Association between the non-HDL-cholesterol to HDL-cholesterol ratio and non-alcoholic fatty liver disease in Chinese children and adolescents: a large single-center cross-sectional study

Abstract

Background: The non-HDL-cholesterol to HDL-cholesterol (NHDLC/HDLC) ratio is closely related to a variety of dyslipidemia-related diseases. This study aimed to inspect the relationship between the NHDLC/HDLC ratio and non-alcoholic fatty liver (NAFLD) in children and adolescents.Methods: In this cross-sectional survey, a total of 7,759 eligible Chinese children and adolescents (5,692 boys and 2,067 girls) 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 exploited to compare the diagnostic significance of the above parameters for NAFLD.Results: The 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 that of 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 that of NHDLC (0.661, P < 0.001). Furthermore, 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 that of 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 that of NHDLC (0.646, P < 0.001)Conclusions: The 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.

Association between the uric acid to high density lipoprotein cholesterol ratio and alanine transaminase in Chinese short stature children and adolescents: a cross-sectional study

“…Regarding the association between UHR and ALT, Mehmet Ali Kosekli et al observed that UHR was positively associated with ALT through a controlled study [24]. Moreover, a positive association between UHR and ALT was also reported in Chinese lean individuals by Ya-Nan Zhang et al [29]. These results are consistent with the ndings of our study.…”

The burden and sexual dimorphism with nonalcoholic fatty liver disease in Asian children: A systematic review and meta‐analysis

“…The search identified 735 references and 127 papers were selected for full‐text review. Finally, 31 articles 14‐44 describing 33 study populations fulfilled the criteria and included in the systematic review and pooled analysis (Figure 1). All the articles were published after 2004, and before April 28, 2021.…”

“…The features of the 31 studies 14‐44 were provided in Table 1. Eighteen studies in Eastern Asia (15 from China, two from Japan, one from Korea), 11 studies in Western Asia (five from Iran, five from Turkey, one from Israel) and two studies in Southern Asia (two from India).…”

Non-alcoholic fatty liver disease in children and adolescents: a meta-analysis

“…Alkassabany et al, 2014 (15) 7.4% 1.10 [0.21, 5.87] Ayonrinde et al, 2011 (16) 6.0% 0.08 [0.01, 0.58] Yu et al, 2019 (17) 8.5% 0.07 [0.02, 0.31] Ezaizi et al, 2019 (18) 6.1% 0.04 [0.00, 0.26] Gupta et al, 2011 (19) 8.3% 0.13 [0.03, 0.57] Jimenez-Rivera et al, 2017 (20) 5.7% 0.01 [0.00, 0.07] Kang et al, 2018 (21) 5.7% 0.17 [0.02, 1.38] Malespin et al, 2015 (22) 5.7% 0.16 [0.02, 1.37] Mohamed et al, 2020 (23) 6.0% 0.01 [0.00, 0.11] Park et al, 2020 (24) 5.9% 0.09 [0.01, 0.70] Peña-Vélez et al, 2020 (25) 6.1% 0.01 [0.00, 0.06] Sae-Wong et al, 2021 (26) 5.8% 0.08 [0.01, 0.67] Conjeevaram Selvakumar et al, 2018 (27) 5.8% 0.12 [0.02, 1.00] Song et al, 2017 (28) 5.9% 0.11 [0.01, 0.87] Yang et al, 2020 (29) 5.5% 0.25 [0.03, 2.24] Zhang et al, 2015 (30) 5.6% 0. (15) Egypt 800 ALT Ayonrinde et al, 2011 (16) Australia 1,170 Ultrasound Yu et al, 2019 (17) United States 408 MRI and ALT Ezaizi et al, 2019 (18) United States 344 ALT Gupta et al, 2011 (19) United States 655 ALT Jimenez-Rivera et al, 2017 (20) Canada 97 Ultrasound and biochemical method Kang et al, 2018 (21) Korea 1,416 ALT Malespin et al, 2015 (22) United States 407 ALT Mohamed et al, 2020 (23) Malaysia 33 Ultrasound Park et al, 2020 (24) Korea 4,448 ALT Peña-Vélez et al, 2020 (25) Mexico 112 Ultrasound Sae-Wong et al, 2021 (26) Thailand 50 ALT Conjeevaram Selvakumar et al, 2018 (27) United States 1,482 ALT Song et al, 2017 (28) China 831 ALT Yang et al, 2020 (29) China 7,759 Ultrasound Zhang et al, 2015 (30) China 7,229 Ultrasound ALT -alanine transaminase; MRI -magnetic resonance imaging.…”