Association between neutrophil to high-density lipoprotein cholesterol ratio and risk of non-alcoholic fatty liver disease and liver fibrosis: A cross-sectional study

Background Non-alcoholic fatty liver disease (NAFLD) is closely associated with chronic inflammation and lipid metabolism disorders. The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) is an integrative marker reflecting inflammatory responses and lipid metabolism disorders. It has been associated with the prognosis of several diseases. This study aimed to investigate the relationship between NHR and the risk of NAFLD and liver fibrosis. Methods We conducted a cross-sectional study using data from the 2017–2020 National Health and Nutrition Examination Survey (NHANES).weighted multivariate regression was used to investigate the association of NHR with NAFLD and liver fibrosis. and restricted cubic spline model was used to explore potential non-linear relationships. Subgroup analyses were used to verify the stability of the relationship of NHR with NAFLD and liver fibrosis in different populations. Results A total of 6526 participants were included in the study. After adjusting for confounders, the elevated NHR levels were positively associated with the risk of NAFLD. for every unit increase in NHR, there was a 2.5 dB/m increase in the controlled attenuation parameter (CAP) (β = 2.5; P = 0.019) and an 11% increase in NAFLD prevalence (OR = 1.11; P < 0.05). Participants in the highest quartile of NHR had a twofold increased risk of developing NAFLD compared with those in the lowest quartile (OR = 2.00; P < 0.001). However, after adjusting for confounders, the association between NHR and liver fibrosis was not statistically significant. RCS analyses showed that the risk of NAFLD increased with increasing NHR water at NHR values below 3.013. The risk of developing liver fibrosis was significantly increased at NHR above 3.013. Subgroup analyses showed that the positive association between NHR and NAFLD was more pronounced in women and participants without diabetes or hypertension. Conclusion Elevated NHR levels are positively correlated with the risk of NAFLD, particularly in women and individuals without diabetes or hypertension. and the risk of developing liver fibrosis significantly increases at NHR values above 3.013. which can help in the early detection of NAFLD and liver fibrosis and timely intervention.