Predictive Value of AIP and AGR for Non-alcoholic Fatty Liver Disease and Significant Liver Fibrosis

doi:10.37015/AUDT.2025.250017

Abstract

Abstract:

Objective: Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease with a high incidence worldwide, and its incidence is increasing year by year. Plasma atherogenic Index (AIP) is used to assess the risk of cardiovascular disease and metabolic dysfunction, and albumin to glutamyltransferase ratio (AGR) is often used to assess liver function, nutritional status, and immune system diseases. This study aimed to assess the association of AIP, AGR and non-alcoholic fatty liver disease and to establish a practical and cost-effective prediction model.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) from March 2017 to March 2020, residents 18 years of age and older with complete demographic, laboratory, and instantaneous elastography test data were included. SPSS 27.0 and R 4.4.0 were used to analyze the data, single-factor Logistic regression analysis was applied to screen the influencing factors of NAFLD, stepwise regression was applied to screen the variables, and multi-factor Logistic regression was performed to construct the prediction model and draw the column graph.

Results: AIP (OR = 3.549, 95% CI: 1.876-6.712) was a risk factor for NAFLD, and AGR (OR = 0.782, 95% CI: 0.655-0.934) was a protective factor for NAFLD. The calibration curve of NAFLD was stable, and the ROC curve AUC was 0.859.

Conclusion: AIP is an independent risk factor for NFLAD. AGR is an independent protective factor for NAFLD

Key words: Non-alcoholic fatty liver disease; Atherogenic index of plasma; Albumin to gamma-glutamyl transferase ratio; Prediction model

Zhang Simin, Zhou Changyu, Shi Xianquan, Huang Lizhen. Predictive Value of AIP and AGR for Non-alcoholic Fatty Liver Disease and Significant Liver Fibrosis. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(2): 197-206.

Figures/Tables 7

Figure 1

Table 1

Baseline Characteristics of the NAFLD Group and the Non-NAFLD Group"

Research variables	All patients (n = 960)	NAFLD (n = 346)	Non-NAFLD (n =614)	P value
Age (years)	50 (28)	55 (24)	47(28)	< 0.001
Gender n(%)				0.083
Male	522(54.4)	201(58.1)	321(52.3)
Female	438(45.6)	145(41.9)	293(47.7)
Race n(%)				< 0.001
Mexican Americans	93(9.7)	45(13.0)	48(7.8)
Other Hispanics	92(9.6)	33(9.5)	59(9.6)
Non-Hispanic Whites	325(33.9)	137(39.6)	188(30.6)
Non-Hispanic Blacks	239(24.9)	72(20.8)	167(27.2)
Other races-including multi-races	211(22.0)	59(17.1)	152(24.8)
Education level n(%)				0.134
Low	140(14.6)	54(15.6)	86(14.0)
Medium	199(20.7)	82(23.7)	117(19.1)
High	621(64.7)	210(60.7)	411(66.9)
Marital status n(%)				< 0.001
Married/Cohabiting	622(64.8)	258(74.6)	364(59.3)
Divorced/Widowed/Separated	172(17.9)	51(14.7)	121(19.7)
Unmarried	166(17.3)	37(10.7)	129(21.0)
Poverty Index (PIR) n(%)				0.355
PIR ≤ 1.3	231(24.1)	92(26.6)	139(22.6)
1.3 < PIR ≤ 1.85	147(15.3)	49(14.2)	98(16.0)
1.85 < PIR	582(60.6)	205(59.2)	377(61.4)
Smoking n(%)				0.094
Yes	309(32.2)	123(35.5)	186(30.3)
No	651(67.8)	223(64.5)	428(69.7)
Diabetes n(%)				< 0.001
Yes	201(20.9)	126(36.4)	75(12.2)
No	290(30.2)	45(13.0)	245(39.9)
Prediabetes	469(48.9)	175(50.6)	294(47.9)
Hypertension n(%)				< 0.001
Yes	399(41.6)	190(54.9)	209(34.0)
No	561(58.4)	156(45.2)	405(66.0)
Cardiovascular disease n(%)				0.014
Yes	73(7.6)	36(10.4)	37(6.0)
No	887(92.4)	310(89.6)	577(94.0)
Hypercholesterolemia n(%)				0.316
Yes	289(30.1)	111(32.1)	178(29.0)
No	671(69.9)	235(67.9)	436(71.0)
Hypertriglyceridemia n(%)				< 0.001
Yes	170(17.7)	106(30.6)	64(10.4)
No	790(82.3)	240(69.4)	550(89.6)
Exercise level n(%)				< 0.001
None or light	417(43.4)	184(53.2)	233(37.9)
Moderate	279(29.1)	94(27.2)	185(30.1)
Vigorous	264(27.5)	68(19.7)	196(31.9)
Sedentary time (h) n(%)				0.014
< 4 h	302(31.5)	90(26.0)	212(34.5)
4-5 h	236(24.6)	89(25.7)	147(23.9)
6-7 h	144(15.0)	49(14.2)	95(15.5)
≥ 8h	278(29.0)	118(34.1)	160(26.1)
BMI (kg/m²)	28.0(8.3)	32.4(8.7)	26.0(6.5)	< 0.001
WC (cm)	97.50(22.75)	109.0(20.05)	91.70(18.78)	< 0.001
Laboratory indicators
ALT (U/L)	18.0(12.0)	22.0(15.0)	16.0(10.0)	< 0.001
AST (U/L)	19.0(7.0)	20.0(9.0)	18.0(7.0)	< 0.001
GGT (U/L)	20.0(16.0)	24.5(19.0)	18.0(13.0)	< 0.001
ALP (IU/L)	71.0(27.00)	75.0(28.25)	69.0(25.00)	< 0.001
LDH (U/L)	149.0(37.00)	151.0(37.25)	148.0(35.25)	0.013
Albumin (g/L)	40.0(4.0)	40.0(4.0)	41.0(4.0)	< 0.001
FBG (mmo/L)	5.72(0.94)	6.11(1.28)	5.55(0.78)	< 0.001
HbA1c (%)	5.6(0.6)	5.8(1.0)	5.5(0.6)	< 0.001
Uric acid (umol/L)	318.2(111.5)	345(114.5)	303.3(101.1)	< 0.001
Blood urea nitrogen (mmol/L)	5.0(2.14)	5.36(2.15)	4.64(1.87)	< 0.001
Creatinine (umol/L)	75.14(24.75)	76.02(25.63)	75.14(24.75)	0.687
TC (mmol/L)	4.65(1.40)	4.70(1.46)	4.65(1.37)	0.28
LDL (mmol/L)	2.767(1.190)	2.845(1.215)	2.74(1.138)	0.185
Insulin (uU/ml)	9.81(9.94)	15.59(13.54)	7.60(6.68)	< 0.001
CRP (mg/L)	1.54(2.96)	2.48(4.09)	1.18(2.05)	< 0.001
TBIL (umol/L)	6.84(5.13)	6.84(5.13)	8.55(5.13)	0.02
AGR (g/U)	2.05(1.52)	1.59(1.09)	2.32(1.71)	< 0.001
AIP	-0.120 ± 0.321	0.039 ± 0.295	-0.200 ± 0.298	< 0.001

Table 1

Table 2

Univariate and multivariate logistic regression analyses of NAFLD"

Variables	Univariate analysis		Multivariate analysis
Variables	OR (95% CI)	P value	OR (95% CI)	P value
AGR (g/U)	0.507 (0.439-0.585)	< 0.001	0.782 (0.655-0.934)	0.007
Q1	1
Q2	0.710 (0.496-1.017)	0.062
Q3	0.407 (0.281-0.589)	< 0.001
Q4	0.152 (0.098-0.236)	< 0.001
AIP	17.433 (10.493-28.965)	< 0.001	3.549 (1.876-6.712)	< 0.001
Q1	1
Q2	2.385 (1.476-3.857)	< 0.001
Q3	5.923 (3.742-9.375)	< 0.001
Q4	10.684 (6.733-16.955)	< 0.001
Age (years)	1.019 (1.011-1.027)	< 0.001
Gender n(%)
Male	1.265 (0.970-1.651)	0.083
Female
Race n(%)		< 0.001		0.096
Mexican Americans
Other Hispanics	2.415 (1.457-4.005)	< 0.001	1.61 (0.863-3.006)	0.135
Non-Hispanic Whites	1.441 (0.855-2.427)	0.17	1.031 (0.54-1.966)	0.927
Non-Hispanic Blacks	1.877 (1.293-2.725)	< 0.001	1.37 (0.848-2.213)	0.198
Other races-including multi-races	1.111 (0.738-1.671)	0.614	0.779 (0.448-1.354)	0.376
Education level n(%)		0.134
Low
Medium	1.116 (0.717-1.737)	0.626
High	0.286 (0.557-1.188)	0.286
Marital status n(%)		< 0.001		0.004
Married/Cohabiting
Divorced/Widowed/Separated	2.471 (1.658-3.682)	< 0.001	2.241 (1.312-3.826)	0.003
Unmarried	1.470 (0.900-2.400)	0.124	1.416 (0.746-2.689)	0.287
Poverty Index (PIR) n(%)		0.355
PIR ≤ 1.3	1.217 (0.890-1.665)	0.219
1.3 < PIR ≤ 1.85	0.920 (0.627-1.348)	0.667
1.85 < PIR
Smoking n(%)
Yes
No	0.095 (0.596-1.042)	0.095
Diabetes n(%)		< 0.001
No
Yes	9.147 (5.965-14.026)	< 0.001
Prediabetes	3.241 (2.241-4.686)	< 0.001
Hypertension n(%)
No
Yes	2.360 (1.802-3.091)	< 0.001
Exercise level n(%)		< 0.001
None or light	1.554 (1.135-2.129)	0.006
Moderate	0.683 (0.471-0.990)	0.044
Vigorous
Sedentary time (h) n(%)		0.015
< 4 h	0.576 (0.409-0.810)	0.002
4-5 h	0.821 (0.576-1.171)	0.276
6-7 h	0.699 (0.460-1.063)	0.094
≥ 8 h
Cardiovascular disease n(%)
Yes
No	0.552 (0.342-0.892)	0.015
Hypercholesterolemia n(%)
Yes
No	0.864 (0.650-1.150)	0.316
Hypertriglyceridemia n(%)
Yes
No	0.263 (0.187-0.372)	< 0.001
BMI (kg/m²)	1.189 (1.157-1.222)	< 0.001
WC (cm)	1.088 (1.075-1.101)	< 0.001	1.066 (1.05-1.081)	< 0.001
ALT (U/L)	1.048 (1.036-1.061)	< 0.001
AST (U/L)	1.026 (1.011-1.041)	< 0.001
ALP (U/L)	1.013 (1.007-1.019)	< 0.001
LDH (U/L)	1.004 (1.000-1.009)	0.034
Urea nitrogen (mmol/L)	1.139 (1.055-1.229)	< 0.001
Creatinine (umol/L)	1.001 (0.997-1.006)	0.631
FBG (mmo/L)	1.418 (1.274-1.578)	< 0.001
HbA1c (%)	1.903 (1.596-2.27)	< 0.001	1.327 (1.111-1.587)	0.002
TBIL (umol/L)	0.96 (0.932-0.989)	0.008
Uric acid (umol/L)	1.006 (1.005-1.008)	< 0.001
LDL (mmol/L)	1.119 (0.974-1.286)	0.113
TC (mmol/L)	1.101 (0.974-1.246)	0.125
Insulin (uU/ml)(uU/ml)	1.095 (1.075-1.115)	< 0.001	1.021 (1.004-1.039)	0.013
CRP (mg/L)	1.081 (1.046-1.117)	< 0.001

Table 2

Figure 2

Figure 3

Figure 4

Figure 5

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