Evaluation of the CHG index for identifying metabolic dysfunction associated steatotic liver disease: evidence from two independent Asian non-obese populations.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent and is driven by coupled abnormalities in glucose and lipid metabolism. Single metabolic markers such as total cholesterol (TC), fasting blood glucose (FBG), or high-density lipoprotein cholesterol (HDL-C) reflect isolated pathways and often show limited predictive value. The cholesterol, high-density lipoprotein, and glucose (CHG) index integrates lipid and glycaemic information and may better capture MASLD-related metabolic risk. Methods: Two de-identified health-check cohorts from the Dryad repository were analyzed: a Chinese derivation cohort from Wenzhou Medical Center (2010-2014; Results: Higher CHG was consistently associated with MASLD in both populations, showing clear dose-response gradients. Participants in the highest CHG quartile had approximately fourfold higher adjusted odds of MASLD than those in the lowest quartile. CHG yielded the highest AUC among all markers in both cohorts and improved baseline model discrimination and reclassification, with positive NRI and IDI. Conclusion: The CHG is robustly and dose-dependently associated with MASLD and demonstrates superior, reproducible discriminative performance compared with traditional single markers across two independent Asian cohorts. CHG may serve as a practical, low-cost tool for MASLD screening and risk stratification at baseline health check-ups.