Analysis of data from 14,578 adults shows that elevated non-high-density to high-density lipoprotein cholesterol ratio () correlates with increased risk of hepatic steatosis.
A significant positive correlation exists between NHHR and the Fatty Liver Index (), with a correlation coefficient of β = 11.14.
A nonlinear relationship between NHHR and FLI was identified, indicating varying degrees of association at different NHHR levels.
A negative correlation was observed between NHHR and the Fibrosis-4 () index, with a coefficient of β = -0.20.
A V-shaped relationship between NHHR and FIB-4 suggests a breakpoint at 1.51, beyond which the association is statistically insignificant.
NHHR demonstrated better predictive performance for metabolic dysfunction-associated steatotic liver disease (MASLD) compared to traditional cholesterol measures.
Simplified
Recently, the non-high-density to high-density lipoprotein cholesterol ratio () has gained growing attention as an indicator for predicting diseases associated with lipid metabolism. Hepatic steatosis and fibrosis are tightly associated lipid metabolism. Our study aims to analyze the correlations among NHHR, hepatic steatosis, and fibrosis. This study analysed data from 14,578 adults in the US National Health and Nutrition Examination Survey (2005-2018). The degree of hepatic steatosis was measured through the Fatty Liver Index (), while liver fibrosis severity was evaluated with the Fibrosis-4 () index. Multivariate linear regression assessed the association between NHHR and the FLI and FIB-4 score. Smooth curve describing the relationship between NHHR and FLI or FIB-4. Additionally, a two-part linear regression model adopted in order to more accurately account for the nonlinear relationship, with threshold effects estimated through its two components. To confirm the robustness of the findings, interaction tests and subgroup analyses were conducted. The multivariate logistic regression analysis demonstrated a significantly positive correlation of lnNHHR with FLI across all three models. In Model 3, the association was (β = 11.14, 95%CI:10.38,11.90). Curve fitting indicated a nonlinear relationship. The positive correlation between lnNHHR and FLI persists across gender, BMI, and physical activity groups. Nevertheless, a notable negative correlation between lnNHHR and FIB-4 was observed in all three models. In Model 3, the relationship between lnNHHR and FIB-4 was as follows: (β = -0.20; 95% CI: -0.22, -0.17). Curve fitting revealed a V-shaped relationship, with threshold effect analysis identifying a breakpoint at 1.51. Above this threshold, the relationship was found to be statistically insignificant (p-value = 0.424). Receiver operating characteristic (ROC) curve analysis demonstrated that NHHR exhibited better predictive performance for MASLD compared to non-HDL-C, HDL-C, and LDL-C/HDL-C. The current study's findings suggest that elevated levels of NHHR correlate with a greater risk of hepatic steatosis among adults in the U.S. Our findings imply that NHHR may be a valuable tool in improving MASLD prevention strategies in the general population.
Key numbers
11.14
Increase in Hepatic Steatosis Risk
Beta coefficient from fully adjusted model.
-0.20
Decrease in Liver Fibrosis Score
Beta coefficient from fully adjusted model.
0.700
Predictive Performance AUC
Area under the curve from ROC analysis.
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Declarations. Competing interests: The authors declare no competing interests. Ethical statement: The portions of this study involving human participants, human materials, or human data were conducted in accordance with the Declaration of Helsinki and were approved by the NCHS Ethics Review Board. The patients/participants provided their written informed consent to participate in this study.
