Nonlinear associations of remnant cholesterol/high-density lipoprotein cholesterol ratio with the risk of metabolic-associated fatty liver disease: a cross-sectional study

OBJECTIVE: This study aimed to explore the association between the ratio of remnant cholesterol to high-density lipoprotein cholesterol (RC/HDL-C) and metabolic-associated fatty liver disease (MAFLD). METHODS: This cross-sectional study included 2,589 participants underwent physical examinations from 2015 to 2017. Logistic regression, restricted cubic spline (RCS), subgroup analysis and receiver operating characteristic (ROC) curve analysis were applied to assess the association between RC/HDL-C ratio and the risk of MAFLD. RESULTS: There is a positive correlation between RC/HDL-C ratio and the risk of MAFLD (P for trend < 0.001). Results from the multivariate logistic regression analysis showed a positive association between RC/HDL-C ratio and MAFLD (Q4 vs. Q1: OR = 5.91, 95%CI: 4.06–8.74). The results remain stable in subgroup analyses. RCS analysis showed a significant non-linear dose-response relationship (P for nonlinear < 0.001) between RC/HDL-C ratio and the risk of MAFLD. ROC analysis indicated that RC/HDL-C had modest discriminative ability for MAFLD (AUC = 0.778, 95%CI: 0.758–0.797). CONCLUSIONS: This cross-sectional study found a significant nonlinear positive relationship between RC/HDL-C and MAFLD, and RC/HDL-C showed modest discriminative ability for MAFLD. These findings suggest that RC/HDL-C may serve as a potential risk-related biomarker for MAFLD.