Research Papers:

Increased levels of low-density lipoprotein cholesterol within the normal range as a risk factor for nonalcoholic fatty liver disease

Dan-Qin Sun _, Wen-Yue Liu, Sheng-Jie Wu, Gui-Qi Zhu, Martin Braddock, Dong-Chu Zhang, Ke-Qing Shi, Dan Song and Ming-Hua Zheng

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Oncotarget. 2016; 7:5728-5737. https://doi.org/10.18632/oncotarget.6799

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Dan-Qin Sun1*, Wen-Yue Liu2*, Sheng-Jie Wu3*, Gui-Qi Zhu4,5, Martin Braddock6, Dong-Chu Zhang7, Ke-Qing Shi4,8, Dan Song1, Ming-Hua Zheng4,8

1Department of Nephrology, Affiliated Wuxi Second Hospital, Nanjing Medical University, Wuxi 214002, China

2Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China

3Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China

4Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China

5School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China

6Global Medicines Development, AstraZeneca R&D, Alderley Park, United Kingdom

7Wenzhou Medical Center, Wenzhou People’s Hospital, Wenzhou 325000, China

8Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China

*These authors have contributed equally to this work

Correspondence to:

Ming-Hua Zheng, e-mail: [email protected]

Dan Song, e-mail: [email protected]

Keywords: low-density lipoprotein cholesterol, non-alcoholic fatty liver disease, risk factor.

Received: October 09, 2015    Accepted: December 04, 2015    Published: December 30, 2015


Objectives: Dyslipidemia exists within the setting of NAFLD and the relationship of a normal level of low-density lipoprotein cholesterol (LDL-c) with NAFLD is largely unknown. This large population-based study aimed to investigate the association between LDL-c levels within the normal range and the incidence of NAFLD.

Methods: A total of 60527 subjects from 2 medical centers who had undergone liver ultrasonography were initially enrolled into this study. NAFLD was defined by ultrasonographic detection of steatosis in the absence of other liver disease. Subjects were divided into 4 groups (Q1 to Q4) by normal LDL-c quartiles : Q1: ≤ 2.00, Q2: 2.10-2.35, Q3: 2.36-2.68 and Q4: 2.69-3.12 mmol/L. The odds ratios (OR), hazard ratio (HR) and 95% confidence intervals (CIs) for NAFLD were calculated across each quartile of LDL-c, using the Q1 as reference.

Results: The prevalence rates of NAFLD in a cross-sectional population from Q1 to Q4 were 19.34%, 25.86%, 35.65% and 42.08%, respectively. The OR for NAFLD in the cross-sectional population were 1.31 (95% CI 1.14-1.54), 1.73 (95% CI 1.46-2.04), and 1.82 (95% CI 1.49-2.23), respectively, after adjusting for known confounding variables. The HR for NAFLD in the longitudinal population were 1.23 (95% CI 1.12-1.35), 1.57 (95% CI 1.44-1.72) and 2.02 (95% CI 1.86-2.21), compared with Q1. Subjects with higher LDL-c level within the normal range had an increased cumulative incidence rate of NAFLD.

Conclusions: Increased levels of LDL-c within the normal range may play a significant role in the prevalence and incidence of NAFLD, independent of other confounding factors.

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