Wu Ju, Yu Wenjing, Huang Linglong, Hou Shuangshuang, Huang Yanan, Huang Zhihua, Dai Zhiyuan, Yin Jiajun, Nie Zhequn
Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China.
Key Laboratory of Biomarker High Throughput Screening and Target Translation of Breast and Gastrointestinal Tumor, Dalian University, Dalian, China.
BMC Gastroenterol. 2025 May 14;25(1):369. doi: 10.1186/s12876-025-03974-0.
Non-alcoholic fatty liver disease (NAFLD), a metabolic liver disorder closely associated with obesity and diabetes, urgently requires early screening. This population-based study is the first to explore the relationship between glycemic control and a novel dyslipidemia composite index-the glycated hemoglobin/high-density lipoprotein cholesterol (HbA1c/HDL-C) ratio in individuals with NAFLD and liver fibrosis.
Data from 5,891 adults in the 2017-2020 National Health and Nutrition Examination Survey (NHANES) were analyzed. Binary logistic regression and restricted cubic spline (RCS) analyses were used to evaluate the association between HbA1c/HDL-C ratio and the risk of NAFLD and liver fibrosis. The reliability of the results was confirmed using subgroup, interaction, and sensitivity analyses. Screening performance was assessed using receiver operating characteristic (ROC) curves, and differences between various indicators were compared using the DeLong test.
After adjusting for confounding factors, each 1% increase in the HbA1c/HDL-C ratio was associated with a 20% higher risk of NAFLD (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.14-1.27, P < 0.001). Sensitivity analyses confirmed the robustness of these findings (P < 0.001). However, the associations with liver fibrosis (P = 0.064) and moderate-to-severe liver fibrosis (P = 0.130) were not statistically significant. Participants in the highest HbA1c/HDL-C quartile had significantly higher odds of NAFLD than those in the lowest quartile (OR = 2.21, 95% CI: 1.74-2.79). RCS analysis revealed a non-linear positive correlation between the HbA1c/HDL-C and NAFLD risk (P for non-linear = 0.003). Subgroup and interaction analyses showed that this association was more pronounced in the non-diabetic population. The ROC curve yielded an AUC of 0.713 for NAFLD screening.
In U.S. adults, the HbA1c/HDL-C appears to be an effective tool for NAFLD screening. As a novel composite index, it also holds considerable reference value for identifying NAFLD risk in the non-diabetic population.
非酒精性脂肪性肝病（NAFLD）是一种与肥胖和糖尿病密切相关的代谢性肝脏疾病，迫切需要早期筛查。这项基于人群的研究首次探讨了血糖控制与一种新型血脂异常综合指标——糖化血红蛋白/高密度脂蛋白胆固醇（HbA1c/HDL-C）比值在非酒精性脂肪性肝病和肝纤维化个体中的关系。
对2017 - 2020年美国国家健康与营养检查调查（NHANES）中5891名成年人的数据进行分析。采用二元逻辑回归和受限立方样条（RCS）分析来评估HbA1c/HDL-C比值与非酒精性脂肪性肝病和肝纤维化风险之间的关联。通过亚组分析、交互作用分析和敏感性分析来确认结果的可靠性。使用受试者工作特征（ROC）曲线评估筛查性能，并使用德龙检验比较各指标之间的差异。
在调整混杂因素后，HbA1c/HDL-C比值每增加1%，非酒精性脂肪性肝病风险升高20%（比值比[OR]=1.20，95%置信区间[CI]：1.14 - 1.27，P<0.001）。敏感性分析证实了这些发现的稳健性（P<0.001）。然而，与肝纤维化（P = 0.064）和中重度肝纤维化（P = 0.130）的关联无统计学意义。HbA1c/HDL-C四分位数最高组的参与者患非酒精性脂肪性肝病的几率显著高于最低四分位数组（OR = 2.21，95% CI：1.74 - 2.79）。RCS分析显示HbA1c/HDL-C与非酒精性脂肪性肝病风险之间呈非线性正相关（非线性P = 0.003）。亚组分析和交互作用分析表明，这种关联在非糖尿病人群中更为明显。ROC曲线显示非酒精性脂肪性肝病筛查的AUC为0.713。
在美国成年人中，HbA1c/HDL-C似乎是一种有效的非酒精性脂肪性肝病筛查工具。作为一种新型综合指标，它在识别非糖尿病人群的非酒精性脂肪性肝病风险方面也具有相当大的参考价值。
