Metabolic Score for Insulin Resistance Is Inversely Related to Incident Advanced Liver Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease

We determined the relationships between metabolic score for IR (METS-IR), triglyceride-glucose (TyG) index, and homeostatic model assessment for IR (HOMA-IR) and incident advanced liver fibrosis (ALF) and assessed the abilities of the three IR indicators to predict ALF in patients with non-alcoholic fatty liver disease (NAFLD) in adults with NAFLD who were aged 40–69 years old. Among 2218 participants with NAFLD at baseline, the areas under the receiver operating characteristic curve for predicting ALF of the METS-IR was 0.744 (0.679–0.810), significantly higher than that of TyG index (0.644 (0.569–0.720)) or that of HOMA-IR (0.633 (0.556–0.710)). Among 1368 patients with NAFLD and without ALF at baseline, 260 (19.0%) patients with NAFLD progressed to ALF during the 16-year follow-up period. Multivariable Cox proportional hazard regression analysis revealed that the adjusted hazard ratio (95% confidence interval) for incident ALF in the highest tertiles of METS-IR, TyG index, and HOMA-IR compared with the lowest tertile of each IR indicator were 0.5 (0.36–0.91), 0.7 (0.49–1.00), and 1.01 (0.71–1.42), respectively. METS-IR was inversely associated with ALF in patients with NAFLD, which cautiously suggests that the risk of ALF may need to be evaluated when metabolic parameters improve in individuals with NAFLD.