Objective: Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide, particularly among individuals with obesity. This study aimed to investigate the association between the triglyceride-glucose (TyG) index and NAFLD severity in obese patients. Methods: This cross-sectional study included 93 obese adults from Puren Hospital Affiliated to Wuhan University of Science and Technology between January 2022 and December 2023. NAFLD severity was assessed using abdominal ultrasonography and categorized as non-severe (n = 70) or severe (n = 23). The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2]. Spearman correlation and logistic regression models, and receiver operating characteristic (ROC) analysis were used to examine associations between the TyG index and NAFLD severity. Results: Patients with severe NAFLD had significantly higher TyG indices compared to those with non-severe disease (9.40 vs. 8.83, P = 0.003). The proportion of patients with severe NAFLD was significantly higher in the high TyG group (68.8% vs. 15.6%, P < 0.001). Spearman correlation revealed that the TyG index was positively associated with NAFLD severity (P = 0.003). In multivariate logistic regression, the TyG index was independently associated with severe NAFLD after adjusting for confounders. A one-unit increase in TyG was associated with a fourfold increase in the odds of severe NAFLD (adjusted OR = 4.092, 95% CI: 1.825 - 9.175, P = 0.001), and participants with high TyG index had 18.114 times the odds of severe NAFLD (95% CI: 4.452 - 73.708, P < 0.001) compared to the reference group. ROC curve analysis showed that the TyG index had an area under the curve (AUC) of 0.704 (95% CI: 0.576 - 0.833, P = 0.003) for discriminating severe NAFLD, indicating a moderate discriminatory ability. Conclusion: The TyG index is significantly and independently associated with the severity of NAFLD in obese patients. As a simple and non-invasive marker, it may serve as a useful tool for early screening and risk stratification of severe NAFLD in clinical practice.
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