Background: Nonalcoholic fatty liver disease (NAFLD) is commonly occurred in the non-obese individuals. The serum uric acid (UA) to high-density lipoprotein cholesterol (HDL-c) ratio (UHR) is considered as a predictive factor of NAFLD. However, it is still difficult to confirm the correlation in lean Chinese people with normal blood lipid levels. It is aimed to analyze the correlation of UHR with NAFLD among lean Chinese population without dyslipidemia and compared UHR with other predictors in this study.
Methods: 9838 lean people without NAFLD were included in a retrospective cohort study. NAFLD was diagnosed by liver ultrasound.
Results: A total of 9,838 lean patients with normal blood lipid levels were included in the final study. During the five-year follow-up period, the overall prevalence of NAFLD was 8.7%. across the quintile 1, 2, 3, 4 and 5 of UHR, the prevalence of NAFLD among lean patients was increased from 2.4%, 5%, 7.9%, 10.3% to 17.8%. After adjustment for age, markers of liver and kidney function, gender and metabolic indicators, multivariate cox proportional hazard regression analysis demonstrated that the hazard ratio(HR) was 1.99(1.43-2.73) in highest UHR (quintile 5) compared with lowest UHR(quintile 1). The area under the curve(AUC) of UHR (0.690) was higher than in UA (0.666) and HDL-c (0.636), which showed that the predictive ability of the UHR to new-onset NAFLD was better than serum uric acid and HDL-c. Even within the normal range of UA and HDL-c levels, UHR was independently associated with NAFLD, and HR (95% confidence interva, 95%CI) for NAFLD in Quintile 5 of UHR was 6.74(4.32-10.53). Compared with other significant predictors, the AUC value of UHR(0.67) was similar to that of low-density lipoprotein cholesterol(LDL-c)/HDL-c ratio(0.68), non-high-density lipoprotein cholesterol (NHDL-c)/HDL-c ratio(0.68) and alanine aminotransferase (ALT)/ aspartate aminotransferase (AST) ratio(0.7), and superior to that of LDL-c (0.63), remnant cholesterol (RC,0.59), albumin(ALB)/alkaline phosphatase(ALP) ratio(0.61). The sensitivity of UHR (70.5%) was the highest among all indicators. In the subgroup of ALT, the AUC of UHR was 0.70, which was the highest among all predictors in subjects with ALT< 40. For subjects with elevated ALT levels (ALT > 40 U/L), there was no statistical significance among RC (P=0.441), ALB/ALP (P=0.419) and ALT/AST(P=0.159). In contrast, UHR's performance in predicting NAFLD was meaningful and reliable (AUC=0.61, p<0.001).
Conclusions: UHR serve as an inexpensive and reliable predictor of NAFLD in lean Chinese people with normal blood lipid levels. It can be used to identify people at high risk of NAFLD.