Monocytes to Apolipoprotein A1 ratio is associated with metabolic dysfunction-associated fatty liver disease in type 2 diabetes mellitus

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Abstract
The monocyte-to-Apolipoprotein A1 ratio (MAR) emerges as a potentially valuable inflammatory biomarker indicative of metabolic dysfunction-associated fatty liver disease (MASLD). Accordingly, this investigation primarily aims to assess the correlation between MAR and MASLD risk. A cohort comprising 957 individuals diagnosed with type 2 diabetes mellitus (T2DM) participated in this study. The relationship between MAR and MASLD was analyzed through binomial logistic regression analysis and restricted cubic splines (RCS). Furthermore, a comparative assessment of MAR and monocyte to high-density lipoprotein ratio (MHR) in identifying MASLD efficacy was conducted using receiver operating characteristic curve analysis. Remarkably, even after adjusting for metabolic parameters and hepatic functional markers, MAR stood out as an independent predictor for MASLD (OR 1.58, 95% CI 1.36–1.84; P < 0.001) and displayed a nonlinear positive association with MASLD risk according to RCS analysis (P for nonlinearity and overall < 0.001). Notably, MAR exhibited superior diagnostic accuracy for identifying MASLD compared to MHR (AUC: 0.772 vs 0.722, P < 0.001). In summary, MAR emerges as a promising inflammatory indicator for MASLD, demonstrating potential as a valuable screening tool to bolster the management of MASLD within the T2DM population.

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