Serum remnant cholesterol is a potential predictor of liver stiffness in patients with nonalcoholic fatty liver disease

Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) is associated with dyslipidemia, and the connection between dyslipidemia and remnant cholesterol (RC), a component of triglyceride-rich lipoproteins, remains enigmatic.

Methods

In this cross-sectional study, our primary aim was to investigate the role of RC in the progression of NAFLD and to provide robust evidence of RC’s involvement in the pathogenesis of NAFLD. We enrolled 2800 NAFLD patients from the National Health and Nutrition Examination Survey (NHANES). Logistic regression was employed to examine the relationship between serum RC levels and liver stiffness, while receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic capability of RC.

Results

RC exhibited an independent correlation with the extent of liver stiffness, with odds ratios (OR) of 1.02 for liver steatosis (p = 0.014) and 1.02 for liver fibrosis (p = 0.014). To predict NAFLD, the optimal RC thresholds were 17.25 mg/dL for males and 15.25 mg/dL for females in the case of liver steatosis. For advanced liver fibrosis, the best thresholds were 17.25 mg/dL for males and 16.25 mg/dL for females.

Conclusions

RC demonstrated a positive correlation with the degree of liver stiffness and exhibited superior diagnostic efficacy for liver steatosis and fibrosis compared to other cholesterol indicators.

Graphical abstract

PLAIN LANGUAGE SUMMARY

Elevated serum remnant cholesterol (RC) levels may serve as a potential indicator of metabolic diseases, including nonalcoholic fatty liver disease (NAFLD). The connection between serum RC and NAFLD has been previously undervalued. In our investigation, we examined 2800 NAFLD patients from the National Health and Nutrition Examination Survey (NHANES). Our cross-sectional study has revealed a more distinct relationship between RC and the degree of liver stiffness, especially concerning liver steatosis when compared to other cholesterol indicators. Recognizing RC’s significant role in metabolic disorders may lead to innovative approaches for diagnosing and treating NAFLD patients.

Keywords:

• Cholesterol
• cross-sectional study
• liver steatosis
• liver fibrosis
• triglyceride

Authors’ contribution

Ya Wang: Investigation, Data Curation, Writing - Original Draft. Wanhan Song: Validation, Writing - Review & Editing. Qianhua Yuan: Software, Validation. Meiqing Mai: Formal analysis. Mengliu Luo: Visualization. Jiahua Fan: Writing – review & editing, Visualization. Peiwen Zhang: Conceptualization, Methodology, Supervision. Honghui Guo: Resources, Project administration, Supervision. All authors have read and approved the submitted version of the paper.

Disclosure statement

The authors declare that there are no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This research was funded by the National Natural Science Foundation of China (82273622); Science and Technology Project of Zhanjiang City (2021A05241); Guangdong Basic and Applied Basic Research Foundation (2021B1515140057); Discipline Construction Project of Guangdong Medical University (4SG21016G).