Objective   To study the application of triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) combined with liver function indexes to predict metabolic-associated fatty liver disease (MAFLD).

  Methods  A total of 2971 outpatients diagnosed with MAFLD and 2794 healthy controls were enrolled, and their relevant data were collected. Two-sample Mann-Whitney U test and binary logistic regression analysis were conducted to study the relationship between TG/HDL-C and MAFLD and to construct combined diagnosis models of MAFLD. The area under the curve (AUC) of receiver operating characteristic (ROC) was used to pick out the optimal model.

  Results  The TG/HDL-C of MAFLD patients was significantly higher than that of healthy controls. In multivariate analysis, after adjusting for body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, triglycerides, high-density lipoprotein cholesterol, uric acid and creatinine, the odds ratio of TG/HDL-C was 2.356 (95% confidence interval CI: 1.028-5.400). Therefore, TG/HDL-C was an independent risk factor for MAFLD. ROC curve analysis showed that the AUC of using TG/HDL-C to predict MAFLD was 0.795 (95% CI: 0.784-0.807), and when the cut-off value was 1.09, the sensitivity was 0.679 and the specificity was 0.755. The AUC of the diagnosis model established by a combined use of TG/HDL-C, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin (ALB) was 0.890 (95% CI: 0.882-0.898), and when the cut-off value was 0.47, the sensitivity and specificity were 0.792 and 0.839, respectively.

  Conclusion  TG/HDL-C is an independent risk factor for MAFLD. TG/HDL-C can well predict MAFLD when it is used in combination with ALT, AST, and ALB.