Conicity Index and Lipid-Metabolic Indices for Ultrasound-Diagnosed Hepatic Steatosis in HBsAg-positive Adults: a Cross-Sectional Study Emphasizing Normal BMI

Hepatic steatosis commonly coexists with HBsAg positivity, but how low-cost anthropometric and lipid-metabolic indices compare in adjusted cross-sectional association and discrimination, particularly among adults with normal BMI, remains uncertain. We analyzed 7984 HBsAg-positive individuals who underwent routine health examinations between March 2014 and December 2017. Discrimination and incremental model performance were evaluated in a common complete-case sample (N = 7670; 1634 events) using areas under the receiver operating characteristic curve (AUCs) and paired DeLong tests, with pre-specified subgroup analyses by sex, age group, BMI category, and alanine aminotransferase status. Restricted cubic splines were used to assess nonlinearity for the conicity index, TyG-WC, and TyG-BMI, and 1st/99th percentile winsorization was used to assess sensitivity to extreme values. Hepatic steatosis was identified in 1681 participants (21.1