Association of SPISE with Prevalent and Incident MASLD: A Two-Stage Population-Based Study and Development of a Risk Prediction Model

Why It Matters

SPISE offers a low‑cost, routine‑lab‑based metric that can flag individuals at high MASLD risk, enabling earlier intervention and more efficient allocation of screening resources.

Key Takeaways

• Higher SPISE halves odds of prevalent MASLD (OR 0.43) after full adjustment
• SPISE reduces incident MASLD risk by ~50% (HR 0.49) in 16k cohort
• Adding SPISE improves reclassification (NRI 0.363) and discrimination (IDI 0.093) versus TyG
• SPISE‑based model with liver enzymes and BP yields AUC 0.86–0.89 for 12‑24 mo
• Risk rises sharply below SPISE ≈ 7.9, flattening above this threshold

Pulse Analysis

Metabolic dysfunction‑associated steatotic liver disease (MASLD) has become a leading cause of chronic liver injury worldwide, driven by rising obesity and cardiometabolic disorders. Early stages are often silent, making population‑wide screening essential but challenging. Traditional insulin‑resistance indices rely on fasting insulin, limiting their use in routine health checks. SPISE, derived from body‑mass index, triglycerides and HDL‑cholesterol, circumvents this barrier, offering a cheap, easily calculable proxy for insulin sensitivity that can be applied in primary‑care settings.

The recent two‑stage analysis leveraged a cross‑sectional sample of 1,592 individuals and a longitudinal cohort of over 16,000 participants free of MASLD at baseline. Results consistently showed that higher SPISE values were strongly protective: the odds of existing MASLD dropped to 0.43, while the hazard of incident disease fell to 0.49 after adjusting for demographics, blood pressure, liver enzymes and renal markers. Compared with established surrogates such as TyG, METS‑IR and TG/HDL‑C, SPISE added the most predictive value, improving net‑reclassification by 36 % and the integrated discrimination index by 9 %. A multivariable model that combined SPISE with liver enzymes, bilirubin and diastolic blood pressure achieved area‑under‑the‑curve scores of 0.86 at 12 months and 0.89 at 24 months, indicating robust discrimination for short‑term MASLD risk.

These findings suggest that SPISE could become a cornerstone of cost‑effective MASLD risk stratification, especially in resource‑limited environments where advanced imaging is unavailable. By integrating SPISE into electronic health records or online calculators, clinicians can identify high‑risk patients for targeted lifestyle counseling or further diagnostic work‑up. Nonetheless, the study’s reliance on ultrasound‑based diagnosis and limited ethnic diversity calls for external validation in broader populations before widespread clinical adoption. Future research should explore calibration across different regions and assess whether SPISE‑guided interventions translate into reduced liver‑related morbidity and mortality.