Association between remnant cholesterol and cardiometabolic multimorbidity in non-alcoholic fatty liver disease patients: evidence from a cross-sectional study

BACKGROUND: Cardiometabolic multimorbidity (CMM) is a significant concern in patients with non-alcoholic fatty liver disease (NAFLD). However, the relationship between residual cholesterol (RC) levels and CMM risk in adult NAFLD patients remains poorly understood. This study aimed to investigate the association between RC levels and the risk of CMM in adult NAFLD patients using data from a large-scale, cross-sectional cohort. METHODS: Data were derived from the National Health and Nutrition Examination Survey (NHANES). Three multivariable logistic regression models and restricted cubic spline (RCS) analysis were employed to explore the relationship between RC and CMM risk in NAFLD patients, adjusting for potential confounders. Subgroup analyses and interaction tests were also conducted to assess the robustness of the findings. RESULTS: A significant positive association between RC levels and CMM risk was observed in NAFLD patients across all models (model1: OR = 1.094, 95% CI: 1.013,1.182, P = 0.023; model2: OR = 1.153, 95% CI: 1.061,1.253, P < 0.001; model3: OR = 1.158, 95% CI: 1.066,1.259, P < 0.001). Subgroup analysis showed that a stronger association between RC and CMM in patients with high fibrosis risk (P = 0.048). RCS analysis confirmed a nonlinear relationship, with CMM risk plateauing at higher RC concentrations. CONCLUSIONS: RC levels are significantly associated with CMM risk in adult NAFLD patients. These findings underscore the importance of monitoring RC levels as a potential marker for identifying individuals at higher risk of CMM, offering insights into the need for early intervention strategies. Further research is necessary to validate these findings and explore the association's underlying mechanisms.