Association between serum albumin to creatinine ratio and non-alcoholic fatty liver disease: a longitudinal cohort study in non-obese Chinese individuals

1. In a group of Chinese patients with normal low-density lipoprotein cholesterol (LDL-c), serum albumin to creatinine (sACR) showed an inverse and non-linear relationship with the risk of non-alcoholic fatty liver disease (NAFLD). Evidence Rating Level: 2 (Good) NAFLD has been historically considered to result from obesity, yet the prevalence of this disease among non-obese patients is rising. Serum albumin levels are an important index for clinical assessment of liver function, with previous studies showing that reduced serum albumin levels are associated with a greater severity of NAFLD. Additionally, recent studies have shown associations between NAFLD and the incidence and severity of chronic kidney disease, yet investigations into the utility of sACR as a predictive factor for NAFLD development remain limited. This cohort study therefore sought to investigate the relationship between sACR and NAFLD incidence in Chinese patients with normal LDL-c levels. 14,698 Chinese patients (mean[SD] age, 43.47 ± 15.01 years; 52.29% male) with normal LDL-c levels from a single centre were included in this study. When adjusting for demographic factors and other variables, multivariate analysis using 2 different models showed that for every 1-unit increase in sACR, there was a reduction in the risk of NAFLD by 2.9% (HR = 0.971, 95%CI 0.967–0.975) and 3.3% (HR = 0.967, 95%CI 0.963–0.972) for models 1 and 2 respectively. This relationship was found to be nonlinear, with recursive algorithm analysis identifying an inflection point corresponding to an sACR value of 44.675 indicating a greater protective association beyond this value. Overall, this study found that among Chinese patients with a normal LDL-c level, sACR showed an inverse and non-linear relationship with NAFLD occurrence. Click to read the study in BMC Gastroenterology Image: PD