Elevated remnant cholesterol is linked to non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus

Objective The aim of this study was to investigate the association between remnant cholesterol (RC) levels and non-alcoholic fatty liver disease (NAFLD) in patients diagnosed with type 2 diabetes mellitus (T2DM). Participants and methods This was a cross-sectional study involving 308 patients with T2DM who were hospitalized at Hebei General Hospital. The participants were categorized into a NAFLD group and a non-NAFLD (control) group, and comparative analyses were conducted between the groups. Regression analysis, subgroup analysis, and interaction tests were performed. Additionally, restricted cubic spline (RCS), predicted probability, and sensitivity analyses were used to explore and verify the association between RC levels and NAFLD. Results Elevated RC levels were associated with NAFLD (OR = 4.23, 95% CI: 1.73–12.04) after adjusting for all confounding factors, regardless of whether RC was treated as a continuous or tertile variable. No significant interactions were observed for any of the subgroups, including age ( P = 0.772), gender ( P = 0.231), diabetes duration ( P = 0.757), BMI ( P = 0.221), and HbA1c ( P = 0.916). RCS analysis indicated that there was a significant association between RC levels and NAFLD ( P overall = 0.006), and the relationship was linear ( P nonlinear = 0.399). The mean predicted probability of NAFLD increased with increasing RC concentration, rising from 65.7% (95% CI: 53.6%−76.1%) at 0.2 mmol/L to 85.8% (95% CI: 76.9%−91.7%) at 1.0 mmol/L. In the sensitivity analysis, when RC was categorized into tertiles, the association between RC levels and NAFLD remained significant across all models (Model 3: Tertile 3 vs. Tertile 1, OR = 2.05, 95% CI: 1.06–4.03, P = 0.035). Furthermore, a significant linear trend was observed ( P trend = 0.035), confirming the robustness of the primary findings. Conclusion In patients with T2DM, RC levels are independently associated with NAFLD.