Diabetes & Metabolism

Published on June 2, 2022 in Recently published articles

Benjamin Rivière, Audrey Jaussent, Valérie Macioce, Stéphanie Faure, Nicolas Builles, Patrick Lefebvre, Philippe Géraud, Marie-Christine Picot, Sandra Rebuffat, Eric Renard, Valérie Paradis, Marie-Dominique Servais, Nathalie de Preville, David Nocca, Anne-Dominique Lajoix, Georges-Philippe Pageaux, Florence Galtier, COMET study group. The triglycerides and glucose (TyG) index: A new marker associated with nonalcoholic steatohepatitis (NASH) in obese patients. Diabetes & Metabolism, 2022, 48(4): 101345.

https://www.sciencedirect.com/science/article/pii/S1262363622000283?dgcid=coauthor

Abstract

Aim

The diagnosis of nonalcoholic steatohepatitis (NASH) relies on liver biopsy. Noninvasive tools would be useful for identifying patients who should be referred for a biopsy. We aimed to determine the diagnostic value of the triglycerides and glucose (TyG) index, an indicator of insulin resistance, for predicting NASH.

Methods

Our study included patients with grade II–III obesity aged 18–65 years who underwent bariatric surgery and were enrolled in the COMET (COllection of MEtabolic Tissues) biobank (NCT02861781). Liver biopsies performed during bariatric surgery were collected from the biobank along with blood samples. Biopsies were analyzed using the steatosis, activity, and fibrosis (SAF) scoring system to diagnose NASH, nonalcoholic fatty liver disease (NAFLD), and fibrosis. Logistic regression models were performed to identify factors predicting NASH, NAFLD, and fibrosis.

Results

Of 238 analysed subjects (mean age 43±12 years, 33.6% men), 29% had type 2 diabetes. Steatosis was present in 67.2%, while NASH and advanced fibrosis (stage F3) were diagnosed in 18.1% and 2.9% respectively. TyG index was independently associated with NASH (odds ratio (OR): 4.7 [95% confidence interval: 2.3;9.5] P < 0.0001), NAFLD (OR: 2.0 [1.1;3.7] P = 0.03) and stages 2-3 fibrosis (OR: 4.0 [1.5;10.8] P = 0.007). NASH was also predicted by gamma-glutamyl transferase (GGT) with an area under the ROC curve: 0.79 [0.71;0.87 P = 0.04] for GGT and TyG index combined.

Conclusion

In our cohort of severely obese patients, the TyG index, when combined with GGT levels, demonstrated high diagnostic accuracy in predicting NASH. Although validation in larger populations is needed, this finding may be of considerable clinical value in predicting the need for a liver biopsy.