The diagnostic value of ogtt t-AUC measurements in non-diabetic MASLD patients and its relationship with Elastography CAP score

Objective: The primary aim of this study was to determine the diagnostic value of total glycemic load (t-AUC) obtained during the Oral Glucose Tolerance Test (OGTT) in non diabetic individuals with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and to investigate the relationship between these measurements and the degree of liver steatosis (CAP score) assessed by Transient Elastography (FibroScan). The secondary aim was to evaluate the independent effects of t-AUC and other metabolic risk factors in predicting the presence of MASLD. Materials and Methods: A total of 135 participants (MASLD=76, Non-MASLD=59) without a history of diabetes or alcohol consumption were included in this cross-sectional and prospective study. A standard 75-g OGTT was administered to the participants, and t-AUC values were calculated using the trapezoidal method. The degree of liver steatosis and fibrosis was quantitatively measured using Vibration-Controlled Transient Elastography (FibroScan). Data were analyzed using Mann-Whitney U, Spearman correlation, and multivariate logistic regression tests. Results: The t-AUC values in the MASLD group were found to be statistically significantly higher compared to the non-MASLD group (Median: 264.4 vs 234.8 mg/dL·h, 𝑝 < 0.001). A positive and significant correlation was observed between t AUC levels and the CAP score indicating the degree of liver steatosis (r = 0.509, p < 0.001). In ROC analysis, the sensitivity and specificity of the 242.9 mg/dL·h cut-off value determined for t-AUC were 73.7% and 61.0%, respectively. However, while t-AUC lost its independent predictive effect in multivariate analysis (𝑝 = 0.556), Waist Circumference (OR: 1.244, 𝑝 < 0.001) and GGT (OR: 1.100, 𝑝 = 0.007) were identified as the strongest independent risk factors for the presence of MASLD. Conclusion: Our study demonstrated that postprandial glucose load (t-AUC) is increased in non-diabetic MASLD patients and is associated with the severity of liver steatosis. Nevertheless, glucose intolerance appears to be a reflection of visceral obesity rather than a sole cause. In clinical practice, waist circumference and GGT measurement are stronger and more independent markers than t-AUC calculation for MASLD risk screening. Keywords: MASLD, Oral Glucose Tolerance Test, t-AUC, Transient Elastography, CAP Score, Insulin Resistance.