Objective To investigate the association of estimated glucose disposal rate (eGDR) with metabolic dysfunction-associated liver steatosis and fibrosis, and to analyze the difference of the association in different population.

Methods A total of 10, 549 participants from 2017 to 2020 in National Health and Nutrition Examination Survey (NHANES) database who underwent vibration-controlled transient elastography (VCTE) were included. eGDR was calculated based on waist circumference, hypertension, and glycated hemoglobin (HbA1c). The controlled attenuation parameter (CAP) ≥ 248 dB/m was used as diagnostic criterion for liver steatosis, and liver stiffness measurement (LSM) ≥ 8.2 kPa was used as criterion for liver fibrosis. Multivariable Logistic regression analysis was conducted to assess the relationship between eGDR and liver steatosis and fibrosis, with subgroup analysis and interaction tests performed.

Results After adjusting for confounding factors, eGDR level was significantly negatively associated with the risks of both liver steatosis and fibrosis. The participants were divided into tertiles based on eGDR levels (Q1, Q2, Q3). Compared with the Q1 group, the risk ratios for liver steatosis in the Q2 and Q3 groups were 0.485 (95%CI, 0.394 to 0.597) and 0.286 (95%CI, 0.239 to 0.343), respectively(P < 0.001); the risk ratios for liver fibrosis were 0.457 (95%CI, 0.363 to 0.576) and 0.162 (95%CI, 0.100 to 0.263), respectively (P < 0.001). Subgroup analysis showed that the negative association between eGDR and liver steatosis differed among populations of different ages and smoking statuses, with statistically significant differences in interaction tests (P for interaction < 0.001); similarly, the negative association between eGDR and liver fibrosis differed among populations with different levels of physical activity, with statistically significant differences in interaction tests (P for interaction < 0.001). The associations of eGDR levels with liver steatosis and fibrosis remained stable (P for interaction>0.05).

Conclusion eGDR levels are closely associated with the risks of liver steatosis and fibrosis and can serve as an effective indicator for assessing liver metabolic abnormalities. This finding provides new insights into early screening, risk stratification, and prognosis assessment for liver steatosis and fibrosis.