Objective:

To investigate the longitudinal association between changes in the Atherogenic Index of Plasma (AIP) and the risk of developing Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), highlighting the significance of this relationship in clinical practice.

Key Findings:

• Three AIP trajectory patterns were identified: low-stable (33.7%), moderate-stable (49.1%), and high-stable (17.3%).
• The high-stable AIP group had a 2.23-fold increased risk of incident MASLD compared to the low-stable group (adjusted HR = 2.23, 95% CI: 1.51–3.30, P < 0.001).
• The moderate-stable group also showed an increased risk of MASLD (HR = 1.42, 95% CI: 1.02–1.98, P = 0.038).
• Subgroup analyses indicated stronger associations in non-diabetic and non-hypertensive individuals.

Interpretation:

Sustained high levels of AIP are independently associated with an increased risk of MASLD, suggesting that monitoring AIP trajectories could aid in early identification and prevention strategies, potentially improving patient outcomes.

Limitations:

• The study's retrospective design may limit causal inferences and introduce biases.
• The cohort was drawn from a single hospital, which may affect generalizability.

Conclusion:

Monitoring AIP trajectories may serve as a valuable tool for early identification and targeted prevention of MASLD, underscoring the need for further research in diverse populations.