Key result
In a non-obese Chinese population, each standard deviation increase in the GGT/HDL-C ratio was associated with a 7% increased risk of new-onset NAFLD (HR 1.07).
Why the study?
Cross-sectional associations between combined HDL-C and GGT with fatty liver have been described, but the longitudinal relationship between the GGT/HDL-C ratio and NAFLD required further evaluation.
Does a higher GGT/HDL-C ratio predict new-onset NAFLD in a non-obese Chinese population?
Cohort (n=12,126)
No
Does a higher GGT/HDL-C ratio predict new-onset NAFLD in a non-obese Chinese population?
Hazard Ratio: 1.07 (95% CI 1.04–1.1)
p-value: p=<0.0001
The GGT/HDL-C ratio is positively and nonlinearly associated with the risk of new-onset NAFLD in non-obese individuals, with a saturation threshold at 31.79 U/mmol.
May support GGT/HDL-C for NAFLD risk stratification in non-obese Chinese adults; leaves open validation in other populations and causal studies.
Background A cross-sectional association between the combination indicator of high-density lipoprotein cholesterol (HDL-C) and gamma-glutamyl transferase (GGT) and fatty liver has been described in several recent studies, and this study aims to further evaluate the longitudinal relationship between the ratio of GGT to HDL-C (GGT/HDL-C ratio) and nonalcoholic fatty liver disease (NAFLD). Methods This cohort study included 12,126 individuals without NAFLD at baseline, followed prospectively for 5 years, and the endpoint of interest was new-onset NAFLD. The relationship of the GGT/HDL-C ratio with new-onset NAFLD and the shape of the association was assessed by Cox regression models and restricted cubic spline (RCS) regression, respectively. Time-dependent receiver operator characteristics (ROC) curves were constructed to evaluate the predictive value of GGT, HDL-C, GGT/HDL-C ratio and BMI for the occurrence of NAFLD at different time points in the future. Results The prevalence of NAFLD was 72.46/1000 person-years during the 5-year follow-up period. Results of multivariate Cox regression analysis showed a positive association of the GGT/HDL-C ratio with new-onset NAFLD after adequate adjustment of the related confounding factors, and the degree of correlation was slightly higher than that of GGT, and further subgroup analysis found that this association was more significant in the population with elevated systolic blood pressure (SBP). In addition, we also found a nonlinear relationship of the GGT/HDL-C ratio with the risk of new-onset NAFLD using the RCS regression, where the saturation threshold was about 31.79 U/mmol. Time-dependent ROC analysis results showed that the GGT/HDL-C ratio was increasingly valuable in predicting NAFLD over time, and was better than HDL-C in predicting NAFLD in the early stage (1–3 years), but was not superior to BMI and GGT. Conclusions In this large longitudinal cohort study based on a Chinese population, our results supported that the GGT/HDL-C ratio was positively and nonlinearly associated with the risk of new-onset NAFLD in a non-obese population. In the assessment of future NAFLD risk, the GGT/HDL-C ratio was slightly better than GGT alone; However, the GGT/HDL-C ratio did not appear to have a significant advantage over GGT and BMI alone in predicting NAFLD.
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Xie et al. (2022) conducted a cohort in Nonalcoholic fatty liver disease (NAFLD) (n=12,126). GGT/HDL-C ratio (per SD increase) vs. Baseline GGT/HDL-C ratio was evaluated on New-onset NAFLD (HR 1.07, 95% CI 1.04-1.10, p=<0.0001). In a non-obese Chinese population, each standard deviation increase in the GGT/HDL-C ratio was associated with a 7% increased risk of new-onset NAFLD (HR 1.07).
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