The associations between apolipoprotein B, A1, and the B/A1 ratio and nonalcoholic fatty liver disease in both normal-weight and overweight Korean population

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is associated with a higher risk of cardiovascular disease, but the relationship has not been established in nonobese populations. Higher apolipoprotein B (apo B) levels and the apo B/A1 ratio and lower apo A1 levels are associated with an elevated risk of cardiovascular disease. We investigated the associations between apo B, apo A1, and the apo B/A1 ratio and the presence of metabolic syndrome and NAFLD in both normal-weight and overweight Koreans. METHODS: This cross-sectional study consisted of 8327 consecutive both normal-weight and overweight Koreans with NAFLD diagnosed by ultrasonography at the Samsung Medical Center in Korea from January 2008 to December 2010. RESULTS: The prevalence of NAFLD was 27.1% among the 8327 participants. Higher serum triglyceride levels and the apo B/A1 ratio and lower high-density lipoprotein cholesterol and apo A1 levels were significantly associated with higher prevalence of metabolic syndrome in both normal-weight group and overweight group. The multivariate-adjusted odds ratios (ORs) for NAFLD in normal-weight group after comparing the fourth vs the first quartiles of the triglyceride, HDL cholesterol, low-density lipoprotein (LDL) cholesterol, apo B, apo A1, and the apo B/A1 ratio data were 2.89 (95% confidence interval [CI], 2.19-3.83; P trend < .001), 0.60 (95% CI, 0.46-0.78; P trend < .001), 1.67 (95% CI, 1.33-2.11; P trend < .001), 1.88 (95% CI, 1.48-2.39; P trend < .001), 0.73 (95% CI, 0.58-0.93; P trend < .001), and 1.86 (95% CI, 1.45-2.38; P trend < .001), respectively. The corresponding adjusted ORs in the overweight group were 3.43 (95% CI, 2.60-4.54; P trend < .001), 0.89 (95% CI, 0.68-1.16; P trend = .221), 1.41 (95% CI, 1.11-1.78; P trend = .001), 1.58 (95% CI, 1.21-2.06; P trend < .001), 0.99 (95% CI, 0.77-1.27; P trend = .958), and 1.53 (1.16-2.01; P trend = .002), respectively. CONCLUSIONS: Higher serum triglyceride, LDL cholesterol, apo B1 levels, and the apo B/A1 ratio were significantly associated with NAFLD independent of metabolic syndrome in both normal-weight and overweight Koreans. Lower serum HDL cholesterol and apo A1 levels were related to NAFLD in normal-weight participants. Our results suggest that the presence of NAFLD may be associated with increased risk for coronary artery disease in both normal-weight and overweight Koreans. (C) 2016 National Lipid Association. All rights reserved.