Triglyceride-glucose-waist circumference index: A powerful tool for metabolic dysfunction-associated steatotic liver disease

Abstract

The search for reliable biomarkers to predict metabolic dysfunction-associated steatotic liver disease (MASLD) remains a key research focus. Traditional anthropometric parameters, such as triglycerides, glucose, and waist circumference (WC), have proven to be robust tools for diagnosing, stratifying, and predicting health outcomes. These measures facilitate early detection, personalized treatment strategies, and long-term risk assessment in metabolic health. The triglyceride-glucose (TyG) index and related parameters, particularly the TyG-WC index, are gaining recognition as reliable biomarkers for MASLD, with consistently high diagnostic accuracy across diverse populations. The TyG-WC index is associated with MASLD and an increased likelihood of all-cause, cardiovascular, and diabetes-related mortality, highlighting its importance in stratification and patient management. This opinion review summarizes key findings on the TyG-WC index across different MASLD populations and provides nutritional recommendations aimed at reducing this index. The TyG-WC index stands out as a practical and scalable biomarker for identifying and stratifying the risk of MASLD, particularly in resource-limited environments where access to advanced diagnostic tools is restricted. However, before the TyG-WC index can be integrated into routine clinical practice, rigorous, longitudinal studies involving ethnically diverse cohorts must validate its prognostic performance. It should be viewed as a complementary tool within a comprehensive metabolic risk assessment framework, supporting preventive strategies while awaiting formal endorsement in clinical guidelines.

Keywords: Steatotic liver disease; Liver steatosis; Non-invasive; Biomarkers; Nutritional therapy; Cardiometabolic risk

Core Tip: The search for reliable biomarkers for metabolic dysfunction-associated steatotic liver disease (MASLD) remains a critical priority. Among non-invasive and accessible tools, the triglyceride-glucose-waist circumference index (TyG-WC) has emerged as a particularly robust marker, demonstrating superior diagnostic performance compared with other indices. Its utility extends beyond MASLD, offering valuable insights into cardiovascular risk and other extrahepatic manifestations. Given its simplicity and affordability, the TyG-WC index holds significant promise, particularly in low-resource settings. Nonetheless, longitudinal studies are needed to validate its predictive capacity and guide clinical implementation. Integrating this index within clinical and research frameworks, alongside investigations into the gut microbiota, multiomic profiling, and artificial intelligence, may unlock new pathways for improving MASLD diagnosis and management.