Metabolic score for insulin resistance is associated with metabolic dysfunction-associated steatotic liver disease among adults with hypertension: a cross-sectional secondary analysis of a Chinese single-center health check-up population.

The prevalence of MASLD among adults with hypertension in this Chinese health check-up cohort was 67.9%.

• 943 adults with hypertension were included in the cross-sectional analysis.
• 640 of the 943 participants had MASLD.
• MASLD was operationally defined as ultrasonographically detected hepatic steatosis after exclusion of excessive alcohol intake and other known causes of liver disease.
• This is a single-center Chinese health check-up population, which may not be representative of the general hypertensive population.

MASLD prevalence increased in a graded fashion across METS-IR quartiles, from 40.7% in the lowest quartile to 89.0% in the highest quartile.

• Quartile 1 prevalence: 40.7%.
• Quartile 2 prevalence: 67.2%.
• Quartile 3 prevalence: 74.6%.
• Quartile 4 prevalence: 89.0%.
• This represents more than a doubling in MASLD prevalence from the lowest to the highest METS-IR quartile.

Each 1-standard deviation increase in METS-IR was significantly associated with higher odds of prevalent MASLD in the primary multivariable model.

• Odds ratio (OR) = 2.78, 95% confidence interval (CI): 2.24–3.44, P < 0.001.
• The primary model was adjusted for age group, sex, tobacco use, alcohol use, and diabetes.
• Compared with quartile 1, the ORs for quartiles 2, 3, and 4 were 2.99, 4.01, and 9.72, respectively.
• The association remained statistically significant after adjustment.

The association between METS-IR and MASLD remained significant in an extended multivariable model that included additional metabolic covariates.

• The extended model additionally adjusted for uric acid, total cholesterol, low-density lipoprotein cholesterol, and fat-to-muscle ratio.
• In the extended model, the OR per 1-standard deviation increase in METS-IR was 2.47 (95% CI: 1.91–3.18, P < 0.001).
• The attenuation from 2.78 to 2.47 suggests partial but not complete mediation or confounding by these additional metabolic factors.

Restricted cubic spline analysis indicated a mildly non-linear dose-response relationship between METS-IR and MASLD.

• The association between METS-IR and MASLD was not strictly linear across the continuous range of METS-IR values.
• The pattern was described as a 'graded, mildly non-linear pattern.'
• Non-linearity was assessed using restricted cubic spline analysis.

Exploratory ROC analysis showed METS-IR had moderate discriminative ability for MASLD, with an AUC of 0.738.

• Area under the curve (AUC) = 0.738, 95% CI: 0.705–0.772.
• A data-derived METS-IR cut-point of 42.40 was identified.
• At this cut-point, sensitivity was 53.0% and specificity was 81.8%.
• The authors noted that the data-derived cut-point requires independent validation.

A borderline statistically significant interaction by sex was observed, while interactions by age group and diabetes status were not statistically significant.

• P for interaction by sex = 0.046, described as a 'borderline interaction.'
• Interactions by age group and diabetes status were not statistically significant.
• The possible sex-specific association was flagged by the authors as requiring independent validation.
• Subgroup interaction analyses were performed as part of exploratory analyses.

METS-IR is calculated without requiring insulin measurement, using body mass index, fasting blood glucose, triglycerides, and high-density lipoprotein cholesterol.

• METS-IR stands for metabolic score for insulin resistance.
• Its components are BMI, fasting blood glucose, triglycerides, and HDL cholesterol — all routinely available in clinical settings.
• The absence of a required insulin measurement is noted as a practical advantage for use as an auxiliary metabolic indicator.
• The study investigated whether METS-IR could serve as a practical auxiliary indicator of metabolic dysfunction in hypertensive adults.