TITLE:
Clinical Utility of C-Reactive Protein-Triglyceride Glucose Index (CTI) and hs-CRP for Distinguishing Obese and Non-Obese Phenotypes of NAFLD: NHANES 2017-2020
AUTHORS:
Hao Li, Chuanxin Zou
KEYWORDS:
NAFLD, Obesity, hs-CRP, C-Reactive Protein-Triglyceride Glucose Index, Phenotype, NHANES
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.13 No.10,
October
21,
2025
ABSTRACT: Background: Non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, but emerging evidence suggests significant heterogeneity between obese and non-obese phenotypes. We aimed to evaluate the discriminative ability of high-sensitivity C-reactive protein (hs-CRP) and the C-reactive protein-triglyceride glucose index (CTI) in identifying the obese NAFLD phenotype using data from NHANES 2017-2020. Methods: We analyzed 1171 adults with NAFLD from NHANES 2017-2020 (obese, n = 729; non-obese, n = 442). Obesity was defined as BMI ≥ 30 kg/m2. Logistic regression models (models 1 - 4) assessed associations of hs-CRP and CTI with obesity, progressively adjusted for demographics and metabolic factors. Receiver operating characteristic (ROC) curves evaluated discrimination. Results: We enrolled 1171 participants diagnosed with non-alcoholic fatty liver disease (NAFLD) (53.7% male), of whom 62.3% were classified into the obese phenotype group. Univariate logistic regression revealed that both hs-CRP (OR = 1.11, 95% CI: 1.08 - 1.15, p Conclusions: Both CTI and hs-CRP demonstrated significant associations with the obese phenotype of NAFLD. However, after adjusting for multiple confounding factors, only CTI remained an independent risk factor for the obese phenotype, suggesting that, as a composite metric reflecting metabolic-inflammatory interactions, it more accurately captures the core pathophysiological mechanism underlying obese-phenotype NAFLD. Notably, hs-CRP exhibited superior discriminatory power (AUC = 0.711) and calibration accuracy, making it more suitable for use as a tool for rapid clinical screening. Although CTI showed relatively weaker standalone discriminatory ability (AUC = 0.628), its independent and robust association supports its unique value in comprehensive multifactorial risk assessment models. The low collinearity (VIF = 1.2) further indicates that these two markers provide complementary rather than redundant information for phenotypic differentiation. In summary, this study advocates for a hierarchical biomarker application strategy to distinguish NAFLD phenotypes: hs-CRP can be used for initial phenotypic screening, while CTI provides deeper mechanistic insights for precise risk stratification and individualized management of NAFLD. Future multicenter diagnostic studies are needed to validate their clinical utility and define optimal diagnostic cut-off values.