title: Association of low-density lipoprotein cholesterol within the normal range and NAFLD in the non-obese Chinese population: a cross-sectional and longitudinal study.
abstract: The relationship between normal low-density lipoprotein cholesterol (LDL-c) levels and non-alcoholic fatty liver disease (NAFLD) in non-obese individuals remains unclear. We aimed to investigate the precise prevalence and incidence of NAFLD within the normal LDL-c range in non-obese individuals.
  
  
  
  Cross-sectional and longitudinal study.
  
  
  
  Wenzhou Medical Center of Wenzhou People's Hospital from 2010 to 2014.
  
  
  
  183 903 non-obese individuals were enrolled from a cross-sectional population, and a total of 16 173 initially NAFLD-free non-obese individuals were included who completed a 5-year follow-up examination in the longitudinal population.
  
  
  
  In our study, NAFLD was defined by ultrasonographic detection of steatosis in the absence of other liver disease. The cross-sectional study showed that at baseline, the prevalence of NAFLD was 13.9% in non-obese individuals with normal LDL-c levels. The prospective study demonstrated that NAFLD-free participants developed NAFLD during the 5-year follow-up period, with a cumulative incidence of 14.4%. In addition, the ORs for NAFLD in the cross-sectional population were 1.11 (95% CI 1.04 to 1.18), 1.37 (95% CI 1.27 to 1.47) and 1.56 (95% CI 1.43 to 1.69), respectively, after adjusting for known confounding variables. The HRs for NAFLD in the longitudinal population were 1.15 (95% CI 0.98 to 1.36), 1.32 (95% CI 1.10 to 1.58) and 1.82 (95% CI 1.47 to 2.52), compared with Q1. Individuals with higher LDL-c level within the normal range had an increased cumulative incidence rate of NAFLD in non-obese individuals.
  
  
  
  NAFLD is prevalent in the non-obese Chinese population. Furthermore, this is the first study to demonstrate that increased normal LDL-c levels are independently associated with an elevated risk of NAFLD in non-obese individuals.
authors.affiliation: Department of Nephrology, Affiliated Wuxi Second Hospital, Nanjing Medical University, Wuxi, China.
authors.forename: Dan-Qin
authors.initials: DQ
authors.lastname: Sun
authors.affiliation: Department of Cardiovascular Medicine, The Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Wu
authors.affiliation: Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Wen-Yue
authors.initials: WY
authors.lastname: Liu
authors.affiliation: Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China.
authors.forename: Li-Ren
authors.initials: LR
authors.lastname: Wang
authors.affiliation: Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China.
authors.forename: Yi-Ran
authors.initials: YR
authors.lastname: Chen
authors.affiliation: Wenzhou Medical Center, Wenzhou People's Hospital, Wenzhou, China.
authors.forename: Dong-Chu
authors.initials: DC
authors.lastname: Zhang
authors.affiliation: Global Medicines Development, AstraZeneca R&D, Alderley Park, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Braddock
authors.affiliation: Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
authors.forename: Ke-Qing
authors.initials: KQ
authors.lastname: Shi
authors.affiliation: Department of Nephrology, Affiliated Wuxi Second Hospital, Nanjing Medical University, Wuxi, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Song
authors.affiliation: Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
authors.forename: Ming-Hua
authors.identifier: 0000-0003-4984-2631
authors.initials: MH
authors.lastname: Zheng
mesh_terms: D000328:Adult; D044466:Asian People; D015992:Body Mass Index; D002681:China / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood*; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D014463:Ultrasonography
chemical_list: D008078:Cholesterol, LDL
keywords: low-density lipoprotein cholesterol; non-alcoholic fatty liver disease; non-obese; risk factor