The Combination of Remnant Cholesterol and Waist Circumference Offers Predictive Value for Nonalcoholic Fatty Liver Disease: A Cross-Sectional Study from a Medical Examination Center

Figures & data

Figure 1 Study subject flowchart.

Table 1 Participant Characteristics Grouped According to NAFLD Status

Variables	Non-NAFLD (n=2634)	NAFLD (n=2279)	P value
Male (%)	1155 (43.8%)	1656 (72.7%)	<0.001*
Age (yr)	49 (40, 59)	52 (43, 61)	<0.001*
Age≥45yr	1595 (60.6%)	1618 (71%)	<0.001*
Age<45yr	1039 (39.4%)	661 (29%)
History of alcohol consumption (%)	631 (24%)	931 (40.9%)	<0.001*
Smoking history (%)	337 (12.8%)	591 (25.9%)	<0.001*
WC (cm)	80 (73, 86)	90 (85, 96)	<0.001*
BMI (kg/m^2)	22.77 (20.96, 24.56)	25.93 (24.31, 27.95)	<0.001*
SBP (mmHg)	116 (106, 127)	124 (114, 135)	<0.001*
DBP (mmHg)	75 (69, 82)	80 (74, 88)	<0.001*
FBG (mmol/L)	5.34 (5.04, 5.69)	5.69 (5.3, 6.27)	<0.001*
TC (mmol/L)	4.94 (4.31, 5.6)	5.05 (4.45, 5.72)	<0.001*
TG (mmol/L)	1.02 (0.75, 1.43)	1.58 (1.15, 2.24)	<0.001*
HDL-C (mmol/L)	1.43 (1.24, 1.65)	1.21 (1.07, 1.4)	<0.001*
LDL-C (mmol/L)	3.04 (2.62, 3.54)	3.24 (2.79, 3.7)	<0.001*
ALT (U/L)	14.5 (11.3, 19.48)	20.7 (15.4, 29.8)	<0.001*
AST (U/L)	19.9 (17.2, 23.7)	21.8 (18.6, 26.2)	<0.001*
SUA (mmol/L)	318.2 (267.7, 379.35)	383.9 (329.2, 451.1)	<0.001*
RC (mmol/L)	0.42 (0.27, 0.57)	0.56 (0.42, 0.74)	<0.001*

Note: *P < 0.05.

Abbreviations: NAFLD, nonalcoholic fatty liver disease; WC, waist circumference; BMI, body mass index; DBP, diastolic blood pressure; SBP, systolic blood pressure; AST, aspartate aminotransferase; ALT, alanine aminotransferase; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; RC, residual cholesterol; TC, total cholesterol; FBG, fasting blood glucose; SUA serum uric acid.

Figure 2 Comparisons of WC and RC between individuals with and without NAFLD. (A) WC, (B) RC.

Note: ***P < 0.001.

Abbreviations: WC, waist circumference; RC, residual cholesterol; NAFLD, nonalcoholic fatty liver disease.

Table 2 Participant Characteristics Grouped According to RC Levels

Variables	Low-RC Group (n=2458)	High-RC Group (n=2455)	P value
Male (%)	1289 (45.9%)	1522 (54.1%)	<0.001*
Age (yr)	49 (39, 60)	52 (43, 60)	<0.001*
History of alcohol consumption (%)	695 (44.5%)	867 (55.5%)	<0.001*
Smoking history (%)	368 (39.7%)	560 (60.3%)	<0.001*
WC (cm)	82 (74, 90)	87 (80, 94)	<0.001*
BMI (Kg/m^2)	23.51 (21.31, 25.71)	25.01 (23.14, 27.1)	<0.001*
SBP (mmHg)	117 (107, 129)	122 (112, 134)	<0.001*
DBP (mmHg)	76 (70, 83)	79 (72, 86)	<0.001*
FBG (mmol/L)	5.4 (5.06, 5.85)	5.57 (5.23, 6.09)	<0.001*
TC (mmol/L)	4.51 (4.01, 5.01)	5.49 (4.96, 6.08)	<0.001*
TG (mmol/L)	0.96 (0.72, 1.25)	1.66 (1.24, 2.32)	<0.001*
HDL-C (mmol/L)	1.4 (1.2, 1.63)	1.25 (1.09, 1.46)	<0.001*
LDL-C (mmol/L)	2.77 (2.39, 3.14)	3.52 (3.13, 3.93)	<0.001*
ALT (U/L)	15.3 (11.7, 21.6)	18.5 (14, 26.8)	<0.001*
AST (U/L)	20 (17.3, 24)	21.5 (18.5, 25.8)	<0.001*
SUA (mmol/L)	329.6 (274.7, 391.35)	370.3 (308.3, 441)	<0.001*
NAFLD (%)	825 (33.6%)	1454 (59.2%)	<0.001*

Note: *P < 0.05.

Abbreviations: NAFLD, nonalcoholic fatty liver disease; WC, waist circumference; BMI, body mass index; DBP, diastolic blood pressure; SBP, systolic blood pressure; AST, aspartate aminotransferase; ALT, alanine aminotransferase; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; RC, residual cholesterol; TC, total cholesterol; FBG, fasting blood glucose; SUA serum uric acid.

Figure 3 Comparisons of WC and NAFLD prevalence among individuals with low and high RC levels. (A) WC, (B) NAFLD.

Note: ***P < 0.001.

Abbreviations: WC, waist circumference; NAFLD, nonalcoholic fatty liver disease; RC, residual cholesterol.

Table 3 Multifactorial Logistic Regression Analysis of the Relationship Between RC and NAFLD Risk

Variables	β	SE	Wald χ^2	P value	OR (95% CI)
Model 1	2.663	0.132	405.332	<0.001*	14.333 (11.06, 18.574)
Model 2	2.532	0.136	346.357	<0.001*	12.58 (9.635, 16.425)
Model 3	1.806	0.149	147.384	<0.001*	6.085 (4.546, 8.144)
Model 4	1.159	0.217	28.496	<0.001*	3.186 (2.082, 4.876)

Notes: *P < 0.05. Model 1: Unadjusted; Model 2: Adjusted for age and sex; Model 3: Adjusted for age, sex, smoking history, drinking history, WC, and BMI; Model 4: Adjusted for Model 3 covariates and SBP, DBP, FBG, SUA, TC, HDL-C, LDL-C, ALT, AST.

Table 4 Analyses of the Predictive Performance of RC, WC, and R-W for NAFLD in All Participant Subgroups

Variable	AUC (95% CI)	P value	Sensitivity (%)	Specificity (%)	Youden Index	Cutoff Value
Total
RC	0.679 (0.666, 0.692)	<0.001*	62.97	62.55	0.255	0.48
WC	0.796 (0.785, 0.808)	<0.001*	82.63	62.06	0.447	82
R-W	0.813 (0.802, 0.824)^a,b,c	<0.001*	83.86	63.91	0.478	0.38
Male
RC	0.653 (0.636, 0.671)	<0.001*	62.44	59.91	0.224	0.48
WC	0.734 (0.717, 0.75)	<0.001*	71.72	61.87	0.336	88
R-W	0.756 (0.739, 0.772)^a,b,c	<0.001*	65.84	72.01	0.379	0.6
Female
RC	0.7 (0.68, 0.72)	<0.001*	61.8	67.76	0.295	0.5
WC	0.811 (0.794, 0.828)	<0.001*	83.39	63.77	0.472	76
R-W	0.829 (0.811, 0.844)^a,b,c	<0.001*	79.19	73.27	0.525	0.28
Age≥45 years old
RC	0.631 (0.614, 0.648)	<0.001*	63.04	55.58	0.186	0.48
WC	0.752 (0.737, 0.767)	<0.001*	74.58	61.64	0.362	84
R-W	0.77 (0.755, 0.785)^a,b,c	<0.001*	83.47	56.01	0.395	0.4
Age<45 years old
RC	0.755 (0.735, 0.776)	<0.001*	71.41	67.37	0.388	0.44
WC	0.865 (0.847, 0.881)	<0.001*	88.62	70.63	0.593	81
R-W	0.877 (0.861, 0.892) ^a,b,c	<0.001*	87.56	73.82	0.614	0.3

Notes: *P < 0.05. ^aThe AUC of RC and WC when used to predict NAFLD was significantly different; ^bThe AUC of RC and R-W when used to predict NAFLD was significantly different; ^cThe AUC of WC and R-W when used to predict NAFLD was significantly different.

Abbreviations: AUC, area under the curve; RC, residual cholesterol; WC, waist circumference; R-W, a predictive model combining RC and WC.

Figure 4 ROC curves for the RC-based prediction of NAFLD status in the overall study population and in individual subgroups. (A) Total population, (B) sex subgroup, (C) age subgroup.

Table 5 Binary Logistic Regression Analysis for R-W Model Construction

Variable	β	SE	Wald χ^2	P value	OR (95% CI)
RC	1.894	0.145	171.545	<0.001*	6.643 (5.004, 8.82)
WC	0.12	0.004	821.528	<0.001*	1.128 (1.118, 1.137)
Constants	−11.342	0.364	971.803

Note: *P < 0.05.

Abbreviations: RC, residual cholesterol; WC, waist circumference.

Figure 5 ROC curves for the R-W-based prediction of NAFLD status in the overall study population and in individual subgroups. (A) Total population, (B) sex subgroup, (C) age subgroup.

Figure 6 Comparisons of AUC values for the RC, WC, and R-W models when used to predict NALFD incidence in the overall study population and in each participant subgroup. (A) Total, (B) male, (C) female, (D) age ≥ 45 years, (E) age < 45 years.