Remnant Lipoprotein Cholesterol May Predict Fatty Liver Disease Risk

fatty liver disease
Fatty liver disease and hepatic steatosis body part as a medical health care concept of the digestive system anatomy and vital organ for digestion functions in a 3D illustration style.
The role certain blood lipid components have in the development of fatty liver disease (FLD) has been hypothesized but not confirmed. Researchers studied whether there was a correlation between remnant lipoprotein cholesterol (RLP-C) and occurrence of FLD.

Remnant lipoprotein cholesterol (RLP-C) features a strong and positive correlation with the occurrence and severity of fatty liver disease (FLD), suggesting RLP-C, among other variables, could be used as a marker to predict disease risk and improve early initiation of risk mitigation strategies,. These findings were published in the Journal of Clinical Endocrinology and Metabolism.

Researchers retrospectively collected data of people who received health exams at a university medical center in China between January and December 2019. Participants were categorized based on their liver ultrasound findings, and researchers assessed the association between RLP-C and occurrence of FLD (n=38,885). This analysis was performed through logistic regression, restricted cubic spline, and receiver operating characteristic curve.

Participants were categorized by FLD severity. The researchers then assessed the association between RLP-C and severity of fatty liver disease through multiple logistic regression in an analysis that included only male patients (n=564) aged 53.55±10.13 years.

In the overall population,  the average age of patients with FLD vs those without was 49.39±12.95 years and 45.84±13.92 years, respectively (P <.001).

There was a positive effect of triglycerides on the incidence of FLD (adjusted odds ratio [aOR], 2.68; 95% CI, 2.53-2.84; P <.001). There was also a positive effect of RLP-C on FLD occurrence (aOR, 2.33; 95% CI, 2.21-2.46; P <.001), indicating a dose-response relationship. The researchers established 0.45 mmol/L as the optimal cutoff value of RLP-C, while the area under the curve (AUC) was 0.79.

An 8-variable fatty liver disease discriminant model was developed and included waist circumference, body mass index, gamma-glutamyl transpeptidase, RLP-C, alanine aminotransferase, uric acid, high-density lipoprotein cholesterol, and sex (male). In both the training and the validation sets, the AUC of this 8-variable model was 0.89. The severity of fatty liver disease was significantly associated with RLP-C level (aOR per SD, 1.29; 95% CI, 1.07-1.55; P =.008).

Among the study limitations noted by the authors was that health exam data from China do not include information on the history of medication and alcohol use, therefore the study could not rule out the influence of these factors on their findings.

The researchers concluded their 8-variable model, along with RLP-C level measurement, may be a simple and economical tool that can provide reliable FLD risk discrimination in clinical practice. “This can also help clinicians to identify individuals with high FLD risk, to guide these individuals to perform ultrasound examination to confirm the diagnosis and initiate medical interventions early to improve their quality of life,” they wrote.


Zhang S, Cheng S, He X, et al. Remnant lipoprotein cholesterol as a factor related to adult fatty liver disease. J Clin Endocrinol Metab. Published online November 19, 2021; corrected and typeset December 7, 2021. doi:10.1210/clinem/dgab825

This article originally appeared on Endocrinology Advisor