title: Non-high-density lipoprotein cholesterol as a biomarker for nonalcoholic steatohepatitis.
abstract: OBJECTIVE
  There are no clinically available biomarkers for nonalcoholic steatohepatitis (NASH); differentiating between steatosis and NASH requires histologic evaluation. Noninvasive methods are needed to replace liver biopsy and its associated risks. Production of very low density lipoprotein (VLDL) contributes to the development of NASH and might be used to distinguish steatosis from NASH. However, it is not possible to measure levels of VLDL directly in the clinic. Non-high-density lipoprotein-cholesterol (non-HDL-C) encompasses all apolipoprotein-B-containing lipoproteins, including VLDL, and can be calculated from standard lipid panels without additional cost.
  
  
  METHODS
  We evaluated the ability of non-HDL-C to differentiate steatosis from NASH in a prospective study of 218 patients with suspected NASH (steatosis, n = 100 and NASH, n = 118).
  
  
  RESULTS
  Patients with NASH had a trend toward increased levels of non-HDL-C, compared with those with steatosis (P = .08). However, among subjects not on lipid-lowering medications, those with NASH had significantly higher levels of non-HDL-C (144.6 mg/dL) than those with steatosis (129.3 mg/dL; P = .025). This difference remained significant when adjusted for levels of cholesterol and triglycerides, indicating that the difference results from increased levels of apolipoprotein B including VLDL. These findings were validated in a cohort of 40 patients with steatosis or NASH who were not taking lipid-lowering agents. The NASH group had significantly higher levels of non-HDL-C than the steatosis group (162.8 vs 145.9 mg/dL; P = .04).
  
  
  CONCLUSIONS
  NASH is associated with significantly higher levels of non-HDL-C than steatosis in patients who do not take lipid-lowering agents. This low-cost biomarker could be used in noninvasive differentiation between steatosis and NASH.
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Corey
authors.forename: Michelle
authors.initials: M
authors.lastname: Lai
authors.forename: Louis G
authors.initials: LG
authors.lastname: Gelrud
authors.forename: Joseph
authors.initials: J
authors.lastname: Misdraji
authors.forename: Lydia L
authors.initials: LL
authors.lastname: Barlow
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.forename: Karin L
authors.initials: KL
authors.lastname: Andersson
authors.forename: Michael
authors.initials: M
authors.lastname: Thiim
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Pratt
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D019411:Clinical Laboratory Techniques / Q000379:methods*; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL