{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T01:42:48Z","timestamp":1792546968313,"version":"4.5.0"},"reference-count":35,"publisher":"BMJ","issue":"12","funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81500665"],"award-info":[{"award-number":["81500665"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,11,9]]},"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The relationship between normal low-density lipoprotein cholesterol (LDL-c) levels and non-alcoholic fatty liver disease (NAFLD) in non-obese individuals remains unclear. We aimed to investigate the precise prevalence and incidence of NAFLD within the normal LDL-c range in non-obese individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional and longitudinal study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Wenzhou Medical Center of Wenzhou People's Hospital from 2010 to 2014.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>183\u2005903 non-obese individuals were enrolled from a cross-sectional population, and a total of 16\u2005173 initially NAFLD-free non-obese individuals were included who completed a 5-year follow-up examination in the longitudinal population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In our study, NAFLD was defined by ultrasonographic detection of steatosis in the absence of other liver disease. The cross-sectional study showed that at baseline, the prevalence of NAFLD was 13.9% in non-obese individuals with normal LDL-c levels. The prospective study demonstrated that NAFLD-free participants developed NAFLD during the 5-year follow-up period, with a cumulative incidence of 14.4%. In addition, the ORs for NAFLD in the cross-sectional population were 1.11 (95% CI 1.04 to 1.18), 1.37 (95% CI 1.27 to 1.47) and 1.56 (95% CI 1.43 to 1.69), respectively, after adjusting for known confounding variables. The HRs for NAFLD in the longitudinal population were 1.15 (95% CI 0.98 to 1.36), 1.32 (95% CI 1.10 to 1.58) and 1.82 (95% CI 1.47 to 2.52), compared with Q1. Individuals with higher LDL-c level within the normal range had an increased cumulative incidence rate of NAFLD in non-obese individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>NAFLD is prevalent in the non-obese Chinese population. Furthermore, this is the first study to demonstrate that increased normal LDL-c levels are independently associated with an elevated risk of NAFLD in non-obese individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-013781","type":"journal-article","created":{"date-parts":[[2016,12,7]],"date-time":"2016-12-07T21:40:55Z","timestamp":1481146855000},"page":"e013781","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":64,"title":["Association of low-density lipoprotein cholesterol within the normal range and NAFLD in the non-obese Chinese population: a cross-sectional and longitudinal study"],"prefix":"10.1136","volume":"6","author":[{"given":"Dan-Qin","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Nephrology, Affiliated Wuxi Second Hospital, Nanjing Medical University, Wuxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Jie","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, The Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Yue","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Ren","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"},{"name":"School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Ran","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"},{"name":"School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Chu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Wenzhou Medical Center, Wenzhou People's Hospital, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Braddock","sequence":"additional","affiliation":[{"name":"Global Medicines Development, AstraZeneca R&D, Alderley Park, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke-Qing","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"},{"name":"Institute of Hepatology, Wenzhou Medical University, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Affiliated Wuxi Second Hospital, Nanjing Medical University, Wuxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4984-2631","authenticated-orcid":false,"given":"Ming-Hua","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"},{"name":"Institute of Hepatology, Wenzhou Medical University, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,12,7]]},"reference":[{"key":"2025120521270655000_6.12.e013781.1","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1517\/14728222.2016.1096930","article-title":"Serum uric acid: a new therapeutic target for nonalcoholic fatty liver disease","volume":"20","author":"Sun","year":"2016","journal-title":"Expert Opin Ther Targets"},{"key":"2025120521270655000_6.12.e013781.2","doi-asserted-by":"crossref","first-page":"e842","DOI":"10.1097\/MD.0000000000000842","article-title":"Increased levels of systolic blood pressure within the normal range are associated with significantly elevated risks of nonalcoholic fatty liver disease","volume":"94","author":"Wu","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"2025120521270655000_6.12.e013781.3","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1111\/jgh.13264","article-title":"Nonalcoholic fatty liver disease is associated with an almost twofold increased risk of incident type 2 diabetes and metabolic syndrome. 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