Jie Sheng,1,2,* Shuwei Shi,1,2,* Xuan Ma,1,2 Hongyan Zhao,1,2 Guanqi Gao,2 Baolan Ji2 

1School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, 261000, People’s Republic of China; 2Department of Endocrinology, Linyi People’s Hospital Affiliated to Shandong Second Medical University, Linyi, Shandong, 276034, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Guanqi Gao; Baolan Ji, Department of Endocrinology, Linyi People’s Hospital Affiliated to Shandong Second Medical University, North Side of the Intersection of Wohushan Road and Wuhan Road in Lanshan District, Linyi, Shandong, 276034, People’s Republic of China, Email guanqi_gao@yeah.net; jibaolan@yeah.net

Aim: Metabolic dysfunction-associated steatotic liver disease (MASLD) is commonly associated with metabolic disorders such as obesity, diabetes and dyslipidemia. Previous studies have explored the relationship between traditional lipid parameters and MASLD. The atherogenic combined index (ACI), a novel non-traditional lipid marker, has recently been proposed as a potential indicator of coronary artery disease. The relationship between the ACI and MASLD remains unclear. This study aims to investigate this relationship in patients with type 2 diabetes (T2D).
Methods: This cross-sectional study analyzed 2703 patients with T2D. Ultrasound was used to assess MASLD. The clinical and biochemical data were gathered. The ACI was calculated as the base-10 logarithm of the product of triglyceride and non-high-density lipoprotein cholesterol divided by high-density lipoprotein cholesterol. Statistical analyses explored the association between the ACI and MASLD.
Results: Compared to the non-MASLD group, the ACI was higher in the MASLD group (P < 0.001). Spearman correlation analysis revealed a positive association between ACI and MASLD (P < 0.001). Logistic regression analysis showed that the ACI was independently associated with MASLD. Compared with participants in the lowest ACI quartile (Q1), Q4 (OR: 3.636, 95% CI: 2.361– 5.601) showed significantly increased risks of MASLD (P < 0.001). Subgroup analyses confirmed that the significant association between ACI and MASLD was consistent across sex (females and males), body mass index (BMI < 24 kg/m² and BMI ≥ 24 kg/m²) and age groups (age < 60 years and age ≥ 60 years).
Conclusion: The ACI is independently correlated with MASLD in T2D patients, supporting its potential as a useful marker for MASLD screening and management in this population.

Keywords: atherogenic combined index, metabolic dysfunction-associated steatotic liver disease, type 2 diabetes