ArticleBMC gastroenterology2025
The HbA1c/HDL-C ratio as a screening indicator of NAFLD in U.S. adults: a cross-sectional NHANES analysis (2017-2020).
Article in BMC gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Association between hemoglobin A1c to HDL cholesterol ratio and hypertension in middle-aged and older Chinese adults: a cross-sectional study.BMC cardiovascular disorders · 2026Article
- The association between HbA1c/HDL-C ratio and cardiometabolic multimorbidity among middle-aged and older adults: data from two national prospective cohorts in the United Kingdom and United States.Frontiers in nutrition · 2026Article
- Association between HbA1c/HDL-C ratio and diabetic foot ulcer: a cross-sectional study based on the Han population in Northwest China.Frontiers in nutrition · 2026Article
- Nonlinear association of HbA1c/HDL-C ratio with heart failure in adults: a large cross-sectional study.Frontiers in cardiovascular medicine · 2026Article
- Borderline liver enzyme patterns and their metabolic-inflammatory signatures: an observational outpatient study.Frontiers in medicine · 2026Article
- Longitudinal investigation of the HbA1c/HDL-c ratio as a potential biomarker of cognitive decline among Chinese older adults: evidence from CHARLS.BMC public health · 2025Article
- Data-driven analysis of the relationship between the HbA1c/HDL-C ratio and coronary artery calcification: a cross-sectional study.Scientific reports · 2025Article
- The newly proposed dietary index for gut microbiota and its association with the risk of nonalcoholic fatty liver disease: the mediating role of body mass index.Diabetology & metabolic syndrome · 2025Article
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9 authors.
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Abstract
backgroundNon-alcoholic fatty liver disease (NAFLD), a metabolic liver disorder closely associated with obesity and diabetes, urgently requires early screening. This population-based study is the first to explore the relationship between glycemic control and a novel dyslipidemia composite index-the glycated hemoglobin/high-density lipoprotein cholesterol (HbA1c/HDL-C) ratio in individuals with NAFLD and liver fibrosis.
methodsData from 5,891 adults in the 2017-2020 National Health and Nutrition Examination Survey (NHANES) were analyzed. Binary logistic regression and restricted cubic spline (RCS) analyses were used to evaluate the association between HbA1c/HDL-C ratio and the risk of NAFLD and liver fibrosis. The reliability of the results was confirmed using subgroup, interaction, and sensitivity analyses. Screening performance was assessed using receiver operating characteristic (ROC) curves, and differences between various indicators were compared using the DeLong test.
resultsAfter adjusting for confounding factors, each 1% increase in the HbA1c/HDL-C ratio was associated with a 20% higher risk of NAFLD (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.14-1.27, P < 0.001). Sensitivity analyses confirmed the robustness of these findings (P < 0.001). However, the associations with liver fibrosis (P = 0.064) and moderate-to-severe liver fibrosis (P = 0.130) were not statistically significant. Participants in the highest HbA1c/HDL-C quartile had significantly higher odds of NAFLD than those in the lowest quartile (OR = 2.21, 95% CI: 1.74-2.79). RCS analysis revealed a non-linear positive correlation between the HbA1c/HDL-C and NAFLD risk (P for non-linear = 0.003). Subgroup and interaction analyses showed that this association was more pronounced in the non-diabetic population. The ROC curve yielded an AUC of 0.713 for NAFLD screening.
conclusionIn U.S. adults, the HbA1c/HDL-C appears to be an effective tool for NAFLD screening. As a novel composite index, it also holds considerable reference value for identifying NAFLD risk in the non-diabetic population.
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