{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T02:08:20Z","timestamp":1791684500311,"version":"4.3.4"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T00:00:00Z","timestamp":1731024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background\/objective<\/jats:title><jats:p>Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver disorders, from benign steatosis to more severe conditions like non-alcoholic steatohepatitis, with risks of progressing to fibrosis, cirrhosis, and hepatocellular carcinoma. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) indicates lipid metabolic dysregulation and is associated with increased risks of various diseases. This study examines the relationship between NHHR and NAFLD to evaluate NHHR as a potential predictive biomarker for NAFLD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from the 2017\u20132018 National Health and Nutrition Examination Survey (NHANES) were used for cross-sectional analysis. After excluding individuals with incomplete data, hepatitis infections, heavy alcohol use, and those under 18, the study included 2,757 adults. The relationship between NHHR and NAFLD was analyzed using multivariable logistic regression, including subgroup analysis and interaction testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 2,757 participants (mean age 49.91\u2009years), 44.9% had NAFLD. NHHR showed a significant positive association with NAFLD, with an unadjusted odds ratio (OR) of 1.71 and a fully adjusted OR of 1.45. Quartile analysis revealed a 228% higher prevalence of NAFLD in the highest NHHR quartile, with an OR of 3.28. This positive association was consistent across various subgroups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings suggest that elevated NHHR is positively correlated with the prevalence of NAFLD and possesses predictive value. We recommend that future research validate the clinical utility of NHHR, particularly for early detection of high-risk individuals and guiding personalized interventions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1477820","type":"journal-article","created":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T04:31:01Z","timestamp":1731040261000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["The correlation between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with non-alcoholic fatty liver disease: an analysis of the population-based NHANES (2017\u20132018)"],"prefix":"10.3389","volume":"11","author":[{"given":"Yuhao","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengxi","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenmei","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangqing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,11,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1038\/s41591-018-0104-9","article-title":"Mechanisms of NAFLD development and therapeutic strategies","volume":"24","author":"Friedman","year":"2018","journal-title":"Nat Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.cld.2017.08.003","article-title":"The natural history of non-alcoholic fatty liver disease-an evolving view","volume":"22","author":"Lindenmeyer","year":"2018","journal-title":"Clin Liver Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.1053\/j.gastro.2017.01.003","article-title":"Changes in the prevalence of hepatitis C virus infection, non-alcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation","volume":"152","author":"Goldberg","year":"2017","journal-title":"Gastroenterology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1002\/hep.20466","article-title":"Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity","volume":"40","author":"Browning","year":"2004","journal-title":"Hepatology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/3920196","article-title":"The intricate relationship between type 2 diabetes mellitus (T2DM), insulin resistance (IR), and non-alcoholic fatty liver disease (NAFLD)","volume":"2020","author":"Tanase","year":"2020","journal-title":"J Diabetes Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1691","DOI":"10.1136\/gutjnl-2020-320622","article-title":"NAFLD and increased risk of cardiovascular disease: clinical associations, pathophysiological mechanisms and pharmacological implications","volume":"69","author":"Targher","year":"2020","journal-title":"Gut"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/j.sleep.2020.04.004","article-title":"Obstructive sleep apnea, chronic obstructive pulmonary disease and NAFLD: an individual participant data meta-analysis","volume":"77","author":"Jullian-Desayes","year":"2021","journal-title":"Sleep Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1136\/postgradmedj-2016-134383","article-title":"Non-alcoholic fatty liver disease and colorectal cancer","volume":"93","author":"Mikolasevic","year":"2017","journal-title":"Postgrad Med J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1186\/1479-5876-11-133","article-title":"Molecular signature of adipose tissue in patients with both non-alcoholic fatty liver disease (NAFLD) and polycystic ovarian syndrome (PCOS)","volume":"11","author":"Baranova","year":"2013","journal-title":"J Transl Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"562","DOI":"10.3390\/ijms17040562","article-title":"NAFLD and chronic kidney disease","volume":"17","author":"Marcuccilli","year":"2016","journal-title":"Int J Mol Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1215790","DOI":"10.3389\/fendo.2023.1215790","article-title":"Causal association of NAFLD with osteoporosis, fracture and falling risk: a bidirectional Mendelian randomization study","volume":"14","author":"Cui","year":"2023","journal-title":"Front Endocrinol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1042\/CS20220572","article-title":"Molecular mechanisms of metabolic associated fatty liver disease (MAFLD): functional analysis of lipid metabolism pathways","volume":"136","author":"Badmus","year":"2022","journal-title":"Clin Sci (Lond)"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1194\/jlr.R067595","article-title":"The role of ER stress in lipid metabolism and lipotoxicity","volume":"57","author":"Han","year":"2016","journal-title":"J Lipid Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1038\/nrgastro.2015.94","article-title":"Inflammasome activation and function in liver disease","volume":"12","author":"Szabo","year":"2015","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1002\/hep.25559","article-title":"Hedgehog pathway activation parallels histologic severity of injury and fibrosis in human non-alcoholic fatty liver disease","volume":"55","author":"Guy","year":"2012","journal-title":"Hepatology"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1038\/s41575-019-0144-8","article-title":"Past, present and future perspectives in non-alcoholic fatty liver disease","volume":"16","author":"Sanyal","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"101092","DOI":"10.1016\/j.molmet.2020.101092","article-title":"Dysregulated lipid metabolism links NAFLD to cardiovascular disease","volume":"42","author":"Deprince","year":"2020","journal-title":"Mol Metab"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1186\/s12967-023-04047-0","article-title":"Lipid metabolism, BMI and the risk of non-alcoholic fatty liver disease in the general population: evidence from a mediation analysis","volume":"21","author":"Lu","year":"2023","journal-title":"J Transl Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1186\/s13098-023-01220-9","article-title":"Remnant cholesterol and severity of non-alcoholic fatty liver disease","volume":"15","author":"Huang","year":"2023","journal-title":"Diabetol Metab Syndr"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1186\/s12944-024-02143-8","article-title":"The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with type 2 diabetes mellitus: recent findings from NHANES 2007-2018","volume":"23","author":"Tan","year":"2024","journal-title":"Lipids Health Dis"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1186\/s12944-024-02152-7","article-title":"The association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and the risk of osteoporosis among U.S. adults: analysis of NHANES data","volume":"23","author":"Wang","year":"2024","journal-title":"Lipids Health Dis"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1818","DOI":"10.1186\/s12889-024-19265-4","article-title":"Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and kidney stone: evidence from NHANES 2007-2018","volume":"24","author":"Chen","year":"2024","journal-title":"BMC Public Health"},{"key":"ref23","first-page":"1","article-title":"The National Health and nutrition examination survey: sample design, 1999\u20132006","volume":"155","author":"Curtin","year":"2012","journal-title":"Vital Health Stat 2"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1053\/j.gastro.2019.01.042","article-title":"Accuracy of FibroScan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with non-alcoholic fatty liver disease","volume":"156","author":"Eddowes","year":"2019","journal-title":"Gastroenterology"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"857110","DOI":"10.3389\/fendo.2022.857110","article-title":"Relationship between non-alcoholic fatty liver disease and degree of hepatic steatosis and bone mineral density","volume":"13","author":"Xie","year":"2022","journal-title":"Front Endocrinol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"875134","DOI":"10.3389\/fneur.2022.875134","article-title":"Non-HDL-C\/HDL-C ratio is associated with carotid plaque stability in general population: a cross-sectional study","volume":"13","author":"Wang","year":"2022","journal-title":"Front Neurol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1186\/s12876-022-02598-y","article-title":"Assessing the longitudinal association between the GGT\/HDL-C ratio and NAFLD: a cohort study in a non-obese Chinese population","volume":"22","author":"Xie","year":"2022","journal-title":"BMC Gastroenterol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e128","DOI":"10.1111\/liv.12318","article-title":"Non-high-density lipoprotein cholesterol independently predicts new onset of non-alcoholic fatty liver disease","volume":"34","author":"Zelber-Sagi","year":"2014","journal-title":"Liver Int"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"931","DOI":"10.5603\/KP.a2015.0086","article-title":"Lipoprotein ratios are better than conventional lipid parameters in predicting coronary heart disease in Chinese Han people","volume":"73","author":"Zhu","year":"2015","journal-title":"Kardiol Pol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1186\/s12944-024-02171-4","article-title":"The relationship between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and hyperuricaemia","volume":"23","author":"Wang","year":"2024","journal-title":"Lipids Health Dis"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1002\/hep.22423","article-title":"Inflammatory stress exacerbates lipid accumulation in hepatic cells and fatty livers of apolipoprotein E knockout mice","volume":"48","author":"Ma","year":"2008","journal-title":"Hepatology"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"135","DOI":"10.3390\/pr9010135","article-title":"Non-alcoholic fatty liver disease: from pathogenesis to clinical impact","volume":"9","author":"Caturano","year":"2021","journal-title":"PRO"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1186\/s12933-019-0954-6","article-title":"Liraglutide improves lipid metabolism by enhancing cholesterol efflux associated with ABCA1 and ERK1\/2 pathway","volume":"18","author":"Wu","year":"2019","journal-title":"Cardiovasc Diabetol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s12944-023-01835-x","article-title":"GRP78\/BiP alleviates ox LDL-induced hepatotoxicity in familial hypercholesterolemia caused by missense variants of LDLR in a Hep G2 cellular model","volume":"22","author":"Varghese","year":"2023","journal-title":"Lipids Health Dis"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"3967","DOI":"10.3390\/ijms23073967","article-title":"The current status of research on high-density lipoproteins (HDL): a paradigm shift from HDL quantity to HDL quality and HDL functionality","volume":"23","author":"Cho","year":"2022","journal-title":"Int J Mol Sci"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"113869","DOI":"10.1016\/j.addr.2021.113869","article-title":"Pathophysiological communication between hepatocytes and non-parenchymal cells in liver injury from NAFLD to liver fibrosis","volume":"176","author":"Kumar","year":"2021","journal-title":"Adv Drug Deliv Rev"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"77","DOI":"10.3350\/cmh.2022.0237","article-title":"Pathogenesis and treatment of non-alcoholic steatohepatitis and its fibrosis","volume":"29","author":"Lee","year":"2023","journal-title":"Clin Mol Hepatol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"2678","DOI":"10.1016\/j.ijcard.2013.03.027","article-title":"Non-HDL-cholesterol\/HDL-cholesterol is a better predictor of metabolic syndrome and insulin resistance than apolipoprotein B\/apolipoprotein A1","volume":"168","author":"Kim","year":"2013","journal-title":"Int J Cardiol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1038\/nrgastro.2016.147","article-title":"NAFLD and diabetes mellitus","volume":"14","author":"Tilg","year":"2017","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s12876-020-01204-3","article-title":"Physical activity intervention for non-diabetic patients with non-alcoholic fatty liver disease: a meta-analysis of randomized controlled trials","volume":"20","author":"Wang","year":"2020","journal-title":"BMC Gastroenterol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1186\/s12916-024-03618-2","article-title":"Accelerometer-derived moderate-to-vigorous physical activity and incident non-alcoholic fatty liver disease","volume":"22","author":"Liu","year":"2024","journal-title":"BMC Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1805","DOI":"10.3390\/cells10071805","article-title":"Diet-induced models of non-alcoholic fatty liver disease: food for thought on sugar, fat, and cholesterol","volume":"10","author":"Eng","year":"2021","journal-title":"Cells"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1477820\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T04:31:05Z","timestamp":1731040265000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1477820\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,8]]},"references-count":42,"alternative-id":["10.3389\/fmed.2024.1477820"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1477820","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,8]]},"article-number":"1477820"}}