The Possible Association Between Blood Level of Free Cholesterol and the Severity of Steatosis in Patients with Nonalcoholic Fatty Liver Disease

Background The global rising prevalence of nonalcoholic fatty liver disease (NAFLD) highlights the need to understand the risk factors related to its pathogenesis and its related complications. NAFLD is mediated by lipotoxicity that results from an imbalance in hepatic lipid metabolism. Emerging evidence suggests that lipotoxicity mediated by hepatic free cholesterol (FC) overload may result in steatohepatitis. Lipotoxicity is not only associated with the pathogenesis of NAFLD, but also related to increased risk of atherosclerosis and cardiovascular complications, the main leading causes of mortality in NAFLD. Aim The study tried to clarify the possible association between serum levels of FC and the severity of hepatic steatosis in NAFLD. Patients and methods This cross-sectional study included 120 participants, who proved to have different stages of hepatic steatosis using elastography with controlled attenuation parameter (CAP). The correlations between different lipid parameters as well as serum FC levels and CAP values of hepatic steatosis for all participants were assessed using multivariate linear regression analysis. Results The most independent significant lipid parameters associated with CAP values were FC, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (P<0.001 for all). Moreover, the discriminately performance of those parameters as risk factors for steatosis using receiver operating characteristics showed an area under the curve of 0.991, 0.957, and 0.861, respectively, with a significant performance (P<0.001 for all). Conclusion We could conclude that increased serum levels of FC along with increased levels of low-density lipoprotein cholesterol and decreased levels of high-density lipoprotein cholesterol have significant correlations to the increased severity of hepatic steatosis in NAFLD.