Association Between NLR and NAFLD in Adults Exposed to Famine in Early Life

Ying Liu,1,* Zhifang Zhong,1,* Zhihong Li,1,* Xin Li,2 Shengkun Zhang,2 Jie Sun,1 Jingfang Zhai,3 Xuekui Liu,4 Min Liu1 1Department of Ultrasound, Xuzhou Central Hospital, Xuzhou, People’s Republic of China; 2Department of Obstetrical and Gynecological, Xuzhou Central hospital, Xuzhou, People’s Republic of China; 3Prenatal Diagnosis Center, Xuzhou Central Hospital, Xuzhou, People’s Republic of China; 4Department of Endocrinology, Xuzhou Central hospital, Xuzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Min Liu, Department of Ultrasound, Xuzhou Central Hospital, Jiefang Road 199#, Xuzhou, 221009, People’s Republic of China, Email 24187358@qq.com Xuekui Liu, Department of Endocrinology, Xuzhou Central Hospital, Jiefang Road 199#, Xuzhou, 221009, People’s Republic of China, Email liuxuekui314@njmu.edu.cnAim: Exposure to famine in early life has been shown to increase the prevalence of non-alcoholic fatty liver disease (NAFLD). Neutrophil-to-lymphocyte ratio (NLR) is a risk factor for developing NAFLD. However, it is not clear that the association between NLR and NAFLD in individuals who were exposed to famine in early life.Methods: To match for age, we selected two group populations from Xuzhou city, China, on two different occasions, 2013 and 2017. The group recruited in 2013 included participants who were born during a period of great famine in China. Participants in the another group recruited in 2017 were born between 1965 and 1968. Clinical characteristics of individuals as well as serology indexes were examined for all participants. Ultrasonography to diagnose NAFLD was performed by trained doctors. A total of 10,574 participants were included in the final analysis.Results: Individuals born during the famine period have a higher NAFLD prevalence than those who had not been exposed to famine and these findings were similar for both sexes (male: 57.6% vs 48.9%, female: 47.6% vs 40.3%). The prevalence of NAFLD according to NLR quartiles in those exposed to famine was 49.5%, 52.7%, 52.9% and 55.5% for Q1, Q2, Q3 and Q4 NLR, respectively, and was higher than that in non-exposed to famine group. After adjusting for age, BMI, and other metabolic variables, the association between NLR and NAFLD disappeared in the non-famine group. The non-linear relationship between NLR and NAFLD was found in those who had been exposed to famine.Conclusion: Individuals who were exposed to famine in early life have a higher prevalence of NAFLD than those who were not exposed. Compared with lower NLR levels, elevated NLR is a risk factor for developing NAFLD. However, there is a non-linear relationship between NLR and the risk of developing NAFLD.Keywords: non-alcoholic fatty liver disease, famine, neutrophil-to-lymphocyte ratio, non-linear relationship