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Remnant cholesterol predicts long-term mortality of patients with metabolic dysfunction-associated fatty liver disease.

CONTEXT
Elevated serum remnant cholesterol independently predicts risks of cardiovascular diseases. However, the association between remnant cholesterol and metabolic dysfunction-associated fatty liver disease (MAFLD) remains unclear.


OBJECTIVES
This study aimed to explore the association of remnant cholesterol with MAFLD and its long-term mortality.


METHODS
We extracted data from the NHANES Ⅲ, 1988-1994 and the linked mortality data till December 31, 2015. The association between remnant cholesterol and MAFLD was analyzed by multivariate logistic regression. Cox proportional hazards regression was performed to assess whether elevated remnant cholesterol increased all-cause and cause-specific mortalities in MAFLD patients.


RESULTS
At baseline, 28.6% (1474/5156) of participants had MAFLD. In multivariate logistic regression, the fourth quartile of remnant cholesterol was associated with an increased risk of MAFLD compared with the first quartile (OR: 1.714, 95% CI: 1.586-1.971; P <0.001). In participants with normal levels of triglyceride, LDL- and HDL-cholesterol, the relationship between remnant cholesterol and MAFLD risk remained significant (OR: 1.346, 95% CI: 1.248-1.761; P <0.001). During a median follow-up of 307 months, MAFLD patients with serum remnant cholesterol in the fourth quartile were associated with a higher risk of all-cause mortality (HR: 2.183, 95% CI: 1.825-2.407; P <0.001), as well as a higher risk of cardiovascular mortality (HR: 2.346, 95% CI: 2.046-2.885; P <0.001) and cancer-related mortality (HR: 2.366, 95% CI: 1.864-2.932; P <0.001) compared with MAFLD patients in the first quartile.


CONCLUSIONS
Remnant cholesterol was independently associated with the risk of MAFLD and predicted all-cause, cardiovascular, and cancer-related mortalities in MAFLD patients.