ESPE Abstracts

Background: The triglyceride glucose (TyG) index is significantly associated with the presence of nonalcoholic fatty liver disease (NAFLD) and is a reliable insulin resistance (IR) surrogate marker. Alanine aminotransferase (ALT) has been commonly used to reflect liver inflammation and liver damage in patients with chronic liver diseases, including NAFLD. Transient elastography (TE) uses pulsed echo ultrasound to measure the hardness of the liver, showing excellent accuracy in the assessment of fibrosis, and is considered a useful test in NAFLD. Liver stiffness measurement (LSM)≥5.5 kPa has been suggested as a predictive finding liver fibrosis in Korean children and adolescents.

Objects: We hypothesized that the combination of TyG and ALT would also be useful in assessing the detection and severity of NAFLD. Therefore, this study evaluated the relationship between TyG-ALT index and TE in pediatric non-alcoholic steatohepatitis (NASH) and compare it with TyG index and homeostatic model assessment for IR (HOMA-IR).

Methods: In this cross-sectional study, elastography was performed on 87 participants with an average age of 11.42±2.19 years who were diagnosed with fatty liver on ultrasound. TE was used to evaluate liver fibrosis in terms of liver stiffness measurement (LSM). The TyG index, the TyG-ALT index, and HOMA-IR were calculated as follows: TyG index=ln(fasting TG [mg/dL]×fasting glucose [mg/dL]/2), TyG–ALT index=ln(fasting triglyceride [mg/dL]×fasting glucose [mg/dL]×ALT [IU/L]/2), and HOMA-IR=(fasting insulin [mIU/L]×fasting glucose [mg/dL]/405).

Results: The TyG-ALT index was significantly correlated with TE (r=0.268, p=0.022), TyG index (r=0.784, p<0.001), HOMA-IR (r=0.413, p=0.001), AST (r=0.664, P<0.001), and ALT (r=0.723, p<0.001). The TE was significantly correlated with BMI SDS (r=0.361, p=0.001), AST (r=0.432, p<0.001), and ALT (r=0.421, p<0.001), but not with TyG index (r=0.173, p=0.133) and HOMA-IR (r=0.074, p=0.454). According to the results of univariate logistic regression analysis, TyG-ALT index (OR 2.582; p=0.44) was significantly associated with NASH diagnosed by TE, but not with TyG index (OR 1.436; p=0.579) and HOMA-IR (OR 1.150, p=0.225). In the receiver operating characteristic analysis, the TyG–ALT index (area under the curve [AUC]=0.746, p=0.033) showed a better performance for detection of NASH than HOMA-IR (AUC=0.649, p=0.232) and the TyG index (AUC=0.537, p=0.750).

Conclusions: The TyG-ALT index was significantly associated with TE than TyG index and HOMA-IR, and further studies are needed as a useful non-invasive marker for NASH detection.