1419-P: The Effect of Remnant Cholesterol on Pathophysiology of Metabolic Dysfunction–Associated Steatotic Liver

Insulin resistance is associated with the inactivation of lipoprotein lipase and elevated levels of remnant lipoproteins, including remnant cholesterol (Rem-C). On the other hand, insulin resistance is the risk factor for progression of MASLD, and might induces cirrhosis, hepatocellular caricinoma, and liver-related death. Additionally, DM, high Rem-C level, and MASLD are risk factors for cardiovascular disease (CVD), and these three pathologies may be closely related. However, the correlation between REM-C levels and the pathophysiology of MASLD remains unclear. The present study aimed to elucidate the relationship between serum REM-C levels and the histological finding of MAFLD. We assessed 222 patients (94 men and 128 women; age 20-80 years) who were diagnosed with NAFLD by liver biopsy with available medical history, physical examination, and biochemical measurement data. Serum ester-type cholesterol and free cholesterol contents in the remnant lipoproteins were measured using an enzymatic method. The relationship between serum Rem-C levels and histological findings was analyzed. Serum Rem-C levels were significantly higher in patients with NAFLD activity score (NAS) 5-8,>66% steatosis grade, lobular inflammation with ≥ 5 foci, and many cells/prominent ballooning cells than in patients with NAS 1-4, < 33% steatosis grade, lobular inflammation with < 2 foci, and few ballooning cells. While univariate analysis revealed no significant association between Rem-C levels and advanced fibrosis, a significant association between Rem-C levels and NAS was evident. The relationship remained significant in multivariate analysis adjusted for confounders.

In conclusion, high serum Rem-C levels were associated with high NAS but not with fibrosis stage. Controlling serum Rem-C level may help alleviate NAFLD.