Low-density lipoprotein cholesterol (LDL-C) always underestimates the true cholesterol burden in patients with nonalcoholic fatty liver disease (NAFLD). We aimed to compare LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) in the identification of high-risk dyslipidemic phenotypes in those with NAFLD. We conducted a cross-sectional analysis using a cohort of 9560 apparently healthy Chinese adults who underwent comprehensive health checkups including abdominal ultrasonography. Among 3709 patients with NAFLD, the prevalence of abnormal LDL using LDL-C was 68.5%, whereas the prevalence was relatively lower when using non-HDL-C (55.9%). The concordance between non-HDL-C- and LDL-C-based diagnoses of abnormal LDL was similar in the hypertriglyceridemic (ҝ = 0.56; 95% CI 0.52–0.60) and normotriglyceridemic subgroups (ҝ = 0.47; 95% CI 0.44–0.51). Non-HDL-C detected fewer patients with abnormal LDL than LDL-C in normotriglyceridemic patients. However, non-HDL-C detected more patients with abnormal LDL than LDL-C in hypertriglyceridemic patients: 114 of the 1662 patients considered as abnormal LDL according to LDL-C fell into the normonon-HDL-C phenotype, whereas 204 of the 1662 patients considered as abnormal LDL according to non-HDL-C fell into the normoLDL-C phenotype. Among patients with NAFLD, LDL-C is superior to non-HDL-C in the detection of high-risk phenotypes in normotriglyceridemic patients, whereas non-HDL-C seems to be superior in hypertriglyceridemic patients.

We aimed to determine the association between nonalcoholic fatty liver disease (NAFLD) and diabetes risk among body size phenotypes which was based on cross-classification of body mass index (BMI) categories (normal or overweight/obesity) and metabolic status (metabolically health or metabolically at-risk). We conducted a cross-sectional analysis using a cohort of 10,761 apparently healthy Chinese adults who underwent comprehensive health checkups including abdominal ultrasonography. Subjects were classified as metabolically at-risk by having any two of the following, consistent with the Adult Treatment Panel-III metabolic syndrome definition: (1) systolic/diastolic blood pressure ≥130/85 mmHg, (2) triglycerides ≥1.7 mmol/L, (3) fasting blood glucose ≥5.6 mmol/L, (4) HDL-cholesterol ≥1.0/1.3 mmol/L for men/women. Among participants without metabolically at-risk, multivariate-adjusted odds ratios (ORs) for diabetes from NAFLD compared with those without NAFLD in the normal-weight (BMI <23 kg/m2) and overweight/obese (BMI ≥23 kg/m2) group were 2.10 (1.85–3.93) and 1.85 (1.35–2.53), respectively. Among participants with metabolically at-risk, the significant association between NAFLD and diabetes was lost, regardless of obesity status. There were only 27.1 % subjects with the presence of the three factors (overweight/obesity, NAFLD, and metabolically at-risk) occurring together, while the three factors occurring together was common (56.16 %) in diabetic individuals. The multivariate-adjusted ORs for diabetes were 1.1 (0.61–1.98) for overweight/obesity, 2.23 (1.05–5.14) for NAFLD, and 8.04 (5.0–12.09) for metabolically at-risk. The OR for the presence of all the three factors occurring together was 23.22 (13.96–38.63). NAFLD was associated with diabetes risk among participants without metabolically at-risk. The clustering of overweight/obesity, NAFLD, and metabolically at-risk is common in diabetic subjects and strikingly and markedly increases the diabetes risk.