Insulin resistance is a central pathophysiologic feature of metabolic dysfunction-associated steatotic liver disease (MASLD) and has been linked to adverse cardiometabolic outcomes. Whether the estimated glucose disposal rate (eGDR), a surrogate marker of insulin resistance, carries prognostic value in this population has remained uncertain. A nationally representative observational cohort study published in Cardiovascular Diabetology evaluated the association between eGDR and cause-specific mortality among adults with MASLD.

The study included 6,847 patients with MASLD from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. Participants were categorized into quartiles based on eGDR levels. Outcomes included all-cause, cardiovascular, and diabetes mortality. Restricted cubic spline models and multivariable Cox proportional hazards models were used to assess associations, and receiver operating characteristic analyses evaluated discriminative performance.

Over a median follow-up of 8.8 years, 19.6% of patients died. After adjustment for confounders, higher eGDR levels were associated with lower risks of all-cause mortality (HR 0.94; 95% CI, 0.92-0.97; P<.001), cardiovascular mortality (HR 0.90; 95% CI, 0.85-0.95; P<.001), and diabetes mortality (HR 0.70; 95% CI, 0.62-0.80; P<.001). Receiver operating characteristic analyses showed modest discrimination for all-cause and cardiovascular mortality and moderate discrimination for diabetes mortality.

In this NHANES-based cohort of patients with MASLD, higher eGDR levels were independently associated with lower risks of all-cause, cardiovascular, and diabetes mortality. The modest discriminative performance suggests eGDR may have a role in cardiometabolic risk stratification in this population.