To investigate the diagnostic value of triglyceride-glucose (TyG) index and its combination with waist circumference (TyG-WC), waist-to-height ratio (TyG-WHtR), body mass index (TyG-BMI) and relative fat mass (RFM) index for nonalcoholic fatty liver disease (NAFLD) in perimenopausal women.

A total of 448 perimenopausal women who visited the Guizhou Hospital of Beijing Jishuitan Hospital from March 2022 to November 2024 were selected. They were divided into the NAFLD group (n=61) and the control group (n=387) based on the results of chest or abdominal CT. The data of age, height, weight, waist circumference (WC), systolic blood pressure, diastolic blood pressure, blood routine, blood biochemistry, fasting blood glucose, etc. were collected. The body mass index (BMI), waist-to-height ratio (WHtR), TyG, TyG-WC, TyG-WHtR, TyG-BMI and RFM index were calculated. According to the results of chest or abdominal CT, the women were divided into NAFLD group and control group. The differences of each index between the two groups were compared by independent sample t test or Mann-Whitney U test. The independent risk factors for NAFLD were analyzed by multivariable logistic regression. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of TyG index, its combined indices and RFM index for NAFLD.

There were statistically significant differences (P<0.05) in weight, BMI, WC, WHtR, systolic blood pressure, diastolic blood pressure, hemoglobin, triglycerides, high-density lipoprotein, fasting blood glucose, TyG, TyG-WC, TyG-WHtR, TyG-BMI, and RFM between the NAFLD group and the control group of perimenopausal women. The results of multivariable logistic regression analysis showed that TyG (OR=2.860, 95% CI: 1.900-4.305), TyG-WC(OR=1.011, 95% CI: 1.008-1.014), TyG-WHtR (OR=3.491, 95% CI: 2.077-5.868), TyG-BMI (OR=1.018, 95% CI: 1.009-1.028), and RFM (OR=1.172, 95% CI: 1.074-1.279) were all independent risk factors for NAFLD in perimenopausal women (P<0.001). The ROC curve showed that the areas under the ROC curve (AUC) for diagnosing NAFLD in perimenopausal women by TyG, TyG-WC, TyG-WHtR, TyG-BMI, and RFM were 0.779 (95% CI: 0.719-0.839), 0.814 (95% CI: 0.769-0.859), 0.804(95% CI: 0.758-0.851), 0.795 (95% CI: 0.746-0.844), and 0.735 (95% CI: 0.675-0.794), respectively, and the optimal cut-off values were 8.888, 687.312, 4.385, 215.743, and 37.104. The AUC values followed the order TyG-related indices > TyG >RFM, and among the TyG-related indices, the AUC values of TyG-WC and TyG-WHtR were the largest (especially TyG-WC), both of which were greater than those of TyG-BMI.

The TyG index and its combined indices, as well as the RFM index, are all good diagnostic indicators for NAFLD in perimenopausal women. Among them, the diagnostic value of the TyG combined indices is greater than that of the TyG index and the RFM index. Among the TyG combined indices, TyG-WC and TyG-WHtR showed the greatest diagnostic value, especially TyG-WC. The results of this study provide a reference for the early diagnosis, prevention, and treatment of NAFLD in perimenopausal women.