Triglyceride -glucose-waist-to-height ratio predicts fatty liver in older adults

A recent large observational study has found that the triglyceride-glucose-waist-to-height ratio (TyGWHtR) was a strong predictor of non-alcoholic fatty liver disease (NAFLD) among older adults in the United States, suggesting a simple screening tool could improve early identification of liver disease risk in primary care settings.

Simple index may aid liver disease screening

Non-alcoholic fatty liver disease represents a spectrum of metabolic liver conditions, from simple steatosis to more advanced steatohepatitis and cirrhosis, and is a growing cause of chronic liver disease worldwide. Early identification of individuals at risk remains a key challenge, as the condition is often asymptomatic in its early stages.

The triglyceride-glucose-waist-to-height ratio is a composite index combining routine metabolic and anthropometric measures that reflect insulin resistance and central adiposity, both known contributors to fatty liver disease.

Study design and findings

Investigators analysed data from a large cohort of adults aged over 60 in the United States, comparing the ability of TyGWHtR with multiple other obesity, metabolic, and inflammatory indices to predict NAFLD status. Diagnosis of NAFLD was based on non-invasive assessment methods commonly used in epidemiological studies.

The analysis showed that TyGWHtR outperformed many conventional indices in identifying individuals with NAFLD, offering robust discrimination across a range of metabolic profiles. This simple ratio may therefore serve as a practical tool for early risk stratification in clinical and community care environments.

Why this matters for hepatology practice

Routine liver disease screening in primary care is not yet widely implemented, and many at-risk individuals remain undiagnosed until advanced fibrosis or steatohepatitis develops. Because TyGWHtR can be calculated from standard blood tests and anthropometric measures, it could help clinicians identify patients who require further evaluation with imaging or specialist referral.

This approach fits within broader efforts to integrate metabolic risk assessment into liver disease care pathways, particularly given the rising prevalence of metabolic dysfunction-associated steatotic liver disease in ageing populations.

Limitations and future directions

While promising, the predictive value of TyGWHtR requires validation in diverse populations and clinical settings, including in patients with established liver fibrosis or co-existing conditions such as diabetes or obesity. Prospective studies are also needed to determine whether use of this index improves long-term clinical outcomes by enabling earlier intervention.

Researchers emphasised that no single index replaces comprehensive clinical assessment, but simple tools like TyGWHtR could enhance initial screening and guide risk-based decision making in hepatology care.

Reference

The association between triglyceride glucose-waist-to-height ratio and non-alcoholic fatty liver disease in adults aged over 60 in the United States: a cross-sectional study. Front Public Health. 2026;DOI:10.3389/fpubh.2025.1569324.