title: Increased levels of low-density lipoprotein cholesterol within the normal range as a risk factor for nonalcoholic fatty liver disease.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Nephrology, Affiliated Wuxi Second Hospital, Nanjing Medical University, Wuxi 214002, China.
authors.forename: Dan-Qin
authors.initials: DQ
authors.lastname: Sun
authors.affiliation: Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Wen-Yue
authors.initials: WY
authors.lastname: Liu
authors.affiliation: Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Wu
authors.affiliation: Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Gui-Qi
authors.initials: GQ
authors.lastname: Zhu
authors.affiliation: Global Medicines Development, AstraZeneca R&D, Alderley Park, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Braddock
authors.affiliation: Wenzhou Medical Center, Wenzhou People's Hospital, Wenzhou 325000, China.
authors.forename: Dong-Chu
authors.initials: DC
authors.lastname: Zhang
authors.affiliation: Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Ke-Qing
authors.initials: KQ
authors.lastname: Shi
authors.affiliation: Department of Nephrology, Affiliated Wuxi Second Hospital, Nanjing Medical University, Wuxi 214002, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Song
authors.affiliation: Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zheng
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors
chemical_list: D008078:Cholesterol, LDL
keywords: low-density lipoprotein cholesterol; non-alcoholic fatty liver disease; risk factor