Higher fasting glucose-to-HDL ratio associated with increased MASLD risk in non-diabetic Japanese adults

In a cross-sectional analysis of 13,682 non-diabetic Japanese adults from the NAGALA cohort (2004–2015), researchers examined the association between the fasting blood glucose to high-density lipoprotein cholesterol ratio (GHR) and metabolic dysfunction-associated steatotic liver disease (MASLD) risk. The overall prevalence of MASLD was 15.25% (n = 2,087). The mean GHR was significantly higher in participants with MASLD (4.93 ± 1.14) compared to those without (3.59 ± 1.07).

The primary analysis showed a positive association between GHR and MASLD risk. For each 1-unit increase in GHR, the odds of having MASLD were 23% higher (odds ratio 1.23, 95% confidence interval 1.15 to 1.31). The study did not report specific safety or tolerability data related to the biomarker measurement.

Key limitations include the cross-sectional design, which cannot establish causality or temporal sequence. The study population was exclusively non-diabetic Japanese adults, limiting generalizability to other ethnic groups or individuals with diabetes. The comparator for the GHR metric was not reported, and the analysis did not adjust for all potential confounders. The findings suggest GHR may be a simple biomarker associated with MASLD presence in this specific population, but its clinical utility for risk prediction or monitoring requires prospective evaluation.