a Chinese single-center health check-up cohort. A total of 943 adults with hypertension were included. MASLD was operationally defined as ultrasonographically detected hepatic steatosis in adults with hypertension after exclusion of excessive alcohol intake and other known causes of liver disease. The primary multivariable model was adjusted for age group, sex, tobacco use, alcohol use, and diabetes; an extended model additionally included uric acid, total cholesterol, low-density lipoprotein cholesterol, and fat-to-muscle ratio. Logistic regression, quartile analysis, restricted cubic spline analysis, sensitivity analyses, receiver operating characteristic analysis, and subgroup interaction analyses were performed. Results Among the 943 participants, 640 had MASLD, corresponding to a prevalence of 67.9%. The prevalence of MASLD increased across METS-IR quartiles from 40.7% to 67.2%, 74.6%, and 89.0%. After adjustment for age group, sex, tobacco use, alcohol use, and diabetes, each 1-standard deviation increase in METS-IR was associated with higher odds of prevalent MASLD (odds ratio [OR] = 2.78, 95% confidence interval [CI]: 2.24-3.44, P < 0.001). Compared with quartile 1, the ORs for quartiles 2, 3, and 4 were 2.99, 4.01, and 9.72, respectively. In the extended model, the corresponding OR per 1-standard deviation increase was 2.47 (95% CI: 1.91-3.18, P < 0.001). Restricted cubic spline analysis suggested mild non-linearity. Exploratory ROC analysis yielded an area under the curve of 0.738 (95% CI: 0.705-0.772); the data-derived METS-IR cut-point of 42.40 had a sensitivity of 53.0% and a specificity of 81.8%. A borderline interaction by sex was observed (P for interaction = 0.046), whereas interactions by age group and diabetes status were not statistically significant. Conclusion Among adults with hypertension in a Chinese single-center health check-up population, higher METS-IR was associated with a higher likelihood of prevalent MASLD and showed a graded, mildly non-linear pattern. METS-IR may serve as an accessible auxiliary metabolic indicator, but its data-derived cut-point and possible sex-specific association require independent validation.