Longitudinal Plasma Atherogenic Index Trajectories Predict MASLD Risk

Overview

This longitudinal cohort study of 1,894 participants identified three distinct plasma atherogenic index (AIP) trajectories—low-stable, moderate-stable, and high-stable—and demonstrated that sustained high AIP levels significantly increase the risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD). The high-stable AIP group had more than double the risk of incident MASLD compared to the low-stable group over a median follow-up of nearly 3 years.

Background

MASLD is a growing global health concern characterized by fatty liver disease associated with metabolic dysfunction, affecting approximately 30% of adults worldwide and linked to increased cardiovascular risk and mortality. The atherogenic index of plasma (AIP) is a novel biomarker reflecting lipid metabolism balance and has shown promise in predicting metabolic diseases including MASLD. Prior studies have mostly been cross-sectional, lacking insight into how longitudinal changes in AIP relate to MASLD development. This study addresses this gap by analyzing AIP trajectories over time and their association with incident MASLD.

Data Highlights

Key Findings

• Three distinct AIP trajectory patterns were identified: low-stable (33.7%), moderate-stable (49.1%), and high-stable (17.3%).
• Participants in the high-stable AIP group had a 2.23-fold increased risk of developing MASLD compared to the low-stable group after adjusting for confounders.
• The moderate-stable group also showed a significantly elevated MASLD risk (HR 1.42) relative to the low-stable group.
• Associations remained robust after adjusting for metabolic mediators such as BMI and fasting glucose.
• Subgroup analyses revealed stronger associations in individuals without diabetes or hypertension.
• Sensitivity analyses confirmed the stability and reliability of the observed relationships.

Clinical Implications

Monitoring longitudinal changes in AIP can aid in early identification of individuals at elevated risk for MASLD, enabling targeted preventive strategies. Incorporating AIP trajectory assessment into routine health examinations may improve risk stratification beyond traditional metabolic parameters. Clinicians should consider sustained high AIP levels as an independent risk factor when evaluating patients for MASLD risk.

Conclusion

Sustained high plasma atherogenic index levels are independently associated with increased risk of incident MASLD. Longitudinal AIP trajectory monitoring represents a valuable tool for early detection and prevention of MASLD in clinical practice.

References

1. Chen et al. 2023 -- Dose-response relationship between AIP and MASLD prevalence
2. Sun et al. 2022 -- AIP trajectories predict type 2 diabetes onset
3. International Consensus Panel 2020 -- MASLD diagnostic criteria