Background: Insulin resistance (IR) is assessed using surrogate markers such as the triglyceride–glucose (TyG) index, the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio, and the metabolic score for IR (METS-IR). Limited studies investigated their association with colorectal cancer (CRC) incidence, and no research has been conducted on their association with the METS-IR. Method: This study used claims data from the Korean National Health Insurance Service, analyzing a cohort of 314,141 Koreans aged over 40 who participated in the National Health Screening Program from 2009 to 2010. The follow-up period was extended until 31 December 2019. Participants were divided into four groups based on quartiles (Q1–Q4) of the markers. Results: All surrogate markers of IR had sequentially statistically lower disease-free probabilities from Q1 to Q4. The Cox proportional hazard model demonstrated statistically significant positive associations between CRC incidence and Q3 and Q4 of the TyG index, as well as Q3 and Q4 of the TG/HDL-C ratio and Q4 of the METS-IR. The constrained cubic spline method revealed a nonlinear, positive dose–response relationship between the TyG index and the METS-IR in relation to CRC incidence. Conclusions: In conclusion, the TyG index, TG/HDL-C ratio, and METS-IR were positively correlated with CRC incidence in Koreans.

Background and Aims: Multiple non-invasive tests (NITs) for identifying advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) are available, but, due to the limitations of single NITs, the American Association for the Study of Liver Disease (AASLD) guidelines suggest a two-step strategy, combining the Fibrosis-4 Index (FIB-4) score with the Enhanced Liver Fibrosis (ELF) test to improve diagnostic accuracy and minimize unnecessary liver biopsies. However, few real-world studies have used such a sequential approach. We here evaluated the diagnostic accuracy of the ELF test in patients with recently established metabolic dysfunction-associated steatotic liver disease (MASLD) and assessed the clinical utility of applying a two-step strategy, including the ELF test following the FIB-4 score assessment, in patients with MASLD. Methods: We enrolled 153 patients diagnosed with MASLD who underwent liver biopsy at the Dong-A University Hospital between June 2018 and August 2023. The degree of fibrosis was determined based on liver biopsy results. Various NITs were used, including the Aminotransferase-to-Platelet Ratio Index (APRI), FIB-4 score, NAFLD Fibrosis score (NFS) and ELF test. The diagnostic efficacy of these NITs was evaluated based on the area under the receiver operating characteristic curve (AUROC). Additionally, the performance of each test was further examined both when applied individually and in a two-step approach, where FIB-4 was used followed by ELF testing. Key metrics such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were used for this analysis. Results: Overall, 153 patients with MASLD (mean age: 46.62 years; 52.3% men; 28.1% with type 2 diabetes) were included. The performance of the NITs in identifying advanced fibrosis was as follows: the AUROC of the APRI, FIB-4, NFS, and ELF tests were 0.803 (95% confidence interval (CI), 0.713–0.863), 0.769 (95% CI, 0.694–0.833), 0.699 (95% CI, 0.528–0.796), and 0.829 (95% CI, 0.760–0.885), respectively. The combination of the FIB-4 score ≥ 1.30 and the ELF score ≥ 9.8 showed 67.86% sensitivity, 90.40% specificity, a PPV of 75.18%, an NPV of 86.78%, an accuracy of 83.64%, and an AUROC of 0.791 for predicting the diagnosis of advanced fibrosis. This approach excluded 28 patients (71.8%) from unnecessary liver biopsies. Conclusions: Our study demonstrated that ELF testing maintained diagnostic accuracy in assessing liver fibrosis in patients with MASLD in real-world practice. This test was used as a second step in the evaluation, reducing clinically unnecessary invasive liver biopsies and referrals to tertiary institutions. This approach allows assessment of MASLD severity in primary care settings without requiring additional equipment.

Background: Chronic periodontitis (CP) and metabolic dysfunction-associated steatotic liver disease (MASLD) have emerged as interconnected conditions with shared mechanisms, such as systemic inflammation and metabolic dysregulation. However, the risk of CP in the newly classified subgroups of steatotic liver disease (SLD), including MASLD and metabolic alcohol-associated liver disease (MetALD), has not been extensively studied. This study investigated the association between SLD subtypes and the incidence of CP in a nationwide cohort. Methods: This retrospective cohort study used data from the Korean National Health Insurance Service database. The study included 115,619 participants aged 40 and older who underwent health screenings between 2009 and 2010. The participants were classified into four groups: normal without risk factors, normal with risk factors, MASLD, and MetALD. The primary outcome was the incidence of CP as defined by ICD-10 codes and dental treatment records. Hazard ratios (HRs) were calculated using the Cox proportional hazards model and adjusted for demographic, clinical, and lifestyle factors. Results: Over a mean follow-up of 7.4 years, individuals with MASLD and MetALD had significantly higher risks of developing CP compared with the normal group without risk factors (MASLD: adjusted HR 1.14, 95% confidence interval (CI): 1.11–1.17; MetALD: adjusted HR 1.21, 95% CI: 1.15–1.27). The risk was more pronounced for severe CP, particularly for those with MetALD (adjusted HR 1.29, 95% CI: 1.22–1.36). Subgroup and sensitivity analyses confirmed these findings across the various definitions of hepatic steatosis and metabolic risk factors. Conclusions: This study reveals that individuals with MASLD and MetALD are at an elevated risk of developing CP, highlighting the need for integrated care strategies that address both periodontal health and metabolic liver conditions. These findings underscore the importance of periodontal health management in reducing the risk of CP among SLD populations.

Moon SY, et al. Korean J Gastroenterol. 2019 Jun;73(6):360-364. https://doi.org/10.4166/kjg.2019.73.6.360