The Association between NHHR and Nonalcoholic Fatty Liver Disease: Result from NHANES 2017 - 2023

BACKGROUND: The non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (NHHR) has emerged as a novel lipid biomarker with potential relevance to nonalcoholic fatty liver disease (NAFLD), yet its role remains underexplored. METHODS: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2017 through 2023, we investigated the relationship between NHHR and NAFLD. NHHR values were log-transformed (LnNHHR) to achieve normal distribution. Multivariate logistic regression and restricted cubic spline (RCS) models were applied to examine the association between NHHR and both NAFLD and hepatic fibrosis. Robustness was evaluated through subgroup and sensitivity analyses. RESULTS: NHHR levels were significantly elevated in individuals with NAFLD and hepatic fibrosis compared to those without (p < 0.001). Multivariate logistic regression indicated a positive correlation between increased LnNHHR and NAFLD risk [odds ratio (OR): 2.94, p < 0.001], whereas no significant association was found with hepatic fibrosis (OR: 1.02, p = 0.870). Participants in the highest LnNHHR quartile (Q4) had a 3.09-fold higher likelihood of NAFLD compared to those in the lowest quartile (Q1) [95% confidence interval (CI): 2.60 - 3.67, p < 0.001]. However, no significant trend was observed for hepatic fibrosis across quartiles (p > 0.05). RCS analysis revealed a J-shaped relationship between LnNHHR and both NAFLD (pinteraction < 0.001) and hepatic fibrosis (pinteraction = 0.006). Stratified analyses further demonstrated that NHHR's impact on NAFLD varied across age groups (pinteraction = 0.024), while its effect on hepatic fibrosis differed by education level (pinteraction = 0.048). CONCLUSIONS: NHHR is strongly linked to an increased risk of NAFLD, suggesting that improving NHHR levels may help mitigate hepatic steatosis.