PMID: 40866810 https://pubmed.ncbi.nlm.nih.gov/40866810/

Abstract

OBJECTIVE: There is limited research on the association between serum albumin to creatinine ratio (sACR) and non-alcoholic fatty liver disease (NAFLD). This study aimed to investigate the association between sACR and NAFLD risk in non-obese Chinese individuals.

METHODS: This longitudinal cohort study comprised 14,698 non-obese individuals with normal LDL-c levels followed from January 2010 to December 2014. We analyzed the relationship between sACR and NAFLD risk employing Cox proportional hazards regression models. Cox proportional hazards regression with cubic spline functions was applied to examine the non-linear relationship between sACR and NAFLD. We conducted various sensitivity and subgroup analyses to validate our findings.

RESULTS: Throughout the follow-up (median 35.4 months), 13.80% of the cohort (n = 2,029) progressed to NAFLD. After multivariable adjustment, each unit increment in sACR corresponded to a 3.3% reduction in NAFLD incidence (HR = 0.967, 95% CI: 0.963-0.972, P < 0.001). A non-linear relationship was evident, featuring a critical value at sACR = 44.675, beyond which the protective effect strengthened (HR = 0.961, 95% CI: 0.955-0.967) compared to levels below this cutoff (HR = 0.979, 95% CI: 0.967-0.991). Sensitivity analyses validated the robustness of our findings. Subgroup analysis demonstrated a stronger relationship in individuals with HDL-c < 1.0 mmol/L (HR = 0.942, 95% CI: 0.932-0.969) than in those with HDL-c ≥ 1.0 mmol/L (HR = 0.969, 95% CI: 0.964-0.974, P for interaction = 0.001).

CONCLUSION: This study demonstrates an inverse and non-linear relationship between sACR and NAFLD risk in non-obese Chinese individuals with normal LDL-c levels. The protective association is stronger when sACR exceeds 44.675. From a preventive and therapeutic perspective, maintaining sACR above this threshold may help reduce NAFLD risk.