Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and nonalcoholic fatty liver disease: NHANES 2017-2020

Background The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) is strongly linked to various dyslipidemia-related conditions. This study aimed to assess the relationship between NHHR and both nonalcoholic fatty liver disease (NAFLD) and liver fibrosis among American adults. Methods Our study utilized data from 5,861 individuals drawn from the National Health and Nutrition Examination Survey (NHANES) 2017–2020 cohort. We employed multivariate logistic regression models to elucidate the association between NHHR and both NAFLD and hepatic fibrosis. To assess the potential nonlinear relationship between NHHR and the risk of NAFLD and hepatic fibrosis, we applied restricted cubic spline (RCS) analysis. Additionally, stratified analyses were conducted to verify the consistency and robustness of the observed associations. Results After adjustment for covariates, the weighted multivariable logistic regression analysis identified a robust positive association between NHHR and the incidence of NAFLD (OR = 1.22, 95% CI: 1.14 to 1.30, P  < 0.001). In contrast, no significant association was detected between NHHR and liver fibrosis when accounting for potential confounders ( P  > 0.05). Restricted cubic spline analysis revealed an S-shaped curve characterizing the relationship between NHHR and NAFLD risk ( P for nonlinearity < 0.05), with a notable inflection point occurring at 2.49. However, a nonlinear association between NHHR and liver fibrosis was not observed ( P for nonlinearity > 0.05). Subgroup analyses further uncovered significant interactions between NHHR and both ethnicity and BMI in relation to liver fibrosis prevalence ( P for interaction < 0.05). Conclusions The NHHR demonstrated a positive correlation with the prevalence of NAFLD among American adults, whereas no such association was observed with liver fibrosis. Clinically, NHHR may serve as a valuable marker for the early identification of individuals at heightened risk for NAFLD.