SAT-699 - Tyg-ALT Index A Minimally Invasive Measure of Liver Disease in the Obese and Morbidly Obese Adolescent Population

Background:
As obesity rates have risen, so has the prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), a spectrum of conditions from accumulation of fat in the liver to inflammation and deposition of fibrosis (Metabolic Dysfunction-Associated Steatohepatitis (MASH)). These present differently histologically and may follow a different course of progression in adolescents than among adults. MASH is linked to liver-related and all-cause mortality and is the most quickly increasing indication for liver transplant.
While ALT is commonly used to stratify individuals to assess the need for further investigation into MASLD, it is a poor biomarker for stratification. There is therefore a need for improved non-invasive testing, the Triglyceride-Glucose-ALT (TyG-ALT) index has been proposed to fill this need.

Objective:
We hypothesize that the TyG-ALT index is a more accurate, non-invasive biomarker compared to ALT alone to stratify and identify MASLD in the obese and morbidly obese adolescent population.

Methods:
We investigated the relationship between obesity and several known complications, including liver disease, by histology, in a cohort of adolescents seen at the bariatric clinic of a tertiary care hospital. Baseline fasting labs were collected and a subset consented to liver biopsy at the time of bariatric surgery. TyG-ALT was calculated using: ln(fasting glucose [mg/dL] x fasting triglyceride(mg/dL]× ALT [IU/L]/2). Biopsies reports from pathology were reviewed for NAFLD Activity Score (NAS). NAS was divided into MASLD (NAS 1-3), indeterminate (NAS 4), or MASH (NAS 5+).

Findings:
The average BMI was 47.19 kg/m2, an average age of 16.1, and 35% male in the 730 participants recruited. 416 of them had surgery and 153 had a biopsy done. 36 had an ALT and a NAS score, and 35 had a TyG-ALT index calculated and a NAS score.
Tyg-ALT and ALT were compared to NAS and a trendline and a coefficient of determination (r2) was calculated. For ALT to NAS, the r2 equals 0.1677 and for the TyG-ALT to NAS, the r2 equals 0.2625. A Chi-square analysis was preformed which showed a non-significant goodness of fit for ALT to NAS, χ²(8, N=36) = 7.14, p 0.52, and a significant goodness of fit for TyG-ALT to NAS, χ²(12, N=35) = 31.51, p 0.0016.

Discussion:
In obese adolescents, TyG-ALT was able to stratify levels of liver disease.
The TyG-ALT index is calculated from routine labs, avoiding more expensive, time-consuming, and invasive testing. This preliminary data suggests that TyG-ALT is a more effective screening tool than ALT in the obese adolescent population. Further studies are needed to confirm its use in identifying those requiring additional interventions to manage obesity associated liver disease and set a cut off point for the TyG-ALT to optimally define specificity and sensitivity for liver disease.

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