Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Oncology Letters
      • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Biomedical Reports
      • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • Information for Authors
    • Information for Reviewers
    • Information for Librarians
    • Information for Advertisers
    • Conferences
  • Language Editing
Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • For Authors
    • For Reviewers
    • For Librarians
    • For Advertisers
    • Conferences
  • Language Editing
Login Register Submit
  • This site uses cookies
  • You can change your cookie settings at any time by following the instructions in our Cookie Policy. To find out more, you may read our Privacy Policy.

    I agree
Search articles by DOI, keyword, author or affiliation
Search
Advanced Search
presentation
Biomedical Reports
Join Editorial Board Propose a Special Issue
Print ISSN: 2049-9434 Online ISSN: 2049-9442
Journal Cover
April-2025 Volume 22 Issue 4

Full Size Image

Sign up for eToc alerts
Recommend to Library

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

Medicine International

An International Open Access Journal Devoted to General Medicine.

Journal Cover
April-2025 Volume 22 Issue 4

Full Size Image

Sign up for eToc alerts
Recommend to Library

  • Article
  • Citations
    • Cite This Article
    • Download Citation
    • Create Citation Alert
    • Remove Citation Alert
    • Cited By
  • Similar Articles
    • Related Articles (in Spandidos Publications)
    • Similar Articles (Google Scholar)
    • Similar Articles (PubMed)
  • Download PDF
  • Download XML
  • View XML
Article Open Access

Non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio as a biomarker for liver health: Insights from National Health and Nutrition Examination Survey data

  • Authors:
    • Liekai Hong
    • Yifan Sun
    • Xiaojia Lu
    • Xinwu Xu
  • View Affiliations / Copyright

    Affiliations: Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515000, P.R. China, Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515000, P.R. China
    Copyright: © Hong et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 61
    |
    Published online on: February 7, 2025
       https://doi.org/10.3892/br.2025.1939
  • Expand metrics +
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )
Cited By (CrossRef): 0 citations Loading Articles...

This article is mentioned in:



Abstract

The non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio (NHHR), a lipid‑related biomarker, remains underexplored in relation to the risk of advanced fibrosis and hepatic steatosis. The present study aimed to investigate the potential association between the NHHR and these hepatic conditions. A total of 6,907 individuals aged 20 years and older from the National Health and Nutrition Examination Survey 2017‑2020 were included in the present study. Advanced fibrosis and hepatic steatosis were assessed using hepatic vibration‑controlled transient elastography. Multivariate regression analysis and subgroup analysis were performed to explore the independent association between the NHHR and the presence of advanced fibrosis and hepatic steatosis. Among the 6,907 adults included in the present study (mean age, 50.56±17.21 years; 3,398 male patients and 3,509 female patients), 409 (5.92%) were diagnosed with advanced fibrosis and 3,034 (43.93%) were diagnosed with hepatic steatosis. Following multivariable adjustment (age, sex, ethnicity, education level, family income‑to‑poverty ratio, smoking status, alcohol use and vigorous physical activity), logistic regression analysis demonstrated that an elevated NHHR was positively associated with increased possibility for advanced fibrosis [odds ratio (OR), 1.10; 95% confidence interval (CI), 1.03‑1.17; P=0.005]. The restricted cubic spline model indicated a linear dose‑response association between the NHHR and advanced fibrosis. The NHHR also exhibited a significant association with a higher risk of hepatic steatosis after full adjustment for covariates (OR, 1.61; 95% CI, 1.53‑1.68; P<0.001). Using a two‑segment linear regression model, an S‑shaped relationship was identified between the NHHR and hepatic steatosis, with an inflection point at 3.83. In conclusion, the present study established a robust association of the NHHR with advanced fibrosis and hepatic steatosis. The NHHR may serve as a straightforward anthropometric index for predicting these conditions.
View Figures

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

View References

1 

Estes C, Razavi H, Loomba R, Younossi Z and Sanyal AJ: Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 67:123–133. 2018.PubMed/NCBI View Article : Google Scholar

2 

Le P, Chaitoff A, Rothberg MB, McCullough A, Gupta NM and Alkhouri N: Population-based trends in prevalence of nonalcoholic fatty liver disease in US adults with type 2 diabetes. Clin Gastroenterol Hepatol. 17:2377–2378. 2019.PubMed/NCBI View Article : Google Scholar

3 

European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 81:492–542. 2024.PubMed/NCBI View Article : Google Scholar

4 

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, Kleiner DE and Loomba R: AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 77:1797–1835. 2023.PubMed/NCBI View Article : Google Scholar

5 

European Association for the Study of the Liver; Clinical Practice Guideline Panel; Chair:; EASL Governing Board representative:; Panel members. EASL clinical practice guidelines on non-invasive tests for evaluation of liver disease severity and prognosis-2021 update. J Hepatol. 75:659–689. 2021.PubMed/NCBI View Article : Google Scholar

6 

Eddowes PJ, Sasso M, Allison M, Tsochatzis E, Anstee QM, Sheridan D, Guha IN, Cobbold JF, Deeks JJ, Paradis V, et al: Accuracy of fibroscan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology. 156:1717–1730. 2019.PubMed/NCBI View Article : Google Scholar

7 

Vilar-Gomez E, Vuppalanchi R, Gawrieh S, Samala N and Chalasani N: CAP and LSM as determined by VCTE are independent predictors of all-cause mortality in the US adult population. Hepatology. 77:1241–1252. 2023.PubMed/NCBI View Article : Google Scholar

8 

Yu H, Huang Y, Li M, Jiang H, Yang B, Xi X, Smayi A, Wu B and Yang Y: Prognostic significance of dynamic changes in liver stiffness measurement in patients with chronic hepatitis B and compensated advanced chronic liver disease. J Gastroenterol Hepatol. 39:2169–2181. 2024.PubMed/NCBI View Article : Google Scholar

9 

Hong H, He Y, Gong Z, Feng J and Qu Y: The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and kidney stones: A cross-sectional study. Lipids Health Dis. 23(102)2024.PubMed/NCBI View Article : Google Scholar

10 

Lin W, Luo S, Li W, Liu J, Zhou T, Yang F, Zhou D, Liu Y, Huang W, Feng Y and Luo J: Association between the non-HDL-cholesterol to HDL- cholesterol ratio and abdominal aortic aneurysm from a Chinese screening program. Lipids Health Dis. 22(187)2023.PubMed/NCBI View Article : Google Scholar

11 

Tan MY, Weng L, Yang ZH, Zhu SX, Wu S and Su JH: 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. Lipids Health Dis. 23(151)2024.PubMed/NCBI View Article : Google Scholar

12 

Hou K, Song W, He J and Ma Z: The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and prevalence of periodontitis among US adults: A cross-sectional NHANES study. Sci Rep. 14(5558)2024.PubMed/NCBI View Article : Google Scholar

13 

Qi X, Wang S, Huang Q, Chen X, Qiu L, Ouyang K and Chen Y: The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and risk of depression among US adults: A cross-sectional NHANES study. J Affect Disord. 344:451–457. 2024.PubMed/NCBI View Article : Google Scholar

14 

Yang S, Zhong J, Ye M, Miao L, Lu G, Xu C, Xue Z and Zhou X: 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. Lipids Health Dis. 19(242)2020.PubMed/NCBI View Article : Google Scholar

15 

Ciardullo S and Perseghin G: Statin use is associated with lower prevalence of advanced liver fibrosis in patients with type 2 diabetes. Metabolism. 121(154752)2021.PubMed/NCBI View Article : Google Scholar

16 

Vilar-Gomez E, Nephew LD, Vuppalanchi R, Gawrieh S, Mladenovic A, Pike F, Samala N and Chalasani N: High-quality diet, physical activity, and college education are associated with low risk of NAFLD among the US population. Hepatology. 75:1491–1506. 2022.PubMed/NCBI View Article : Google Scholar

17 

Yu H, Li M, Yang B, Sun H, Jiang H, Liang Z, Smayi A, Wu B and Yang Y: Proton pump inhibitor use is associated with increased liver steatosis. Biomed Rep. 21(116)2024.PubMed/NCBI View Article : Google Scholar

18 

Leung CW and Tapper EB: Sugar-sweetened beverages are associated with increased liver stiffness and steatosis among apparently healthy adults in the United States. Clin Gastroenterol Hepatol. 20:959–961.e1. 2022.PubMed/NCBI View Article : Google Scholar

19 

Ruan Z, Lu T, Chen Y, Yuan M, Yu H, Liu R and Xie X: Association between psoriasis and nonalcoholic fatty liver disease among outpatient US adults. JAMA Dermatol. 158:745–753. 2022.PubMed/NCBI View Article : Google Scholar

20 

Siddiqui MS, Vuppalanchi R, Van Natta ML, Hallinan E, Kowdley KV, Abdelmalek M, Neuschwander-Tetri BA, Loomba R, Dasarathy S, Brandman D, et al: Vibration-Controlled transient elastography to assess fibrosis and steatosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 17:156–163.e2. 2019.PubMed/NCBI View Article : Google Scholar

21 

Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, Romero D, Abdelmalek MF, Anstee QM, Arab JP, et al: A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Ann Hepatol. 29(101133)2024.PubMed/NCBI View Article : Google Scholar

22 

Loomba R, Friedman SL and Shulman GI: Mechanisms and disease consequences of nonalcoholic fatty liver disease. Cell. 184:2537–2564. 2021.PubMed/NCBI View Article : Google Scholar

23 

Lotta LA, Gulati P, Day FR, Payne F, Ongen H, van de Bunt M, Gaulton KJ, Eicher JD, Sharp SJ, Luan J, et al: Integrative genomic analysis implicates limited peripheral adipose storage capacity in the pathogenesis of human insulin resistance. Nat Genet. 49:17–26. 2017.PubMed/NCBI View Article : Google Scholar

24 

Petersen KF, Oral EA, Dufour S, Befroy D, Ariyan C, Yu C, Cline GW, DePaoli AM, Taylor SI, Gorden P and Shulman GI: Leptin reverses insulin resistance and hepatic steatosis in patients with severe lipodystrophy. J Clin Invest. 109:1345–1350. 2002.PubMed/NCBI View Article : Google Scholar

25 

Kelley DE, McKolanis TM, Hegazi RA, Kuller LH and Kalhan SC: Fatty liver in type 2 diabetes mellitus: Relation to regional adiposity, fatty acids, and insulin resistance. Am J Physiol Endocrinol Metab. 285:E906–E916. 2003.PubMed/NCBI View Article : Google Scholar

26 

Wueest S, Item F, Lucchini FC, Challa TD, Müller W, Blüher M and Konrad D: Mesenteric fat lipolysis mediates obesity-associated hepatic steatosis and insulin resistance. Diabetes. 65:140–148. 2016.PubMed/NCBI View Article : Google Scholar

27 

Caussy C, Tripathi A, Humphrey G, Bassirian S, Singh S, Faulkner C, Bettencourt R, Rizo E, Richards L, Xu ZZ, et al: A gut microbiome signature for cirrhosis due to nonalcoholic fatty liver disease. Nat Commun. 10(1406)2019.PubMed/NCBI View Article : Google Scholar

28 

Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, et al: 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Eur Heart J. 41:111–188. 2020.PubMed/NCBI View Article : Google Scholar

29 

Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, Dagogo-Jack S, DeFronzo RA, Einhorn D, Fonseca VA, et al: Consensus statement by the American Association of Clinical Endocrinologists and American College Of Endocrinology on the comprehensive type 2 diabetes management algorithm-2019 executive summary. Endocr Pract. 25:69–100. 2019.PubMed/NCBI View Article : Google Scholar

30 

Wang K, Shan S, Zheng H, Zhao X, Chen C and Liu C: Non-HDL-cholesterol to HDL-cholesterol ratio is a better predictor of new-onset non-alcoholic fatty liver disease than non-HDL-cholesterol: A cohort study. Lipids Health Dis. 17(196)2018.PubMed/NCBI View Article : Google Scholar

Related Articles

  • Abstract
  • View
  • Download
  • Twitter
Copy and paste a formatted citation
Spandidos Publications style
Hong L, Sun Y, Lu X and Xu X: Non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio as a biomarker for liver health: Insights from National Health and Nutrition Examination Survey data. Biomed Rep 22: 61, 2025.
APA
Hong, L., Sun, Y., Lu, X., & Xu, X. (2025). Non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio as a biomarker for liver health: Insights from National Health and Nutrition Examination Survey data. Biomedical Reports, 22, 61. https://doi.org/10.3892/br.2025.1939
MLA
Hong, L., Sun, Y., Lu, X., Xu, X."Non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio as a biomarker for liver health: Insights from National Health and Nutrition Examination Survey data". Biomedical Reports 22.4 (2025): 61.
Chicago
Hong, L., Sun, Y., Lu, X., Xu, X."Non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio as a biomarker for liver health: Insights from National Health and Nutrition Examination Survey data". Biomedical Reports 22, no. 4 (2025): 61. https://doi.org/10.3892/br.2025.1939
Copy and paste a formatted citation
x
Spandidos Publications style
Hong L, Sun Y, Lu X and Xu X: Non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio as a biomarker for liver health: Insights from National Health and Nutrition Examination Survey data. Biomed Rep 22: 61, 2025.
APA
Hong, L., Sun, Y., Lu, X., & Xu, X. (2025). Non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio as a biomarker for liver health: Insights from National Health and Nutrition Examination Survey data. Biomedical Reports, 22, 61. https://doi.org/10.3892/br.2025.1939
MLA
Hong, L., Sun, Y., Lu, X., Xu, X."Non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio as a biomarker for liver health: Insights from National Health and Nutrition Examination Survey data". Biomedical Reports 22.4 (2025): 61.
Chicago
Hong, L., Sun, Y., Lu, X., Xu, X."Non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio as a biomarker for liver health: Insights from National Health and Nutrition Examination Survey data". Biomedical Reports 22, no. 4 (2025): 61. https://doi.org/10.3892/br.2025.1939
Follow us
  • Twitter
  • LinkedIn
  • Facebook
About
  • Spandidos Publications
  • Careers
  • Cookie Policy
  • Privacy Policy
How can we help?
  • Help
  • Live Chat
  • Contact
  • Email to our Support Team