OBJECTIVES: The relationship between normal low-density lipoprotein cholesterol (LDL-c) levels and nonalcoholic fatty liver disease (NAFLD) in non-obese subjects remains unclear. We aimed to investigate the precise prevalence and incidence of NAFLD within the normal LDL-c range in non-obese subjects. Design: Cross-sectional and longitudinal study. Setting: Wenzhou Medical Center of Wenzhou People’s Hospital from 2010 to 2014. Participants: 183903 non-obese individuals were enrolled from a cross-sectional population and a total of 16173 initially NAFLD-free non-obese subjects were included who completed a 5-year follow-up examination in the longitudinal population. RESULTS: In our study, NAFLD was defined by ultrasonographic detection of steatosis in the absence of other liver disease. The cross-sectional study showed that at baseline, the prevalence of NAFLD was 13.9% in non-obese subjects with normal LDL-c levels. The prospective study demonstrated that NAFLD-free subjects developed NAFLD during the 5-year follow-up period, with a cumulative incidence of 14.4%. In addition, the OR for NAFLD in the cross-sectional population were 1.11(95%CI 1.04-1.18), 1.37 (95%CI 1.27-1.47), and 1.56 (95%CI 1.43-1.69), respectively, after adjusting for known confounding variables. The HR for NAFLD in the longitudinal population were 1.15 (95%CI 0.98-1.36), 1.32 (95%CI 1.10-1.58) and 1.82 (95%CI 1.47-2.52), compared with Q1. Subjects with higher LDL-c level within the normal range had an increased cumulative incidence rate of NAFLD in non-obese subjects. CONCLUSIONS: NAFLD is prevalent in the non-obese Chinese population. Furthermore, this is the first study to demonstrate that increased normal LDL-c levels are independently associated with an elevated risk of NAFLD in non-obese subjects.
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