Predictive markers of nonalcoholic fatty liver disease in lean patients. A multinomial regression model and a 2k factorial analysis

Abstract

Objective Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and insulin resistance; however, there is a group of non-obese patients with NAFLD that need to be characterized. Our aim was to evaluate the factors associated with NAFLD in non-obese subjects in a third-level hospital. Methods A comparative cross-sectional study was performed. Participants were divided into four groups: non-obese without NAFLD (group 1), non-obese with NAFLD (group 2), obese without NAFLD (group 3), and obese with NAFLD (group 4). We evaluated the effect of clinical and biochemical characteristics with the disease by groups using a multinomial regression model and a 2K factorial analysis. Results We included 278 participants. Low platelet–lymphocyte ratio (PLR) as a novel parameter associated with NAFLD in non-obese subjects. Age, uric acid, alanine transaminase (ALT), high-density lipoprotein (HDL)-cholesterol, and neutrophil–lymphocyte ratio (NLR) were other related parameters (akaike information criterion = 557). NLR had the larger OR in groups with NAFLD (lean with NAFLD 7.12, obese with NAFLD 13.02). The 2k factorial design found inverse effect on PLR by NAFLD (effect –21.89, P < 0.001), which was higher than BMI (effect –1.33, P < 0.045). Conclusion Our study found that PLR is a novel parameter with inverse correlation with NAFLD in non-obese patients. Other related parameters are age, hyperuricemia, elevation of ALT and NLR, and low HDL-cholesterol.

Diagnostic performance of novel inflammatory biomarkers based on ratios of laboratory indicators for nonalcoholic fatty liver disease

“…Chronic liver inflammation induces carcinogenesis; it is often observed that patients with NAFLD eventually develop hepatocellular carcinoma (HCC) ( 29 ). The PLR, NLR and LMR have been reported to have inverse correlations with NAFLD, and are related to age, hyperuricemia, elevation of ALT, and low HDL-cholesterol ( 30 , 31 ). Furthermore, using these markers is a simple and low-cost way to diagnose advanced liver fibrosis in NAFLD patients ( 32 ).…”

Association of systemic inflammatory indices with anthropometric measures, metabolic factors, and liver function in non-alcoholic fatty liver disease

“…Regarding PLR, several studies similarly suggested that PLR may be more useful as a marker in determining the increased thrombotic state and inflammatory response in morbid obesity, obstructive sleep apnea–hypopnea syndrome, overall survival in patients with NAFLD-related hepatocellular carcinoma 5 , 36 , 41 , 42 . Taken together, it seems that PLR has relatively higher diagnostic accuracy for liver fibrosis 35 .…”

The correlation between neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with nonalcoholic fatty liver disease: a cross-sectional study

“…Besides, the study also described that NAFLD patients had a significantly higher NLR level in comparison to the controls. Moreover, another study [ 27 ] indicated that PLR was a parameter with inverse correlation with NAFLD in nonobese patients (effect –21.89, P < 0.001). This result was consistent with our study that PLR was negatively associated with NAFLD when PLR was more than 42.29 (β = 0.99, 95% CI: 0.98~0.99, P < 0.001).…”