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Interpreting the triglyceride–glucose index and its derived indices in metabolic dysfunction-associated steatotic liver disease: clinical utility and evidence gaps
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DOI：10.3389/fmed.2026.1857612.png)
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Abstract
En 中文
Metabolic dysfunction-associated steatotic liver disease (MASLD) is common; yet early disease often remains unrecognized. The triglyceride–glucose (TyG) index; calculated from fasting triglyceride and glucose concentrations; has emerged as an accessible surrogate marker of metabolic dysfunction. This review examines the clinical interpretation; biological context; and current limitations of the TyG index and its anthropometric and inflammatory derivatives in MASLD. Current evidence links higher TyG-related measures to prevalent steatosis; fibrosis markers; and selected extrahepatic outcomes. Indices incorporating body mass index; waist circumference; or waist-to-height ratio may improve risk discrimination in some settings; particularly when body-fat distribution is informative. However; their performance varies according to population characteristics; disease definition; reference standard; and clinical purpose. TyG is not a direct measure of hepatic or peripheral insulin resistance; liver inflammation; or fibrosis. It should therefore be considered a metabolic risk marker rather than a stand-alone diagnostic test for MASLD or MASH. Important limitations include the predominance of cross-sectional evidence; heterogeneity among NAFLD; MAFLD; and MASLD definitions; variable cutoff values; and component overlap between TyG-derived indices and cardiometabolic diagnostic criteria. Evidence for liver-specific hard outcomes remains limited. Future studies should directly compare TyG-related markers with established metabolic and liver-directed tests in diverse prospective cohorts; using standardized repeated measurements and outcomes including progressive fibrosis; cirrhosis; hepatocellular carcinoma; and liver-related death. At present; TyG-related measures may complement; but cannot replace; liver-specific assessment.
Keywords:
insulin resistance
metabolic dysfunction-associated steatotic liver disease
triglyceride–glucose index
cardiometabolic risk
non-invasive risk assessment
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