Association of neutrophil-to-high-density lipoprotein cholesterol ratio with nonalcoholic fatty liver disease and liver fibrosis: a nationally representative cross-sectional study by NHANES from 2017 to 2020

Abstract Background The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) has emerged as a promising biomarker reflecting inflammation and lipid dysregulation. Mounting evidence indicates that these metabolic disturbances play a pivotal role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). This study aims to elucidate the interplay among NHR, NAFLD, and liver fibrosis. Methods This cross-sectional investigation utilized data from the 2017–2020 National Health and Nutrition Examination Survey (NHANES). Weighted multivariate logistic regression models were applied to explore the association between NHR and both NAFLD and liver fibrosis. Smoothed curve fitting and threshold effect analysis were conducted to uncover potential nonlinear relationships. Subgroup analyses were conducted to assess the consistency of these associations across different groups. Results The study encompassed 4602 participants. Our results demonstrated a significant positive association between NHR and NAFLD (OR = 1.09, 95% CI: 1.01–1.18). However, no significant association was found between NHR and liver fibrosis (OR = 1.02; 95% CI: 0.96–1.09). The analysis of smoothed curve fitting and threshold effect indicated an inverted U-shaped relationship between NHR and NAFLD, with a turning point at 5.92. Conclusion Our findings highlight a positive correlation between elevated NHR levels and NAFLD prevalence. However, no significant association was observed between NHR and liver fibrosis prevalence. Further prospective research is warranted to verify these results in a longitudinal setting.