โก Quick Summary
This study explored the mediating role of insulin resistance (IR) in the relationship between hypertension and non-alcoholic fatty liver disease (NAFLD), analyzing data from 280,976 individuals. The findings suggest that IR significantly contributes to the risk of NAFLD, with the triglyceride-glucose index (TyG-WC) emerging as a key predictive indicator.
๐ Key Details
- ๐ Dataset: 280,976 individuals from health examinations
- ๐งฉ Conditions studied: Hypertension and NAFLD
- โ๏ธ Key indices: TyG-WC and METS-IR
- ๐ Performance metrics: AUC of 0.91, accuracy of 0.83
๐ Key Takeaways
- ๐ Prevalence: NAFLD was found in 63.61% of hypertensive individuals compared to 33.79% in non-hypertensive participants.
- ๐ก Insulin resistance plays a crucial mediating role in the hypertension-NAFLD relationship.
- ๐ TyG-WC and METS-IR were identified as the most relevant IR indices for predicting NAFLD risk.
- ๐ Mediation analysis: TyG-WC explained 32.03% of the total effect, while METS-IR accounted for 17.02%.
- ๐ค Machine learning models showed comparable performance to traditional logistic regression in predicting NAFLD risk.
- ๐ Implications: Risk prediction models can aid in early screening and prevention of NAFLD in the general population.
๐ Background
Non-alcoholic fatty liver disease (NAFLD) and hypertension are prevalent metabolic disorders that often coexist. Both conditions are closely linked to insulin resistance (IR), which suggests that they may share common pathological mechanisms. Understanding the interplay between these conditions is crucial for developing effective prevention and treatment strategies.
๐๏ธ Study
Conducted at the Health Management Center of the Third Xiangya Hospital of Central South University from August 2017 to December 2021, this study included a large cohort of individuals who underwent comprehensive health examinations. The researchers aimed to elucidate the mediating role of IR in the relationship between hypertension and NAFLD, while also evaluating various IR surrogate indices for their predictive capabilities.
๐ Results
The study revealed a significantly higher prevalence of NAFLD among hypertensive individuals, with a notable increase in IR levels and adverse metabolic features. The TyG-WC and METS-IR indices were consistently associated with NAFLD across multiple models. The predictive performance of the simplified model, which included key demographic and metabolic parameters, demonstrated an accuracy of 0.83 and an AUC of 0.91, indicating strong predictive capabilities.
๐ Impact and Implications
The findings of this study underscore the importance of recognizing insulin resistance as a significant factor in the relationship between hypertension and NAFLD. By utilizing IR surrogate indices like TyG-WC, healthcare professionals can enhance early screening and individualized prevention strategies for NAFLD, potentially improving patient outcomes and reducing the burden of these metabolic disorders.
๐ฎ Conclusion
This research highlights the critical role of insulin resistance in mediating the relationship between hypertension and NAFLD. The identification of TyG-WC as a key predictive indicator offers a promising avenue for risk assessment and early intervention. As we continue to explore the connections between metabolic disorders, the integration of simple and interpretable risk prediction models will be essential for advancing public health initiatives.
๐ฌ Your comments
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[Mediating role of insulin resistance in the relationship between hypertension and NAFLD and construction of its risk prediction model].
Abstract
OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) and hypertension are common metabolic disorders, both closely associated with insulin resistance (IR), suggesting potential shared pathological mechanisms. This study aims to investigate the mediating role of IR in the relationship between hypertension and NAFLD, and to evaluate the applicability and modeling value of various IR surrogate indices in predicting NAFLD risk.
METHODS: A total of 280 976 individuals who underwent health examinations at the Health Management Center of the Third Xiangya Hospital of Central South University between August 2017 and December 2021 were included. NAFLD was diagnosed based on abdominal ultrasound findings, and hypertension was defined according to the criteria of the Chinese Guidelines for the Management of Hypertension. Demographic information, anthropometric indices, and biochemical parameters were collected, and multiple IR surrogate indices were constructed, including the triglyceride-glucose index (TyG) and its derivatives, as well as the metabolic score for insulin resistance (METS-IR). Group comparisons were performed between hypertensive and non-hypertensive participants, as well as between NAFLD and non-NAFLD participants. Pearson correlation analysis was applied to assess the associations of metabolic parameters and IR indices with NAFLD. Furthermore, mediation models were constructed to explore the mediating role of IR in the “hypertension-NAFLD” relationship. Finally, parametric models and machine learning algorithms were compared to evaluate their predictive performance and value in assessing NAFLD risk in this population.
RESULTS: The prevalence of NAFLD was significantly higher in hypertensive individuals than in non-hypertensive participants (63.61% vs 33.79%, P<0.001), accompanied by elevated IR levels and adverse metabolic features. Correlation analysis and variable importance rankings across multiple models consistently identified TyG-waist circumference (TyG-WC) and METS-IR as the IR indices most strongly associated with NAFLD. In mediation analysis, the TyG-WC pathway explained 32.03% of the total effect, and the METS-IR pathway explained 17.02%. Interaction analysis showed that hypertension status may attenuate the mediating effect of IR (all interaction estimates were negative). In prediction model comparisons, the simplified model incorporating sex, age, WC, TyG-WC, and METS-IR demonstrated good performance in the test set. Logistic regression and its regularized form (LASSO regression) achieved an accuracy of 0.83, receiver operating characteristic (ROC)-area under the curve (AUC) of 0.91, and a Brier score of 0.12, comparable to ensemble models (random forest and XGBoost), with consistently stable performance across different algorithms.
CONCLUSIONS: IR plays a significant mediating role in the association between hypertension and NAFLD, with TyG-WC identified as a key indicator showing strong mechanistic relevance and predictive value. Risk prediction models based on IR surrogate indices demonstrate advantages in simplicity and interpretability, providing empirical support for the early screening and individualized prevention of NAFLD in the general population.
Author: [‘He Y’, ‘He H’, ‘Cao Y’, ‘Wang F’]
Journal: Zhong Nan Da Xue Xue Bao Yi Xue Ban
Citation: He Y, et al. [Mediating role of insulin resistance in the relationship between hypertension and NAFLD and construction of its risk prediction model]. [Mediating role of insulin resistance in the relationship between hypertension and NAFLD and construction of its risk prediction model]. 2025; 50:1188-1201. doi: 10.11817/j.issn.1672-7347.2025.250055