AIP demonstrates an independent, linear relationship with NAFLD risk in community-dwelling older adults, exhibiting no discernible safe threshold, and supports a 'single-indicator, dual-prevention' strategy for simultaneous NAFLD screening and cardiometabolic risk stratification in primary care.
NAFLD prevalence was 42.7% among community-dwelling older adults aged ≥65 years in the study population.
NAFLD prevalence rose stepwise across AIP quartiles, from 22.4% in the lowest quartile to 61.3% in the highest quartile.
Each 1-unit increment in AIP was associated with a 6.13-fold higher NAFLD risk after full adjustment for confounders.
Restricted cubic spline analysis revealed a strictly linear, threshold-free association between AIP and NAFLD risk.
The association between AIP and NAFLD was consistent across age, residence, hypertension, and diabetes subgroups, but differed significantly by sex.
Adding AIP to a baseline clinical model significantly improved NAFLD discrimination, calibration, clinical net benefit, and risk reclassification.
This research suggests that a simple blood test calculation called the Atherogenic Index of Plasma (AIP) — derived by dividing triglycerides by HDL ('good') cholesterol and taking the logarithm — is a powerful and independent predictor of non-alcoholic fatty liver disease (NAFLD) in older adults living in the community. Among more than 4,300 Chinese adults aged 65 and older, nearly 43% had NAFLD as detected by ultrasound, and those in the highest quarter of AIP values were nearly three times more likely to have NAFLD compared to those in the lowest quarter. Importantly, there was no 'safe' threshold — risk increased steadily with every rise in AIP, meaning even modest increases in this value corresponded to greater disease risk. The study also found that adding AIP to standard clinical information measurably improved doctors' ability to correctly identify who has NAFLD and who does not, as shown by improvements in multiple statistical measures of predictive accuracy. These benefits held across most patient subgroups, though the strength of the association appeared to differ between men and women. This research suggests that AIP, which can be calculated from routine lipid panel results already commonly ordered in clinical practice, could serve as a low-cost tool for simultaneously screening older adults for NAFLD and flagging elevated cardiovascular risk — a so-called 'single-indicator, dual-prevention' approach. This could be particularly valuable in primary care and community health settings where access to advanced diagnostic tools may be limited.
Xiao M, Xiao C, Zhang J, Ji Y, Zhuang J, Chen Y, et al.. (2026). Atherogenic index of plasma as a simple marker for NAFLD risk stratification in community-dwelling older adults: a cross-sectional study with incremental predictive value assessment.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1907673