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Novel Application of the Traditional Lipid Ratios as Strong Risk Predictors of NASH

Authors Hegazy M, Saleh SA, Ezzat A, Behiry ME

Received 2 September 2019

Accepted for publication 27 November 2019

Published 10 February 2020 Volume 2020:13 Pages 297—305


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Jing Sun

Mona Hegazy,1 Shereen A Saleh,2 Ahmed Ezzat,1 Mervat E Behiry1

1Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Internal Medicine, Faculty of Medicine, Ain-Shams University, Cairo, Egypt

Correspondence: Mona Hegazy
Internal Medicine, Faculty of Medicine, Cairo University, Villa 22A, Compound First Heights, 6th of October City, Cairo 14651, Egypt
Tel +20 1001421551

Purpose: Limited data are available regarding the role of triglycerides, cholesterol and lipoproteins ratios as risk factors for nonalcoholic fatty liver disease (NAFLD) progression. In the present study, the investigators aimed to investigate the value of cardiovascular risk ratios of triglycerides, cholesterol, and lipoproteins as predictors of nonalcoholic steatohepatitis (NASH) and the correlation of such ratios with disease severity.
Patients and Methods: This study included 131 overweight and obese patients with NAFLD who were divided into NASH, borderline NASH, and non-NASH fatty liver (NNFL) subgroups according to NAFLD activity score (NAS) in liver biopsy, and 60 healthy participants as a control group. Lipid profile and lipid ratios including triglycerides/HDL (TGs/HDL), low-density lipoprotein/high-density lipoprotein (LDL/HDL) and total cholesterol/HDL (TC/HDL) ratios were measured.
Results: Significantly higher triglycerides/HDL ratio was found in NASH and borderline NASH, while higher cholesterol/HDL ratio was found in borderline NASH in comparison to controls. There were positive correlations between TGs/HDL and steatosis, ballooning, inflammation, BMI, and NAS; between LDL/HDL and inflammation; and between cholesterol/HDL and BMI, steatosis, and NAS. The highest AUC was that of TG/HDL (0.744), at a cut-off point of 3, with 71.8% sensitivity and 76.8% specificity.
Conclusion: Triglycerides, cholesterol and lipoprotein ratios showed higher levels in NASH and correlated with NAFLD severity, and above these cut-off ratios, we can rule in the NASH cases which confer also the cardiovascular morbidities. Structured lipid ratios could serve as markers to screen NASH progression from simple steatosis cases and clarify the link of NASH with the cardiovascular risk prediction in overweight and obese patients.

Keywords: nonalcoholic steatohepatitis, triglycerides/HDL, total cholesterol/HDL, LDL/HDL, borderline NASH

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