Zhou YG, Tian N, Xie WN. Total cholesterol to high-density lipoprotein ratio and nonalcoholic fatty liver disease in a population with chronic hepatitis B. World J Hepatol 2022; 14(4): 791-801 [PMID: 35646261 DOI: 10.4254/wjh.v14.i4.791]
Corresponding Author of This Article
Wei-Ning Xie, MD, Professor, Department of Scientific Research, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, No. 16 Guicheng South Fifth Road, Nanhai District, Foshan 528200, Guangdong Province, China. xwn1219@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Apr 27, 2022; 14(4): 791-801 Published online Apr 27, 2022. doi: 10.4254/wjh.v14.i4.791
Total cholesterol to high-density lipoprotein ratio and nonalcoholic fatty liver disease in a population with chronic hepatitis B
Yu-Ge Zhou, Ning Tian, Wei-Ning Xie
Yu-Ge Zhou, Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou University of Chinese Medicine, Foshan 528200, Guangdong Province, China
Ning Tian, Preventive Healthcare Center, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, Guangdong Province, China
Wei-Ning Xie, Department of Scientific Research, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, Guangdong Province, China
Author contributions: Xie WN designed the study, constructed the research ideas and interpreted the data; Zhou YG participated in the acquisition and analysis of the data and drafted the initial manuscript; Tian N supervised the project process and revised the article critically for important intellectual content.
Institutional review board statement: This research project was submitted to and approved by the Ethics Committee of Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Approval number: 2018-1254).
Informed consent statement: No informed consent was required because this was a retrospective observational study.
Conflict-of-interest statement: There were no conflicts of interest to report.
Data sharing statement: No additional data was available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Ning Xie, MD, Professor, Department of Scientific Research, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, No. 16 Guicheng South Fifth Road, Nanhai District, Foshan 528200, Guangdong Province, China. xwn1219@qq.com
Received: October 20, 2021 Peer-review started: October 20, 2021 First decision: November 17, 2021 Revised: December 13, 2021 Accepted: April 3, 2022 Article in press: April 3, 2022 Published online: April 27, 2022
Abstract
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) is characterized by hypertriglyceridemia, increased low-density lipoprotein cholesterol levels, and reduced high-density lipoprotein cholesterol (HDL-C) particles. Previous studies have shown that the total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C) was superior to other lipid metabolism biomarkers for predicting NAFLD risk and could be a new indicator of NAFLD. However, the association between TC/HDL-C and NAFLD in patients with hepatitis B virus (HBV) has not yet been determined.
AIM
To investigate the association between TC/HDL-C and NAFLD in a population with chronic hepatitis B (CHB).
METHODS
In this study, 183 HBV-infected patients were enrolled. All participants underwent blood chemistry examinations and abdominal ultrasound. Univariate and multivariate logistic regression models, curve fitting analysis, and threshold calculation were used to assess the relationship between TC/HDL-C and NAFLD.
RESULTS
The overall prevalence of NAFLD was 17.49% (n = 32) in the 183 CHB participants. The TC/HDL-C of non-NAFLD and NAFLD patients were 3.83 ± 0.75 and 4.44 ± 0.77, respectively (P < 0.01). Logistic regression analysis showed that TC/HDL-C was not associated with NAFLD after adjusting for other pertinent clinical variables. However, at an optimal cutoff point of 4.9, a non-linear correlation between TC/HDL-C and NAFLD was detected. The effect size of the left and right sides of the inflection point were 5.4 (95% confidence interval: 2.3-12.6, P < 0.01) and 0.5 (95% confidence interval: 0.1-2.2, P = 0.39), respectively. On the left side of the inflection point, TC/HDL-C was positively associated with NAFLD. However, no significant association was observed on the right side of the inflection point.
CONCLUSION
This study demonstrated a non-linear correlation between TC/HDL-C and NAFLD in a population with CHB. TC/HDL-C was positively associated with NAFLD when TC/HDL-C was less than 4.9 but not when TC/HDL-C was more than 4.9.
Core Tip: Nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB) are both common chronic liver diseases. In this observational cross-sectional study, we explored the association between NAFLD and a lipid metabolism biomarker [the total cholesterol to high-density lipoprotein cholesterol ratio, total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C)] in a population with CHB. Our findings showed a non-linear correlation between TC/HDL-C and NAFLD. TC/HDL-C was positively associated with NAFLD when TC/HDL-C was less than 4.9 but not when TC/HDL-C was more than 4.9.
