High Remnant Cholesterol Increased the Risk of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) or Non-Alcoholic Fatty Liver Disease (NAFLD): A Systematic Review and Meta-Analysis

Taufik Biya; Himawan Sanusi; Andi Makbul Aman

doi:10.15605/jafes.041.01.5159

Authors

Taufik Biya Hasanuddin University, Makassar, Indonesia https://orcid.org/0009-0001-7794-7337
Himawan Sanusi Hasanuddin University, Makassar, Indonesia
Andi Makbul Aman Hasanuddin University, Makassar, Indonesia

DOI:

https://doi.org/10.15605/jafes.041.01.5159

Keywords:

remnant cholesterol, insulin resistance, MAFLD, NAFLD

Abstract

Background. MAFLD is currently acknowledged as the most common chronic liver disease and is strongly associated with obesity, metabolic dysregulation and diabetes. MAFLD is defined by the accumulation of lipids within the liver due to impaired lipid metabolism.

Objective. The objective of this study is to assess the association between increased remnant cholesterol levels and the likelihood of developing MAFLD or NAFLD.

Methodology. A systematic review and meta-analysis were performed in accordance with PRISMA recommendations. Databases such as the Cochrane Library and PubMed were queried for relevant material through March 21, 2025, using specific keywords related to remnant cholesterol and fatty liver disorders. The inclusion criteria concentrated on research investigating the influence of remnant cholesterol on the incidence of NAFLD/MAFLD. Data extraction and quality evaluation were conducted utilizing the JBI Critical Appraisal Checklist for Cohort Studies and ROBINS-I instruments.

Results. Six studies were eventually included in our systematic review, including cross-sectional studies with a total of 45,821participants. The meta-analysis, conducted with Review Manager version 5.4, demonstrated a significant association between elevated remnant cholesterol levels and an increased risk of NAFLD/MAFLD, yielding a relative risk (RR) of 3.18 (95% CI 1.89-5.37; p <0.00001; I2 = 99%). This indicates a robust link between remnant cholesterol and the prevalence of various hepatic disorders.

Conclusion. Remnant cholesterol is associated with MAFLD or NAFLD. Increased remnant cholesterol is a risk factor for MAFLD or NAFLD.

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Author Biographies

Taufik Biya, Hasanuddin University, Makassar, Indonesia

Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Himawan Sanusi, Hasanuddin University, Makassar, Indonesia

Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Andi Makbul Aman, Hasanuddin University, Makassar, Indonesia

Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

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