The association between non–high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and nonalcoholic fatty liver disease in non-obese individuals: A cross-sectional study

ObjectiveThis study aimed to investigate the association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and nonalcoholic fatty liver disease in non-obese individuals, using data from the National Health and Nutrition Examination Survey.MethodsThis cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (2017-2023), including 6265 eligible participants. The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol was calculated, and nonalcoholic fatty liver disease was diagnosed using liver ultrasound transient elastography. The association between the ratio and nonalcoholic fatty liver disease was assessed using multivariable logistic regression and restricted cubic spline models. Threshold effect analysis was conducted to evaluate potential nonlinear relationships, while subgroup analyses and interaction tests were performed to assess consistency across demographic groups. Sensitivity analyses were also conducted using alternative controlled attenuation parameter thresholds to ensure the robustness of the findings.ResultsAmong the 6265 participants (mean age, 44.32 years), 1355 (21.62%) had nonalcoholic fatty liver disease. Restricted cubic spline analysis revealed a nonlinear dose-response relationship between the ratio and nonalcoholic fatty liver disease risk (P for nonlinearity