{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:54:46Z","timestamp":1787241286433,"version":"build-2736575974"},"reference-count":38,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Non-alcoholic fatty liver disease (NAFLD) is a global public health issue. Although liver biopsy remains the gold standard for diagnosing hepatosteatosis, its invasiveness, high cost, and associated risks limit its widespread use. Therefore, there is a need for reliable, non-invasive, and cost-effective biomarkers to aid in the early detection of NAFLD. Our objective was to determine the utility of the triglyceride (TG)-to-high-density-lipoprotein (HDL) ratio in predicting non-alcoholic fatty liver disease. Methods: This retrospective cross-sectional study included 2588 patients who met the inclusion criteria. Demographic data and laboratory results were collected from electronic health records. Experienced radiologists performed abdominal ultrasonography to assess fatty liver according to the EASL 2021 criteria. The TG\/HDL ratio and other non-invasive scores (APRI, FIB-4, ALT\/AST, TG\/glucose) were calculated. Early-stage disease was defined as grade 1 or grade 2 hepatosteatosis. Results: The TG\/HDL ratio was significantly higher in NAFLD patients (AUROC: 0.682) and outperformed the other non-invasive indices. At the optimal cut-off value of 1.86, the sensitivity was 80.7%, and the specificity was 45.5%. The TG\/HDL ratio correlated positively with markers of glycemic control, inflammation, and liver enzymes. Conclusions: The TG\/HDL ratio is an accessible and valuable parameter for predicting non-alcoholic fatty liver disease. It offers a non-invasive alternative to liver biopsy and potentially prevents complications from non-alcoholic fatty liver disease or diagnostic approaches.<\/jats:p>","DOI":"10.3390\/diagnostics15162045","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T15:16:37Z","timestamp":1755184597000},"page":"2045","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Triglyceride\/HDL Ratio as a Non-Invasive Marker for Early-Stage NAFLD: A Retrospective Cross-Sectional Study of 2588 Patients"],"prefix":"10.3390","volume":"15","author":[{"given":"Emre","family":"Hoca","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul 34260, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Cangir","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ba\u015fak\u015fehir \u00c7am ve Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9239-9132","authenticated-orcid":false,"given":"S\u00fcleyman","family":"Ahbab","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul 34260, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2325-7776","authenticated-orcid":false,"given":"Seher \u0130rem","family":"\u015eahin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul 34260, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9223-4212","authenticated-orcid":false,"given":"Ece","family":"\u00c7ift\u00e7i \u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul 34260, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7403-3193","authenticated-orcid":false,"given":"Ay\u015fe \u00d6znur","family":"Urvas\u0131zo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, \u0130stanbul \u015ei\u015fli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul 34093, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1641-5270","authenticated-orcid":false,"given":"Nilsu","family":"Kalayc\u0131","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul 34260, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6493-9194","authenticated-orcid":false,"given":"\u0130smail","family":"Engin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Training and Research Hospital, \u00dcmraniye, University of Health Sciences, Istanbul 34764, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6559-2575","authenticated-orcid":false,"given":"Hayriye Esra","family":"Atao\u011flu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul 34260, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Pouwels, S., Sakran, N., Graham, Y., Leal, A., Pintar, T., Yang, W., Kassir, R., Singhal, R., Mahawar, K., and Ramnarain, D. (2022). Non-alcoholic fatty liver disease (NAFLD): A review of pathophysiology, clinical management and effects of weight loss. BMC Endocr. Disord., 22.","DOI":"10.1186\/s12902-022-00980-1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1007\/s11845-024-03671-z","article-title":"Association between chitinase-3-like protein 1 and metabolic-associated fatty liver disease in patients with type 2 diabetes mellitus","volume":"193","author":"Zhang","year":"2024","journal-title":"Ir. J. Med Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.cld.2004.04.004","article-title":"The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease","volume":"8","author":"McCullough","year":"2004","journal-title":"Clin. Liver Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.metabol.2017.04.011","article-title":"Non-alcoholic fatty liver disease: A sign of systemic disease","volume":"72","author":"Reccia","year":"2017","journal-title":"Metabolism"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Lombardi, R., Iuculano, F., Pallini, G., Fargion, S., and Fracanzani, A.L. (2020). Nutrients, Genetic Factors, and Their Interaction in Non-Alcoholic Fatty Liver Disease and Cardiovascular Disease. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21228761"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1002\/hep.25762","article-title":"The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association","volume":"55","author":"Chalasani","year":"2012","journal-title":"Hepatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jhep.2009.05.023","article-title":"Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance","volume":"51","author":"Schwenzer","year":"2009","journal-title":"J. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1002\/hep.24452","article-title":"Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: A meta-analysis","volume":"54","author":"Hernaez","year":"2011","journal-title":"Hepatology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1186\/s12944-020-01419-z","article-title":"Association between the alanine aminotransferase\/aspartate aminotransferase ratio and new-onset non-alcoholic fatty liver disease in a nonobese Chinese population: A population-based longitudinal study","volume":"19","author":"Zou","year":"2020","journal-title":"Lipids Health Dis."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Rigamonti, A.E., Bondesan, A., Rondinelli, E., Cella, S.G., and Sartorio, A. (2022). The Role of Aspartate Transaminase to Platelet Ratio Index (APRI) for the Prediction of Non-Alcoholic Fatty Liver Disease (NAFLD) in Severely Obese Children and Adolescents. Metabolites, 12, Erratum in Metabolites 2022, 12, 555.","DOI":"10.3390\/metabo12060555"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s12944-021-01457-1","article-title":"LDL\/HDL cholesterol ratio is associated with new-onset NAFLD in Chinese non-obese people with normal lipids: A 5-year longitudinal cohort study","volume":"20","author":"Zou","year":"2021","journal-title":"Lipids Health Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Xuan, Y., Hu, W., Wang, Y., Li, J., Yang, L., Yu, S., and Zhou, D. (2024). Association between RC\/HDL-C ratio and risk of non-alcoholic fatty liver disease in the United States. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1427138"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1016\/S0140-6736(20)32511-3","article-title":"Non-alcoholic fatty liver disease","volume":"397","author":"Powell","year":"2021","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jhep.2018.10.033","article-title":"Non-alcoholic fatty liver disease\u2014A global public health perspective","volume":"70","author":"Younossi","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Tabacu, L., Swami, S., Ledbetter, M., Siddiqui, M.S., Smirnova, E., and Y\u00e1\u00f1ez-Sep\u00falveda, R. (2024). Socioeconomic status and health disparities drive differences in accelerometer-derived physical activity in fatty liver disease and significant fibrosis. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0301774"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.12688\/f1000research.12417.1","article-title":"Gender differences in the prevalence of nonalcoholic fatty liver disease in the Northeast of Thailand: A population-based cross-sectional study","volume":"6","author":"Summart","year":"2017","journal-title":"F1000Research"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1007\/s00535-012-0533-z","article-title":"Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: A multicenter large retrospective study","volume":"47","author":"Nafld","year":"2012","journal-title":"J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e076388","DOI":"10.1136\/bmj-2023-076388","article-title":"Association of non-alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes mellitus: Nationwide population based study","volume":"384","author":"Kim","year":"2024","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1111\/jgh.13264","article-title":"Nonalcoholic fatty liver disease is associated with an almost twofold increased risk of incident type 2 diabetes and metabolic syndrome. Evidence from a systematic review and meta-analysis","volume":"31","author":"Ballestri","year":"2016","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Amernia, B., Moosavy, S.H., Banookh, F., and Zoghi, G. (2021). FIB-4, APRI, and AST\/ALT ratio compared to FibroScan for the assessment of hepatic fibrosis in patients with non-alcoholic fatty liver disease in Bandar Abbas, Iran. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-02038-3"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3361","DOI":"10.3748\/wjg.v24.i30.3361","article-title":"Current guidelines for the management of non-alcoholic fatty liver disease: A systematic review with comparative analysis","volume":"24","author":"Leoni","year":"2018","journal-title":"World J. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/j.cgh.2016.03.034","article-title":"Development and Validation of the Framingham Steatosis Index to Identify Persons With Hepatic Steatosis","volume":"14","author":"Long","year":"2016","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Lin, M.-S., Lin, H.-S., Chang, M.-L., Tsai, M.-H., Hsieh, Y.-Y., Lin, Y.-S., Tsai, M.-S., Yang, C.-L., and Chen, M.-Y. (2022). Alanine aminotransferase to aspartate aminotransferase ratio and hepatitis B virus on metabolic syndrome: A community-based study. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.922312"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.2147\/IJGM.S309311","article-title":"Correlation of Serum Transaminase Levels with Liver Fibrosis Assessed by Transient Elastography in Vietnamese Patients with Nonalcoholic Fatty Liver Disease","volume":"14","author":"Thong","year":"2021","journal-title":"Int. J. Gen. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s41043-023-00372-8","article-title":"Association of C-reactive protein with histological, elastographic, and sonographic indices of non-alcoholic fatty liver disease in individuals with severe obesity","volume":"42","author":"Jamialahmadi","year":"2023","journal-title":"J. Health Popul. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.athplu.2023.08.001","article-title":"High-density lipoproteins and non-alcoholic fatty liver disease","volume":"53","author":"Hoekstra","year":"2023","journal-title":"Atheroscler. Plus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"633","DOI":"10.3892\/br.2014.309","article-title":"Triglyceride is strongly associated with nonalcoholic fatty liver disease among markers of hyperlipidemia and diabetes","volume":"2","author":"Tomizawa","year":"2014","journal-title":"Biomed. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1007\/s00535-013-0758-5","article-title":"Mechanisms of hepatic triglyceride accumulation in non-alcoholic fatty liver disease","volume":"48","author":"Kawano","year":"2013","journal-title":"J. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1186\/s40001-023-01188-2","article-title":"Association between the Triglyceride\u2013Glucose Index and Non-Alcoholic Fatty Liver Disease in patients with Atrial Fibrillation","volume":"28","author":"Li","year":"2023","journal-title":"Eur. J. Med Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.jacl.2015.12.026","article-title":"Nonalcoholic fatty liver disease severity is associated with the ratios of total cholesterol and triglycerides to high-density lipoprotein cholesterol","volume":"10","author":"Wu","year":"2016","journal-title":"J. Clin. Lipidol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1111\/liv.12977","article-title":"Triglycerides to high-density lipoprotein cholesterol ratio is an independent predictor of incident fatty liver; a population-based cohort study","volume":"36","author":"Fukuda","year":"2016","journal-title":"Liver Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1186\/s12944-019-1104-6","article-title":"Correlation of triglyceride to high-density lipoprotein cholesterol ratio with nonalcoholic fatty liver disease among the non-obese Chinese population with normal blood lipid levels: A retrospective cohort research","volume":"18","author":"Chen","year":"2019","journal-title":"Lipids Health Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"791","DOI":"10.4254\/wjh.v14.i4.791","article-title":"Total cholesterol to high-density lipoprotein ratio and nonalcoholic fatty liver disease in a population with chronic hepatitis B","volume":"14","author":"Zhou","year":"2022","journal-title":"World J. Hepatol."},{"key":"ref_34","first-page":"960","article-title":"Incidence of nonalcoholic fatty liver disease in type 2 diabetic patients","volume":"12","author":"Ozkan","year":"2016","journal-title":"Yeditepe Med. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ajg.2022.05.002","article-title":"Evaluation of hepatosteatosis in patients with chronic hepatitis B virus infection","volume":"24","author":"Sayar","year":"2023","journal-title":"Arab. J. Gastroenterol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.3748\/wjg.v30.i18.2440","article-title":"FibroScan-aspartate transaminase: A superior non-invasive model for diagnosing high-risk metabolic dysfunction-associated steatohepatitis","volume":"30","author":"Yin","year":"2024","journal-title":"World J. Gastroenterol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1080\/00325481.2022.2058285","article-title":"Noninvasive fibrosis tools in NAFLD: Validation of APRI, BARD, FIB-4, NAFLD fibrosis score, and Hepamet fibrosis score in a Portuguese population","volume":"134","author":"Rigor","year":"2022","journal-title":"Postgrad. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1159\/000469304","article-title":"Serum alanine aminotransferase to aspartate aminotransferase ratio and degree of fatty liver in morbidly obese patients","volume":"36","author":"Nanji","year":"1986","journal-title":"Enzyme"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/16\/2045\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:27:53Z","timestamp":1760034473000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/16\/2045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,14]]},"references-count":38,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["diagnostics15162045"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15162045","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,14]]}}}