Endocrine Abstracts

JOINT902

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging global health challenge, with cardiovascular mortality as its leading cause of death. The cardiometabolic index (CMI), a novel biomarker derived by multiplying the waist-to-height ratio (WHtR) with the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio, shows promise as a predictive tool for MASLD. This study aims to systematically evaluate the association between CMI and MASLD.

Methods: We performed a systematic review and meta-analysis adhering to PRISMA guidelines. A comprehensive search of PubMed, Scopus, Embase, and Web of Science was conducted up to January 2025. Studies reporting the association between CMI and MASLD in adults were included. Effect sizes, odds ratios (OR), and standardized mean differences (SMD) were pooled. Heterogeneity was assessed using I², and publication bias was evaluated via Egger’s test. Sensitivity analyses and meta-regressions explored sources of heterogeneity.

Results: Seven studies with 41,122 participants were included. Individuals with MASLD had significantly higher CMI (SMD [95%CI] =1.24 [1.00, 1.48]; I² =98.1%). Studies with higher smoking prevalence, female proportion, elevated FBG, SBP, DBP, TG, and AST levels, and lower TC and HDL levels showed a lower SMD of CMI in MASLD compared to non-MASLD patients, while meta-regression indicated that age, BMI, WC, ALT, and LDL were not significant sources of heterogeneity. Each 1-SD increase in CMI was associated with roughly 2-fold higher odds of MASLD (OR [95%CI] =2.33 [1.78, 3.04]; I² =96.8%). Patients in the highest CMI quartile had substantially greater odds of MASLD compared to the lowest quartile (OR [95%CI]=7.44 [4.28, 12.95]; I² =91.8%). The pooled area under the curve (AUC) for CMI in predicting MASLD was 0.82 (95%CI: 0.80–0.84).

Conclusion: CMI emerges as a non-invasive predictor of MASLD with elevated levels serving as an early indicator for identifying individuals at risk, even before significant liver fat accumulation occurs. Its strong association with liver fibrosis underscores the importance of identifying and managing elevated CMI to slow disease progression and prevent complications such as cirrhosis or hepatocellular carcinoma. Furthermore, emerging therapies for MASLD not only reduce liver fat but also improve CMI components, highlighting its potential as a marker for treatment response. Future research should focus on refining CMI cut-off values and validating its applicability across diverse populations.

Keywords: Cardiometabolic index, MASLD, Non-invasive biomarker