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<p>This cross-sectional study aimed to evaluate the association between the total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio and metabolic dysfunction-associated fatty liver disease (MAFLD) risk in older adults. Utilizing data from 4,844 participants aged ≥ 18&#xa0;years from the 2005 to 2020 National Health and Nutrition Examination Survey (NHANES), the TC/HDL-C ratio was calculated and categorized into quartiles. MAFLD was diagnosed according to the 2020 International Expert Consensus Criteria. Multivariable logistic regression assessed the association between the TC/HDL-C ratio and MAFLD prevalence, while restricted cubic splines evaluated the potential non-linearity and threshold effects. Among the participants, 2,716 (56.1%) were diagnosed with MAFLD. A higher TC/HDL-C ratio was significantly associated with an increased prevalence of MAFLD (odds ratio [OR] 1.30; 95% confidence interval [CI] 1.09–1.55; <i>p</i> &lt; 0.01). This analysis revealed a U-shaped positive association (<i>p</i> for non-linearity = 0.004) with an inflection point at a TC/HDL-C ratio of 3.56. Below this threshold, each unit increase in the TC/HDL-C ratio was associated with a steeper increase in MAFLD risk (adjusted OR [aOR] = 1.370, 95% CI 1.066–1.760) compared with increases above the threshold (aOR = 1.165, 95% CI 1.049–1.294; <i>p</i> for log-likelihood ratio = 0.01). The TC/HDL-C ratio demonstrated superior diagnostic accuracy for MAFLD (AUC = 0.682) compared with isolated TC or HDL-C measurements. Subgroup analysis indicated significant interactions with body mass index (BMI) and stroke (both <i>p</i>-interaction &lt; 0.05). Sensitivity analysis confirmed the robustness of the findings. Further longitudinal studies are warranted to validate these results and inform optimal MAFLD prevention strategies.</p>

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U-shaped association between TC/HDL-C ratio and the risk of metabolic dysfunction-associated fatty liver disease in older adults

  • 期刊论文

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  • 发表日期：

    2026年1月3日

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  • Jie Zhou,
  • Jian Dong,
  • Wenyan Zhao,
  • Min Zhao

摘要

This cross-sectional study aimed to evaluate the association between the total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio and metabolic dysfunction-associated fatty liver disease (MAFLD) risk in older adults. Utilizing data from 4,844 participants aged ≥ 18 years from the 2005 to 2020 National Health and Nutrition Examination Survey (NHANES), the TC/HDL-C ratio was calculated and categorized into quartiles. MAFLD was diagnosed according to the 2020 International Expert Consensus Criteria. Multivariable logistic regression assessed the association between the TC/HDL-C ratio and MAFLD prevalence, while restricted cubic splines evaluated the potential non-linearity and threshold effects. Among the participants, 2,716 (56.1%) were diagnosed with MAFLD. A higher TC/HDL-C ratio was significantly associated with an increased prevalence of MAFLD (odds ratio [OR] 1.30; 95% confidence interval [CI] 1.09–1.55; p < 0.01). This analysis revealed a U-shaped positive association (p for non-linearity = 0.004) with an inflection point at a TC/HDL-C ratio of 3.56. Below this threshold, each unit increase in the TC/HDL-C ratio was associated with a steeper increase in MAFLD risk (adjusted OR [aOR] = 1.370, 95% CI 1.066–1.760) compared with increases above the threshold (aOR = 1.165, 95% CI 1.049–1.294; p for log-likelihood ratio = 0.01). The TC/HDL-C ratio demonstrated superior diagnostic accuracy for MAFLD (AUC = 0.682) compared with isolated TC or HDL-C measurements. Subgroup analysis indicated significant interactions with body mass index (BMI) and stroke (both p-interaction < 0.05). Sensitivity analysis confirmed the robustness of the findings. Further longitudinal studies are warranted to validate these results and inform optimal MAFLD prevention strategies.