Association of different blood lipid components with the severity of hepatic steatosis in metabolic dysfunction-associated fatty liver disease

Jinjin LIU; Xinyu ZHAO; Yibin CHEN; Dong XU; Tingting XIAO; Ying WANG; Yuqing ZHAO; Zhengzhao LU; Cheng HUANG; Xiaofei TONG; Hong YOU; Jingjie ZHAO

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Association of different blood lipid components with the severity of hepatic steatosis in metabolic dysfunction-associated fatty liver disease

VernacularTitle:不同血脂成分与代谢相关脂肪性肝病肝脂肪变性严重程度的关联性分析
Author: Jinjin LIU ¹ ; Xinyu ZHAO ² ; Yibin CHEN ³ ; Dong XU ⁴ ; Tingting XIAO ⁵ ; Ying WANG ¹ ; Yuqing ZHAO ¹ ; Zhengzhao LU ¹ ; Cheng HUANG ¹ ; Xiaofei TONG ¹ ; Hong YOU ¹ ; Jingjie ZHAO ¹
Author Information

1. Liver Research Center， Beijing Friendship Hospital， Capital Medical University， Beijing 100050， China
2. Clinical Epidemiology and EBM Unit， Beijing Friendship Hospital， Capital Medical University， Beijing 100050， China
3. School of Basic Medical Sciences， Capital Medical University， Beijing 100069， China
4. Outpatient Service of Beijing Municipal Administrative Center， Beijing Friendship Hospital， Capital Medical University， Beijing 100050， China
5. Department of Nursing， Beijing Friendship Hospital， Capital Medical University， Beijing 100050， China
Publication Type:Journal Article
Keywords: Metabolic Dysfunction-Associated Fatty Liver Disease; Dyslipidemias; Triglycerides; Cholesterol， HDL
From: Journal of Clinical Hepatology 2026;42(9):2059-2066
CountryChina
Language:Chinese
Abstract: ObjectiveTo clarify the independent and synergistic effects of dyslipidemia in the progression of hepatic steatosis in metabolic dysfunction-associated fatty liver disease （MAFLD）. MethodsA total of 7 697 participants who underwent physical examination in Beijing Friendship Hospital， Capital Medical University， from January 2022 to December 2024 were enrolled， and finally 2 177 patients with MAFLD were enrolled as subjects. Transient elastography was used to quantify the severity of hepatic steatosis （grades S1-S3）. The multivariable ordinal Logistic regression analysis was used to investigate the independent and synergistic associations of serum triglyceride （TG）， high-density lipoprotein cholesterol （HDL-C）， and low-density lipoprotein cholesterol （LDL-C） with the severity of hepatic steatosis， and their interactions and potential nonlinear relationships with metabolic factors were also examined. One-way analysis of variance or Kruskal-Wallis H test was used for comparison of continuous data between groups， and chi-square test was used for comparison of categorical data between groups. ResultsAn increase in TG （odds ratio ［OR］=1.77， 95% confidence interval ［CI］： 1.48 — 2.10， P<0.001） and a reduction in HDL-C （OR=1.35， 95%CI： 1.11 — 1.65， P=0.003） were independently associated with a greater severity of hepatic steatosis， with the strongest association when both abnormalities coexisted （OR=2.40， 95%CI： 1.87 — 3.07， P<0.001）. The dose-response relationship analysis further revealed a nonlinear threshold effect of TG on hepatic steatosis at the threshold of 1.51 mmol/L （P_nonlinearity=0.001）， below which the severity of steatosis increased more rapidly with the increase in TG concentration （P=0.001）. The subgroup analysis showed that the association between the reduction in HDL-C and the severity of steatosis was observed only in males， young adults （aged <45 years）， and metabolically healthier subgroups （without diabetes， obesity， hyperuricemia or hypertension）. Significant interactions were observed between the presence or absence of obesity and the abnormal levels of TG and HDL‑C （both P_interaction<0.05）. The association of the increase in LDL-C with steatosis was confined to specific subgroups （without obesity or hyperuricemia）. ConclusionThe increase in TG and the reduction in HDL-C are independently associated with the severity of hepatic steatosis in MAFLD. The synergistic effect of blood lipids and their interactions with metabolic factors may further refine risk stratification， so as to provide a basis for precise management of MAFLD.