Association of Hemoglobin Glycation Index with Non-alcoholic Fatty Liver Disease Diagnosed by Ultrasonogram in Non-diabetic Individuals

Hemoglobin glycation index and NAFLD

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent metabolic diseases worldwide. The hemoglobin glycation index (HGI) quantifies interindividual variations in glycated hemoglobin (HbA1c), and is associated with diabetic complications, and metabolic diseases.

Objective: To evaluate the association of Hemoglobin Glycation Index (HGI) with Non-alcoholic Fatty Liver Disease (NAFLD) in Non-diabetic individuals.

Methods: This cross-sectional analytical study was conducted at Sir Salimullah Medical College from March 2024 to February 2025. This study enrolled a total of 340 non-diabetic suspected cases of NAFLD with age range of 18-65 years attending the outpatient department of Hepatology, Sir Salimullah Medical College Mitford Hospital, Dhaka. The sampling technique was purposive. Based on the ultrasonogram findings, the study subjects were categorized into two groups: NAFLD, and non-NAFLD group. Hemoglobin glycation index (HGI) was calculated by subtracting the predicted value of HbA1c from the measured HbA1c level (HGI = measured HbA1c – predicted HbA1c) for all participants. A predicted value of HbA1c was calculated by inserting fasting plasma glucose concentration into simple linear regression equation (predicted HbA1c = 0.9616 × FPG mmol/L + 0.0963). Subjects were divided into low HGI group (HGI≤median) and high HGI group (HGI>median) using the median HGI as a cut-off value (- 0.38 %). HGI was compared between NAFLD, and non-NAFLD group by chi square test. Risk of NAFLD in subjects with high HGI was calculated by odds ratio (OR). Using the median value as cut off point; performance of high HGI was determined for prediction of NAFLD with respect to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. p value ≤0.05 was considered statistically significant.

Results: Among 340 participants, 141 study subjects (41%) were in the NAFLD group, and the rest 199 subjects (59%) belong to the non-NAFLD group. A significant association of high HGI with NAFLD (P value 0.00001) was observed, and subjects with high HGI found to have 6.85 times more risk to develop NAFLD (OR = 6.85, CI: 4.2 11.1). Receiver operating characteristics (ROC) curve analysis of high HGI (cut-off value- 0.38) for prediction of NAFLD showed area under curve (AUC) to be 0.697 and performance analysis of high HGI for detection of NAFLD showed sensitivity 63.8 %, specificity 79.8 %, PPV 75.2%, NPV 69.4% and accuracy 71.8 %.

Conclusion: There is significant association (OR = 6.85) of high hemoglobin glycation index (HGI) with nonalcoholic fatty liver disease (NAFLD) in non-diabetic individuals. High hemoglobin glycation index (HGI) as a diagnostic biomarker for prediction of nonalcoholic fatty liver disease (NAFLD) is not satisfactory because of its low sensitivity, poor specificity and low area under curve (AUC).

Bangladesh Medical Res Counc Bull 2025;51(2): 81-85