Abstract
BackgroundLow-density lipoprotein to high density lipoprotein (LDL/HDL) cholesterol ratio has been reported to predict the risk of many metabolic diseases. However, the association between the LDL/HDL cholesterol ratio and nonalcoholic fatty liver disease (NAFLD) has not been established.MethodsA longitudinal cohort design was adopted in this study; 9767 non-obese subjects without NAFLD were included and analyzed. The subjects were grouped according to the quintile of LDL/HDL cholesterol ratio. The cumulative incidence of NAFLD and the independent effect of the LDL/HDL cholesterol ratio on NAFLD during 5 years of follow-up were calculated using the Kaplan-Meier method and Cox proportional-hazards regression model.ResultsDuring the 5-year follow-up period, 841 subjects were diagnosed with new-onset NAFLD, and the 1-, 2-, 3-, 4-, and 5-year cumulative incidence rates of NAFLD were 1.16, 4.65, 8.33, 12.43, and 25.14%, respectively. In the multivariable-adjusted Cox proportional-hazards regression model, the LDL/HDL cholesterol ratio was significantly associated with the risk for NAFLD (HR: 1.66, 95% CI: 1.38–1.99, P trend< 0.001), especially among young people (HR: 3.96, 95% CI: 1.50–10.46, P interaction< 0.05). Additionally, receiver operating characteristic curve analysis showed that the LDL/HDL cholesterol ratio was better than HDL cholesterol and LDL cholesterol in predicting new-onset NAFLD.ConclusionsLDL/HDL cholesterol ratio is an independent predictor of NAFLD in Chinese non-obese people with normal lipids, and its predictive value is higher than that of other lipoproteins. In clinical practice, the LDL/HDL cholesterol ratio can be used to identify people at high risk of NAFLD.
Highlights
Low-density lipoprotein to high density lipoprotein (LDL/HDL) cholesterol ratio has been reported to predict the risk of many metabolic diseases
The study found that in Chinese non-obese people with normal lipids, the LDL/HDL cholesterol ratio was significantly associated with new-onset nonalcoholic fatty liver disease (NAFLD) events, which was independent of other risk factors
No studies have been reported on the association between the ratio of LDL/HDL cholesterol and NAFLD, so it is difficult to compare the findings of LDL/HDL cholesterol ratio (Quintile), hazard ratios (HR) (95%confidence intervals (CI))
Summary
Low-density lipoprotein to high density lipoprotein (LDL/HDL) cholesterol ratio has been reported to predict the risk of many metabolic diseases. The association between the LDL/HDL cholesterol ratio and nonalcoholic fatty liver disease (NAFLD) has not been established. Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and the main cause of various liver diseases [1,2,3]. In recent years, many studies have pointed out that non-obese people are prone to NAFLD [12, 13]. Several recent large cohort studies have shown that compared to obese NAFLD patients, nonobese NAFLD patients are at significantly increased risk for metabolic syndrome and hypertension [16, 17], making early detection and intervention of risk factors in non-obese NAFLD patients extremely important
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