Title: Association between neutrophil-to-high-density lipoprotein cholesterol ratio and
metabolic dysfunction-associated steatotic liver disease and liver fibrosis in the US population:
a nationally representative cross-sectional study using NHANES data from 2017 to 2020
Version: 1 Date: 26 Jun 2024
Reviewer:  Mona Hegazy
Reviewer's report:
1. All the authors in Guangxi University China, and presenting data from NHANES!!!
2. Now its MASLD no  more NAFLD
3. In exclusion; (male average daily drinking > 20g, female average daily drinking > 10g) as
you define, but the MASLD” NAFLD” less than 20gm in women and 30 in men, and between
20-50nin women and 30-60 in men is MetALD, so now with new guidelines must respect those
4. VCTE examination must mentioned using which machine, and the classification built in about
Cap and kpa reading (S0-S3 &F0-F4) not like you mention ( A quick, non-invasive test called
VCTE has proven to be useful in determining the extent of liver steatosis and fibrosis[29]. In the
case of VCTE detection, fibrosis is defined as liver stiffness measurement (LSM) of 8.0 kPa or
above, and steatosis is determined by controlled attenuation parameter (CAP), where a steatosis
threshold is CAP > 274 dB/m [30, 31]) fibrosis considered significant if equal or above 8, but
from 5.8-7.9 had fibrosis but non-significant, some VCTE machine consider above 218 presence
of steatosis, and 274 is S2 not only from274, by this you excluded a lot of MASLD participants
5. I think with the significant role of diabetes and prediabetes on NHR, and the high percentage
of their presence you can’t grantee the pure MASLD role in NHR results
Title: Association between neutrophil-to-high-density lipoprotein cholesterol ratio and
metabolic dysfunction-associated steatotic liver disease and liver fibrosis in the US population:
a nationally representative cross-sectional study using NHANES data from 2017 to 2020
Version: 1 Date: 26 Jun 2024
Reviewer:  Mona Hegazy
Reviewer's report:
1. All the authors in Guangxi University China, and presenting data from NHANES!!!
2. Now its MASLD no  more NAFLD
3. In exclusion; (male average daily drinking > 20g, female average daily drinking > 10g) as
you define, but the MASLD” NAFLD” less than 20gm in women and 30 in men, and between
20-50nin women and 30-60 in men is MetALD, so now with new guidelines must respect those
4. VCTE examination must mentioned using which machine, and the classification built in about
Cap and kpa reading (S0-S3 &F0-F4) not like you mention ( A quick, non-invasive test called
VCTE has proven to be useful in determining the extent of liver steatosis and fibrosis[29]. In the
case of VCTE detection, fibrosis is defined as liver stiffness measurement (LSM) of 8.0 kPa or
above, and steatosis is determined by controlled attenuation parameter (CAP), where a steatosis
threshold is CAP > 274 dB/m [30, 31]) fibrosis considered significant if equal or above 8, but
from 5.8-7.9 had fibrosis but non-significant, some VCTE machine consider above 218 presence
of steatosis, and 274 is S2 not only from274, by this you excluded a lot of MASLD participants
5. I think with the significant role of diabetes and prediabetes on NHR, and the high percentage
of their presence you can’t grantee the pure MASLD role in NHR results
Please review this paper.
user
Title: Association between neutrophil-to-high-density lipoprotein cholesterol ratio and
metabolic dysfunction-associated steatotic liver disease and liver fibrosis in the US population:
a nationally representative cross-sectional study using NHANES data from 2017 to 2020
Version: 1 Date: 26 Jun 2024
Reviewer:  Mona Hegazy
Reviewer's report:
1. All the authors in Guangxi University China, and presenting data from NHANES!!!
2. Now its MASLD no  more NAFLD
3. In exclusion; (male average daily drinking > 20g, female average daily drinking > 10g) as
you define, but the MASLD” NAFLD” less than 20gm in women and 30 in men, and between
20-50nin women and 30-60 in men is MetALD, so now with new guidelines must respect those
4. VCTE examination must mentioned using which machine, and the classification built in about
Cap and kpa reading (S0-S3 &F0-F4) not like you mention ( A quick, non-invasive test called
VCTE has proven to be useful in determining the extent of liver steatosis and fibrosis[29]. In the
case of VCTE detection, fibrosis is defined as liver stiffness measurement (LSM) of 8.0 kPa or
above, and steatosis is determined by controlled attenuation parameter (CAP), where a steatosis
threshold is CAP > 274 dB/m [30, 31]) fibrosis considered significant if equal or above 8, but
from 5.8-7.9 had fibrosis but non-significant, some VCTE machine consider above 218 presence
of steatosis, and 274 is S2 not only from274, by this you excluded a lot of MASLD participants
5. I think with the significant role of diabetes and prediabetes on NHR, and the high percentage
of their presence you can’t grantee the pure MASLD role in NHR results
assistant