Triglyceride-Glucose Index Associated With Risk of End-Stage Liver Disease in MASLD

The triglyceride-glucose (TYG) index, a traditional marker of insulin resistance, has demonstrated its efficacy in predicting incident end-stage liver disease in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) without diabetes.¹

Presented at the Endocrine Society (ENDO) Annual Meeting 2026 in Chicago, Illinois, by Michal Meron, MD, an endocrine fellow at the Albert Einstein College of Medicine, these data reflect a recent push for alternative methods of identifying patients at risk of progression, given that existing markers, such as diabetes and obesity, are insufficient.¹

“The problem of steatohepatitis, or MASLD, as we call it today, is very prevalent and underdiagnosed,” Meron told HCPLive in an exclusive interview. “We’ve been recommending only screening those who are in high-risk populations, mainly those with diabetes, obesity, and those with known MASLD, but the reality is that many, many people have MASLD – they’re just not being diagnosed, and they are still at risk of progressing to end-stage liver disease.”

The TYG index, first proposed in 2008, is a composite indicator comprised of fasting triglyceride and fasting plasma glucose. The index has particularly high sensitivity and specificity and has been utilized as an alternative biomarker for insulin resistance with limited constraints on cost or time. Additionally, the index has a linear dose-response association with insulin resistance and has shown a significant correlation with a variety of diseases in prior research.²

To validate the index’s efficacy in MASLD, Meron and colleagues conducted a nationwide retrospective cohort study based on the medical records data of Clalit Health Services in Israel. Adult patients aged ≥40 years with TYG index measurements taken between 2005 and 2020 were included; patients who had diabetes or chronic liver disease, or who were taking glucose/lipid-lowering medications, were excluded.¹

The study’s primary outcome was incident end-stage liver disease, which Meron and colleagues noted as including cirrhosis, cirrhosis-related complications, or hepatocellular carcinoma. The team also analyzed associations between sex-stratified TYG quartiles and incident end-stage liver disease by Cox model, adjusting for sex, ethnicity, age, and body mass index (BMI).¹

A total of 948,317 patients were enrolled and followed for a median of 13.1 years (10,736,020 person-years). Among these patients, 2165 had developed end-stage liver disease during this period (incidence rate: 20.2 per 100,000 person-years; mean age at diagnosis, 56.2 +/- 12.6 years). The highest TYG quartile displayed a 22% increased risk of end-stage liver disease compared to the lowest quartile (adjusted HR, 1.22; 95% CI, 1.08-1.38); these results were consistent across sensitivity analyses. The team also noted an association with sex (P = .03), with stronger associations in women (HR, 1.37; 95% CI, 1.13-1.65) than in men (HR, 1.16; 95% CI, 0.98-1.37).¹

Meron and colleagues stated that, while the elevated TYG index has displayed some association with end-stage liver disease risk in the present analysis, further studies are needed to determine whether the index can contribute to risk stratification among patients not currently being offered screening for liver steatosis.¹

“I would be happy to see if someone else did a similar trial in a different population showing the same trend – we have to see that this repeats itself in other populations,” Meron said. “I think the TYG index will allow us to get a more accurate and 360-degree surrounding view of the patient’s overall metabolic comorbidities. This is something that really comes into play in everyday practice, I believe, even in primary healthcare clinics.”

Editors’ Note: Meron reports no relevant disclosures.

References

1. Meron M, Hornik-Lurie T, Rotman-Pikielny P, et al. The Triglyceride-Glucose Index in Non-Diabetic Adults and its Association with End Stage Liver Disease: A Nationwide Cohort Study. Abstract presented at the Endocrine Society (ENDO) Annual Meeting 2026, Chicago, IL. June 13-15, 2026.

2. Sun Y, Ji H, Sun W, An X, Lian F. Triglyceride glucose (TyG) index: A promising biomarker for diagnosis and treatment of different diseases. Eur J Intern Med. 2025;131:3-14. doi:10.1016/j.ejim.2024.08.026