Association Between eGDR and MASLD and Liver Fibrosis: A Cross-Sectional Study Based on NHANES 2017-2023

Wenjing Peng¹Zeyu Li^2*Nian Fu^1*

• ¹Affiliated Nanhua Hospital, University of South China, Hengyang, Hunan Province, China
• ²Department of Thyroid Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China

Background: This study aimed to investigate the association between estimated glucose disposal rate (eGDR) and metabolic dysfunction-associated steatotic liver disease (MASLD), as well as liver fibrosis, using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2023 dataset.Methods: Data from 7,855 participants in the NHANES 2017-2023 dataset were analyzed. Multivariable logistic regression models were constructed to assess the association between eGDR and MASLD, as well as liver fibrosis, adjusting for potential confounders. Generalized additive models (GAM) were used to explore non-linear relationships, stratified by age, hypertension, diabetes, CVD, and BMI. A two-piecewise linear regression model was used to examine threshold effects. Subgroup analyses were conducted to assess effect modification. Mediation analysis was performed to determine the role of the atherogenic index of plasma (AIP). Sensitivity analysis was performed to test the robustness of the results.Results: In the fully adjusted model, higher eGDR was inversely associated with MASLD (OR = 0.62) and liver fibrosis (OR = 0.50; both P < 0.0001). Participants in higher eGDR quartiles (Q2–Q4) had progressively lower odds of MASLD (Q2: OR = 0.56, Q3: OR = 0.25, Q4: OR = 0.13) and liver fibrosis (Q2: OR = 0.24, Q3: OR = 0.06, Q4: OR = 0.05) compared to Q1 (all P < 0.0001). A non-linear relationship with threshold effects at an eGDR value of 3.25 was observed for MASLD. Subgroup analyses revealed that the inverse association between eGDR and MASLD was more pronounced in individuals without diabetes. Additionally, smoothing curve fitting showed that the dose-response relationship between eGDR and both MASLD and liver fibrosis differed by metabolic and clinical status. Mediation analysis suggested that AIP partially mediated the association between eGDR and MASLD, accounting for approximately 10.6% of the total effect. Sensitivity analyses excluding extreme eGDR values confirmed the robust inverse associations with MASLD and liver fibrosis.Conclusions: This study found a significant non-linear inverse association between eGDR and both MASLD and liver fibrosis, with a threshold effect observed for MASLD. The association was stronger in non-diabetic individuals and partially mediated by AIP. Moreover, the dose-response relationships varied across metabolic and clinical subgroups.