Abstract
BackgroundThe non-HDL-cholesterol to HDL-cholesterol (NHDLC/HDLC) ratio is closely related to a variety of dyslipidemia-related diseases. This study examined the relationship between the NHDLC/HDLC ratio and non-alcoholic fatty liver (NAFLD) in children and adolescents.MethodsThis cross-sectional survey included a total of 7759 eligible Chinese children and adolescents (5692 boys and 2067 girls) who received routine medical examinations. The anthropometric and laboratory data of the subjects were collected. NAFLD was diagnosed by liver ultrasonography. Binary logistic regression analysis was performed on the NHDLC/HDLC ratio, NHDLC, HDLC and NAFLD. Receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic significance of the above parameters for NAFLD.ResultsThe total prevalence of NAFLD was 4.36%, and the prevalence in boys was higher than that in girls (5.61% vs. 1.9%, P < 0.001). The prevalence of NAFLD was positively correlated with the NHDLC/HDLC ratio (P < 0.001). The binary logistic regression analysis demonstrated that the OR was 8.61 (95% CI, 5.90–12.57, P < 0.001) in tertile 3 (highest NHDLC/HDLC ratio) compared with tertile 1 (lowest NHDLC/HDLC ratio). After adjustment for age, sex, body mass index (BMI), alanine aminotransferase (ALT), uric acid (UA), total bilirubin (TB), fasting plasma glucose (FPG) and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), the OR for tertile 3 (OR = 1.83, 95% CI, 1.04–3.22, P = 0.035) was still significantly higher than that of tertile 1. The area under the curve (AUC) of the NHDLC/HDLC ratio of boys was 0.787, which was significantly greater than NHDLC and HDLC (0.719 and 0.726, P < 0.001). For girls, the AUC of the NHDLC/HDLC ratio was 0.763, which was also significantly greater than NHDLC (0.661, P < 0.001). The cutoff point of the NHDLC/HDLC ratio was 2.475 in boys and 2.695 in girls. In addition, the AUC of the NHDLC/HDLC ratio was 0.761 in subjects with normal ALT levels (ALT ≤40 U/L), which was significantly higher than NHDLC (0.680, P < 0.001) and HDLC (0.724, P = 0.007). For subjects with elevated ALT levels (ALT > 40 U/L), the AUC of the NHDLC/HDLC ratio (0.746) was also significantly greater than NHDLC (0.646, P < 0.001).ConclusionsThe NHDLC/HDLC ratio was positively correlated with NAFLD in Chinese children and adolescents. It may serve as an effective indicator to help identify NAFLD in children and adolescents.
Highlights
The non-HDL-cholesterol to HDL-cholesterol (NHDLC/high-density lipoprotein cholesterol (HDLC)) ratio is closely related to a variety of dyslipidemia-related diseases
The non-high-density lipoprotein cholesterol (NHDLC)/HDLC ratio was positively correlated with Non-alcoholic fatty liver disease (NAFLD) in Chinese children and adolescents
Data collected for this study included total cholesterol (TC), fasting plasma glucose (FPG), HDLC, triglycerides (TG), alanine aminotransferase (ALT), alkaline phosphatase (APL), glycated hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDLC), albumin (ALB), uric acid (UA), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), total bilirubin (TB) and creatinine (Cr)
Summary
The non-HDL-cholesterol to HDL-cholesterol (NHDLC/HDLC) ratio is closely related to a variety of dyslipidemia-related diseases. This study examined the relationship between the NHDLC/HDLC ratio and nonalcoholic fatty liver (NAFLD) in children and adolescents. Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease (CLD) involving fatty liver, liver steatosis and nonalcoholic steatohepatitis (NASH) [1]. NAFLD is recognized as metabolic syndrome (MS) that manifested in the hepatic area, and its progressive form NASH increases the risk of liver cancer, end-stage liver disease and cirrhosis [4]. Pediatric NAFLD is considered to be involved in the pathogenesis of diabetes mellitus (DM), MS and cardiovascular disease (CVD) [5]. Liver ultrasonography is a feasible and noninvasive means of diagnosing NAFLD, but not all children undergo liver ultrasonography because their parents may be reluctant to let them receive medical examination for a clinically silent disease [6]. Valuable indicators for NAFLD should be identified for early detection and prevention of later progression
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