Title: Associations of C-reactive protein to lymphocyte ratio and  metabolic-dysfunction-
associated steatotic liver disease: evidence from NHANES 2017-2018
Version: 4 Date: 06 Sep 2024
Reviewer's report:
The authors provide an intersting manuscript regarding the association between inflammation
and hepatic steatosis. The article is well-written and solid, however  have a few suggestions to
further improve it.
1. NAFLD should be substituted for MASLD according to latest nomenclature (ref: doi:
10.1097/HEP.0000000000000520)
2. The part regarding inflammation in introduction section ("Inflammation plays an important
role in the pathogenesis of NAFLD, which is not only a direct causative agent of
liver parenchymal cell injury, but also an important pathologic basis for driving disease
progression [16]. ") should be moved to the third paragraph (beginning with  "C-reactive
protein and lymphocyte ratio (CLR) have received much attention in recent years as an
emerging combination of inflammatory biomarkers") and further  expanded (with references
to mitochondrial dysfunction, endothelial cell dysfunction and gut dysbiosis and impaired
immune cells function), since inflammation plays a central role in presence and development
of MASLD (ref: doi: 10.1016/j.jhep.2017.11.014;  doi: 10.1053/j.gastro.2018.06.083;  doi:
10.3390/cells11162511; doi: 10.1002/hep.30506).  Alternatively, this section could be added in
discussion section, where the authors discuss inflammation.
3. Since inflammation sems to be critical not only for the presence of steatosis but also for the
development of  steathepatitis,  the authors should see if there was a connection between CLR
and non-invasive biomarkers like FIB-4 or APRI scores
4.  The findings should be better explained in the discussion section for those not familiar with
statistics. Was 1.08 the threshold for the presence of MASLD? If so, what was the positive and
negative predicitive value?
Title: Associations of C-reactive protein to lymphocyte ratio and  metabolic-dysfunction-
associated steatotic liver disease: evidence from NHANES 2017-2018
Version: 4 Date: 06 Sep 2024
Reviewer's report:
The authors provide an intersting manuscript regarding the association between inflammation
and hepatic steatosis. The article is well-written and solid, however  have a few suggestions to
further improve it.
1. NAFLD should be substituted for MASLD according to latest nomenclature (ref: doi:
10.1097/HEP.0000000000000520)
2. The part regarding inflammation in introduction section ("Inflammation plays an important
role in the pathogenesis of NAFLD, which is not only a direct causative agent of
liver parenchymal cell injury, but also an important pathologic basis for driving disease
progression [16]. ") should be moved to the third paragraph (beginning with  "C-reactive
protein and lymphocyte ratio (CLR) have received much attention in recent years as an
emerging combination of inflammatory biomarkers") and further  expanded (with references
to mitochondrial dysfunction, endothelial cell dysfunction and gut dysbiosis and impaired
immune cells function), since inflammation plays a central role in presence and development
of MASLD (ref: doi: 10.1016/j.jhep.2017.11.014;  doi: 10.1053/j.gastro.2018.06.083;  doi:
10.3390/cells11162511; doi: 10.1002/hep.30506).  Alternatively, this section could be added in
discussion section, where the authors discuss inflammation.
3. Since inflammation sems to be critical not only for the presence of steatosis but also for the
development of  steathepatitis,  the authors should see if there was a connection between CLR
and non-invasive biomarkers like FIB-4 or APRI scores
4.  The findings should be better explained in the discussion section for those not familiar with
statistics. Was 1.08 the threshold for the presence of MASLD? If so, what was the positive and
negative predicitive value?
Please review this paper.
user
Title: Associations of C-reactive protein to lymphocyte ratio and  metabolic-dysfunction-
associated steatotic liver disease: evidence from NHANES 2017-2018
Version: 4 Date: 06 Sep 2024
Reviewer's report:
The authors provide an intersting manuscript regarding the association between inflammation
and hepatic steatosis. The article is well-written and solid, however  have a few suggestions to
further improve it.
1. NAFLD should be substituted for MASLD according to latest nomenclature (ref: doi:
10.1097/HEP.0000000000000520)
2. The part regarding inflammation in introduction section ("Inflammation plays an important
role in the pathogenesis of NAFLD, which is not only a direct causative agent of
liver parenchymal cell injury, but also an important pathologic basis for driving disease
progression [16]. ") should be moved to the third paragraph (beginning with  "C-reactive
protein and lymphocyte ratio (CLR) have received much attention in recent years as an
emerging combination of inflammatory biomarkers") and further  expanded (with references
to mitochondrial dysfunction, endothelial cell dysfunction and gut dysbiosis and impaired
immune cells function), since inflammation plays a central role in presence and development
of MASLD (ref: doi: 10.1016/j.jhep.2017.11.014;  doi: 10.1053/j.gastro.2018.06.083;  doi:
10.3390/cells11162511; doi: 10.1002/hep.30506).  Alternatively, this section could be added in
discussion section, where the authors discuss inflammation.
3. Since inflammation sems to be critical not only for the presence of steatosis but also for the
development of  steathepatitis,  the authors should see if there was a connection between CLR
and non-invasive biomarkers like FIB-4 or APRI scores
4.  The findings should be better explained in the discussion section for those not familiar with
statistics. Was 1.08 the threshold for the presence of MASLD? If so, what was the positive and
negative predicitive value?
assistant