Atherogenic index of plasma combined with waist circumference and body mass index to predict metabolic-associated fatty liver disease

doi:10.3748/wjg.v28.i36.5364

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World Journal of Gastroenterology

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Observational Study

World J Gastroenterol. Sep 28, 2022; 28(36): 5364-5379
Published online Sep 28, 2022. doi: 10.3748/wjg.v28.i36.5364

Table 1 Baseline characteristics of the study subjects

Variable	Non-MAFLD, n = 352	MAFLD, n = 512	Statistics¹	P value
Demographics
Sex			χ² = 14.020	< 0.001
Male	230 (65.3)	394 (77.0)
Female	122 (34.7)	118 (23.0)
Age in yr	37.750 ± 10.736	41.240 ± 10.852	t = -4.634	< 0.001
Age ≥ 40 yr	115 (32.7)	254 (49.6)	χ² = 24.461	< 0.001
Age < 40 yr	237 (67.3)	258 (40.4)
Smoking history	81 (23.0)	174 (34.0)	χ²= 12.073	< 0.001
Drinking history	76 (21.6)	145 (28.3)	χ²= 4.962	0.027
Anthropometrics
WC in cm	86.240 ± 9.893	96.790 ± 8.618	t = -16.219	< 0.001
BMI in kg/m²	24.436 ± 3.169	28.028 ± 3.221	t = -16.228	< 0.001
SBP in mmHg	125.880 ± 14.883	133.610 ± 16.859	t = -6.908	< 0.001
DBP in mmHg	77.500 ± 11.658	82.950 ± 12.525	t = -6.461	< 0.001
Laboratory tests
ALT in U/L	21.0 (15.0, 30.0)	34.0 (24.0, 54.0)	Z = -12.276	< 0.001
AST in U/L	19.0 (17.0, 23.0)	23.0 (19.0, 29.0)	Z = -9.058	< 0.001
TC in mmol/L	4.539 ± 0.847	4.783 ± 0.902	t = -4.104	< 0.001
TG in mmol/L	1.1 (0.7, 1.5)	1.8 (1.3, 2.6)	Z = -13.650	< 0.001
HDL-C in mmol/L	1.351 ± 0.283	1.191 ± 0.256	t = 8.321	< 0.001
LDL-C in mmol/L	2.645 ± 0.708	2.906 ± 0.884	t = -4.568	< 0.001
FBG in mmol/L	5.2 (4.9, 5.4)	5.4 (5.1, 5.9)	Z = -7.637	< 0.001
SUA in μmol/L	332.722 ± 86.289	377.836 ± 85.859	t = -7.590	< 0.001
AIP	-0.11 (-0.30, 0.08)	0.20 (0.03, 0.39)	Z = -14.006	< 0.001

¹Comparison of significant differences between the two groups; χ² value calculated by the χ² test; Z value calculated by the Mann-Whitney U test; t value calculated by the independent samples t test. Data are presented as median and interquartile range, mean and standard deviation or frequency (percentage). MAFLD: Metabolic-associated fatty liver disease; WC: Waist circumference; BMI: Body mass index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TC: Total cholesterol; TG: Triglyceride; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; FBG: Fasting blood glucose; SUA: Serum uric acid; AIP: Atherogenic index of plasma.

Table 2 Multivariate logistic regression of atherogenic index of plasma for the risk of metabolic-associated fatty liver disease

Variable		β	SE	Wald χ²	P value	OR (95%CI)
Model 1	AIP level (per change in SD)	3.918	0.318	151.599	< 0.001	50.286 (26.953-93.819)
	Quartiles of AIP
	A1 (≤ -0.1265)	-	-	-	-	1 (Ref)
	A2 (-0.1265-0.0947)	1.241	0.209	35.108	< 0.001	3.460 (2.295-5.217)
	A3 (0.0947-0.3023)	2.323	0.226	105.794	< 0.001	10.204 (6.554-15.885)
	A4 (> 0.3022)	2.826	0.245	132.611	< 0.001	16.882 (10.436-27.311)
Model 2	AIP level (per change in SD)	3.889	0.32	147.414	< 0.001	48.874 (26.087-91.569)
	Quartiles of AIP
	A1 (≤ -0.1265)	-	-	-	-	1 (Ref)
	A2 (-0.1265-0.0947)	0.847	0.241	12.347	< 0.001	3.218 (2.124-4.876)
	A3 (0.0947-0.3023)	1.690	0.260	42.107	< 0.001	9.774 (6.256-15.270)
	A4 (> 0.3022)	2.103	0.281	55.913	< 0.001	16.514 (10.176-26.799)
Model 3	AIP level (per change in SD)	2.784	0.362	59.147	< 0.001	16.184 (7.961-32.902)
	Quartiles of AIP
	A1 (≤ -0.1265)	-	-	-	-	1 (Ref)
	A2 (-0.1265-0.0947)	0.847	0.241	12.347	< 0.001	2.334 (1.455-3.744)
	A3 (0.0947-0.3023)	1.690	0.260	42.107	< 0.001	5.421 (3.253-9.032)
	A4 (> 0.3022)	2.103	0.281	55.913	< 0.001	8.194 (4.721-14.22)
Model 4	AIP level (per change in SD)	2.519	0.371	46.230	< 0.001	12.420 (6.008-25.675)
	Quartiles of AIP
	A1 (≤ -0.1265)	-	-	-	-	1 (Ref)
	A2 (-0.1265-0.0947)	0.828	0.249	11.088	0.001	2.288 (1.4063-725)
	A3 (0.0947-0.3023)	1.642	0.268	37.636	< 0.001	5.167 (3.058-8.732)
	A4 (> 0.3022)	1.969	0.289	46.343	< 0.001	7.160 (4.062-12.62)

Model 1: Unadjusted. Model 2: Adjusted for age and sex. Model 3: Adjusted for age, sex, smoking history, drinking history, waist circumference and body mass index. Model 4: Adjusted for age, sex, smoking history, drinking history, waist circumference, body mass index, systolic blood pressure, diastolic blood pressure, alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting blood glucose, and serum uric acid. AIP: Atherogenic index of plasma; SE: Standard error; OR: Odds ratio; CI: Confidence interval; SD: Standard deviation.

Table 3 Results analysis of the receiver operating characteristic curves

Variable	AUC (95%CI)	P value	Sensitivity (%)	Specificity (%)	Youden index	Cutoff value
Total
AIP	0.780 (0.751-0.807)	< 0.0001	75.20	69.89	0.4508	0.0340
WC in cm	0.790 (0.761-0.817)	< 0.0001	85.94	58.52	0.4446	88.00
BMI in kg/m²	0.788 (0.759-0.814)	< 0.0001	83.20	59.09	0.4229	25.10
A-W-B	0.833 (0.807-0.858)¹^,²^,³	< 0.0001	86.13	68.47	0.5460	0.5019
Male
AIP	0.755 (0.719-0.788)	< 0.0001	75.89	64.78	0.4067	0.0821
WC in cm	0.770 (0.735-0.803)	< 0.0001	72.59	67.39	0.3998	92.50
BMI in kg/m²	0.773 (0.738-0.805)	< 0.0001	72.34	68.70	0.4103	26.32
A-W-B	0.814 (0.781-0.843)¹^,²^,³	< 0.0001	82.99	65.65	0.4865	0.5932
Female
AIP	0.819 (0.764-0.865)	< 0.0001	82.2	70.49	0.5270	-0.1390
WC in cm	0.820 (0.765-0.866)	< 0.0001	81.36	69.67	0.5103	85.50
BMI in kg/m²	0.804 (0.748-0.852)	< 0.0001	88.98	58.20	0.4718	23.34
A-W-B	0.874 (0.826-0.914)¹^,²^,³	< 0.0001	78.81	83.61	0.6242	0.4105
Age ≥ 40 yr
AIP	0.726 (0.678-0.771)	< 0.0001	71.26	66.96	0.3822	0.0367
WC in cm	0.736 (0.688-0.780)	< 0.0001	82.68	52.17	0.3485	88.00
BMI in kg/m²	0.736 (0.688-0.780)	< 0.0001	71.26	66.96	0.3822	26.03
A-W-B	0.787 (0.742-0.828)¹^,²^,³	< 0.0001	77.56	69.57	0.4712	0.5574
Age < 40 yr
AIP	0.816 (0.779-0.849)	< 0.0001	73.64	77.22	0.5086	0.0814
WC in cm	0.824 (0.787-0.856)	< 0.0001	89.15	61.60	0.5075	88.00
BMI in kg/m²	0.820 (0.783-0.853)	< 0.0001	83.72	66.24	0.4997	25.31
A-W-B	0.863 (0.830-0.892)¹^,²^,³	< 0.0001	89.92	71.73	0.6165	0.4947
BMI ≥ 28 kg/m²
AIP	0.579 (0.519-0.638)	0.0849	25.63	90.91	0.1654	0.4140
WC in cm	0.597 (0.688-0.780)	0.0303	36.97	79.55	0.1652	104.50
BMI in kg/m²	0.648 (0.589-0.704)	0.0005	65.13	68.18	0.3331	29.38
A-W-B	0.644 (0.585-0.700)¹	0.0007	43.28	84.09	0.2737	0.9009
BMI < 28 kg/m²
AIP	0.783 (0.747-0.816)³	< 0.0001	69.71	76.30	0.4601	0.0340
WC in cm	0.754 (0.717-0.789)	< 0.0001	78.1	63.31	0.4141	87.50
BMI in kg/m²	0.733 (0.695-0.768)	< 0.0001	77.37	59.42	0.3679	24.56
A-W-B	0.822 (0.789-0.852)¹^,²^,³	< 0.0001	80.66	72.08	0.5273	0.4531

¹Indicates significantly larger compared with atherogenic index of plasma.

²Indicates significantly larger as compared with waist circumference.

³Indicates significantly larger as compared with body mass index.

AUC: Area under the receiver operating characteristic curve; AIP: Atherogenic index of plasma; WC: Waist circumference; BMI: Body mass index; A-W-B: Prediction model combining atherogenic index of plasma, waist circumference, and body mass index; CI: Confidence interval.

Table 4 Establishment of the logistic regression prediction model A-W-B combined with the atherogenic index of plasma, waist circumference, and body mass index

Variable	β	SE	Wald χ²	P value	OR (95%CI)
AIP	2.560	0.345	55.017	< 0.001	12.939 (6.578-25.45)
WC	0.049	0.017	7.951	0.005	1.050 (1.015-1.087)
BMI	0.170	0.051	11.087	0.001	1.186 (1.073-10311)
Constant	-8.782	1.003	76.689

AIP: Atherogenic index of plasma; WC: Waist circumference; BMI: Body mass index; SE: Standard error; OR: Odds ratio; CI: Confidence interval.

Table 5 Spearman’s correlation analysis results between various indicators (r value)

Variable	AIP	WC	BMI	A-W-B
SBP in mmHg	0.299^b	0.358^b	0.362^b	0.392^b
DBP in mmHg	0.327^b	0.325^b	0.315^b	0.375^b
ALT in U/L	0.470^b	0.455^b	0.451^b	0.530^b
AST in U/L	0.306^b	0.307^b	0.304^b	0.351^b
TC in mmol/L	0.193^b	0.070^a	0.056	0.132^b
TG in mmol/L	0.954^b	0.455^b	0.430^b	0.763^b
HDL-C in mmol/L	-0.617^b	-0.365^b	-0.373^b	-0.543^b
LDL-C in mmol/L	0.253^b	0.128^b	0.105^b	0.190^b
FBG in mmol/L	0.294^b	0.280^b	0.274^b	0.334^b
SUA in μmol/L	0.462^b	0.375^b	0.358^b	0.469^b

^aP < 0.05.

^bP < 0.01.

SBP: Systolic blood pressure; DBP: Diastolic blood pressure; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TC: Total cholesterol; TG: Triglyceride; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; FBG: Fasting blood glucose; SUA: Serum uric acid; AIP: Atherogenic index of plasma; WC: Waist circumference; BMI: Body mass index; A-W-B: Prediction model combining atherogenic index of plasma, waist circumference, and body mass index.

Table 6 Data comparison between training set and validation set

Variable	Training set, n = 864	Validation set, n = 131	P value
Sex, female	240 (27.8)	38 (29.0)	0.770
Age in yr	39.820 ± 10.934	39.660 ± 10.861	0.885
Smoking history	255 (29.5)	38 (29.0)	0.906
Drinking history	221 (25.6)	24 (18.3)	0.072
WC in cm	92.490 ± 10.522	93.690 ± 10.759	0.057
BMI in kg/m²	26.563 ± 3.653	27.055 ± 3.772	0.155
SBP in mmHg	130.460 ± 16.517	129.090 ± 16.822	0.386
DBP in mmHg	80.730 ± 12.464	78.560 ± 12.192	0.063
ALT in U/L	28.0 (19.0, 42.0)	28.0 (19.0, 43.0)	0.837
AST in U/L	21.0 (18.0, 26.0)	22.0 (18.0, 26.0)	0.612
TC in mmol/L	4.683 ± 0.888	4.607 ± 0.865	0.349
TG in mmol/L	1.5 (1.0, 2.2)	1.6 (1.0, 2.5)	0.307
HDL-C in mmol/L	1.256 ± 0.279	1.241 ± 0.293	0.533
LDL-C in mmol/L	2.800 ± 0.826	2.763 ± 0.769	0.651
FBG in mmol/L	5.3 (5.0, 5.7)	5.2 (4.9, 5.8)	0.326
SUA in μmol/L	359.434 ± 88.800	342.901 ± 88.448	0.052
AIP	0.09 (-0.13, 0.30)	0.12 (-0.13, 0.33)	0.306

Data are presented as median and interquartile range, mean ± SD, or n (%). WC: Waist circumference; BMI: Body mass index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TC: Total cholesterol; TG: Triglyceride; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; FBG: Fasting blood glucose; SUA: Serum uric acid; AIP: Atherogenic index of plasma.

Citation: Duan SJ, Ren ZY, Zheng T, Peng HY, Niu ZH, Xia H, Chen JL, Zhou YC, Wang RR, Yao SK. Atherogenic index of plasma combined with waist circumference and body mass index to predict metabolic-associated fatty liver disease. World J Gastroenterol 2022; 28(36): 5364-5379
URL: https://www.wjgnet.com/1007-9327/full/v28/i36/5364.htm
DOI: https://dx.doi.org/10.3748/wjg.v28.i36.5364