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CN 22-1108/R
Volume 41 Issue 6
Jun.  2025
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Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(6): 1083-1089

Association between serum creatinine/cystatin C ratio and nonalcoholic fatty liver disease in adults

DOI: 10.12449/JCH250613
  • 1.

    Spleen，Stomach and Hepatobiliary Department，The First Affiliated Hospital of Henan University of Chinese Medicine，Zhengzhou 450000，China

  • 2.

    The First Clinical Medical College of Henan University of Chinese Medicine，Zhengzhou 450000，China

Research funding:

National Natural Science Foundation of China (81904154);

Special Scientific Research Project on Traditional Chinese Medicine under the “Double First-Class” Initiative in Henan Province (HSRP-DFCTCM-2023-1-10)

More Information
  • Corresponding author: LIU Minghao， liumh015@163.com （ORCID： 0009-0001-7712-4605）
  • Received Date: 2024-11-04
  • Accepted Date: 2024-11-22
  • Published Date: 2025-06-25
    Abstract
  •   Objective  To investigate the association between serum creatinine/cystatin C ratio （CCR） and nonalcoholic fatty liver disease （NAFLD） based on the NHANES database， and to evaluate the potential significance of CCR as an indicator reflecting the metabolic status of the body.  Methods  Based on the data from the NHANES database in 1999‍ ‍—‍ ‍2004， a total of 4 217 participants were enrolled and divided into NAFLD group with 1 726 participants and non-NAFLD group with 2 491 participants. CCR was compared between the two groups， and the association between CCR and NAFLD was analyzed. The Wilcoxon rank-sum test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. The multivariate logistic regression model was used to investigate the association between CCR and NAFLD； CCR was divided into 4 groups based on quartiles， and odds ratio （OR） and 95% confidence interval （CI） in the regression model was calculated with the first quartile as reference. In addition， the restricted cubic spline analysis was used to investigate whether there was a non-linear relationship between CCR and NAFLD， and interaction items were introduced into the Logistic regression model to perform an interaction analysis. Subgroup analyses were performed based on the stratification of variables to investigate the difference in the association between CCR and NAFLD in different populations.  Results  The non-NAFLD group had a significantly higher CCR than the NAFLD group （Z=-4.76，P<0.01）. The Logistic regression analysis showed that in model 1 without adjustment of variables， CCR was negatively associated with NAFLD （OR=0.993，95%CI：0.989‍ ‍—‍ ‍0.996，P<0.01）， and in model 3 with adjustment of all variables， CCR was still negatively associated with NAFLD （OR=0.986，95%CI：0.981‍ ‍—‍ ‍0.991，P<0.01）. The analysis of CCR based on quartiles showed a significant association between the increase in CCR and the reduction in the risk of NAFLD. In model 3， compared with the individuals with the lowest quartile of CCR， the individuals with the highest quartile of CCR had a significantly lower risk of NAFLD （OR=0.426，95%CI：0.316‍ ‍—‍ ‍0.574，P<0.01）. Further interaction and subgroup analyses showed that the interaction between CCR and age/sex had a statistical significance （Pinteraction<0.01 and Pinteraction=0.04）. The subgroup analysis based on age showed a more significant association between CCR and NAFLD in the middle-aged population （≤60 years） （OR=0.982，95%CI：0.976‍ ‍—‍ ‍0.987）， and the subgroup analysis based on sex showed a stronger association between CCR and NAFLD in women （OR=0.979，95%CI：0.972‍ ‍—‍ ‍0.986）.  Conclusion  This study shows a significant negative association between CCR and NAFLD， and such association is more significant in middle-aged individuals and women.

     

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