The role of lipid-derived indices in patients with MASLD in Turkey: a nationwide, multicenter cross-sectional study

To investigate the role of lipid-derived indices—the monocyte-to-HDL cholesterol ratio (MHR), visceral adiposity index (VAI), atherogenic index of plasma (PAI), and cardiometabolic index (CMI)—in determining hepatic steatosis and fibrosis among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) across Turkey. This nationwide, multicenter, retrospective cross-sectional study included 14,322 individuals from 44 internal medicine clinics in 31 provinces of Turkey. Anthropometric, clinical, and biochemical data were collected, and Participants were classified as MASLD (+) if ultrasonographic hepatic steatosis was present in the setting of ≥ 1 cardiometabolic risk factor according to current EASL–EASD–EASO guidelines; individuals without ultrasonographic steatosis were classified as MASLD (–). FIB-4 scores were calculated to assess the risk of advanced hepatic fibrosis. Cardiometabolic risk factors included obesity (BMI ≥ 25 kg/m² or increased waist circumference), type 2 diabetes mellitus, hypertension, impaired fasting glucose, and dyslipidemia as defined by international guidelines. The relationships between MHR, VAI, PAI, CMI, and MASLD presence and fibrosis severity were analyzed via nonparametric statistical tests. MASLD was detected in 10,836 participants (75.7%). The VAI, PAI, and CMI were significantly greater in the MASLD (+) group than in the MASLD (–) group (p < 0.001 for all), whereas the MHR was not significantly different (p = 0.453). Among MASLD (+) patients, 1,214 (11.2%) had high FIB-4 scores (≥ 1.3; ≥2.0 if > 65 years) yet none of the lipid indices correlated significantly with FIB-4 levels. In multivariable logistic regression analysis restricted to MASLD-positive individuals, none of the lipid-derived indices were independently associated with high FIB-4 risk after adjustment for metabolic covariates. A weak negative correlation was observed only between FIB-4 score and the MHR (r=–0.030, p = 0.002). VAI, PAI, and CMI are significantly associated with hepatic steatosis in MASLD, suggesting their potential role as supportive, noninvasive markers in identifying individuals at increased risk of MASLD. However, these indices are not reliable predictors of advanced hepatic fibrosis risk based on FIB-4. The combination of these tools with other noninvasive fibrosis assessment tools may increase diagnostic accuracy in MASLD management.