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: 01 Jul 2024
Reviewer's report:
The present study is a retrospective analysis of a large data set from a nationally conducted
survey in the US (as authors stated).
The large number of NAFLD patients (4602 patients) and its dependence on VCTE for
diagnosing NAFLD give this study a strong impact. However, few points should be addressed:
Study design:
- Kindly replace "materials and methods" with "Patients and methods".
- It was mentioned that the study is based on a US population surveys and that the data set is
from 2017 - 2020referred as ref. (25). however, this reference is since 2012. Kindly revise.
- Before doing VCTE or any other test for MAFLD, we need an abdominal ultrasound first.
Kindly correct this. Abdominal US is the first step in suspecting the presence of NAFLD.
- In the calculation of the ratio; kindly add that HDL was measured while fasting or not. Also,
what was the reference value of this ratio? and what was meant by the last sentence in this
section?
- In section 2.4 Covariates: If the ration is affected by all these variables it would not be an
accurate test for diagnosis. Also, this should had been stated in the introduction.
Results:
- What is meant by the abbreviation PIR?
- There is a repetition of an error sentence in many areas of the manuscript. Kindly explain and
correct this.
- Suddenly from section 3.2 there is a talk about "models"! there were not mention of these
models before. How were those formed and according to what?
-  Before interpreting these results; validation of this ratio in a normal healthy cohort should be
done. OR, inclusion of a control group without NAFLD. This is important because as stated in
the manuscript this ration can be affected by many other factors and conditions.
Discussion:
Discussion should explain how this ratio can help in the management of NAFLD, and how does
it differ from other scores and ratios present in the literature.
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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: 01 Jul 2024
Reviewer's report:
The present study is a retrospective analysis of a large data set from a nationally conducted
survey in the US (as authors stated).
The large number of NAFLD patients (4602 patients) and its dependence on VCTE for
diagnosing NAFLD give this study a strong impact. However, few points should be addressed:
Study design:
- Kindly replace "materials and methods" with "Patients and methods".
- It was mentioned that the study is based on a US population surveys and that the data set is
from 2017 - 2020referred as ref. (25). however, this reference is since 2012. Kindly revise.
- Before doing VCTE or any other test for MAFLD, we need an abdominal ultrasound first.
Kindly correct this. Abdominal US is the first step in suspecting the presence of NAFLD.
- In the calculation of the ratio; kindly add that HDL was measured while fasting or not. Also,
what was the reference value of this ratio? and what was meant by the last sentence in this
section?
- In section 2.4 Covariates: If the ration is affected by all these variables it would not be an
accurate test for diagnosis. Also, this should had been stated in the introduction.
Results:
- What is meant by the abbreviation PIR?
- There is a repetition of an error sentence in many areas of the manuscript. Kindly explain and
correct this.
- Suddenly from section 3.2 there is a talk about "models"! there were not mention of these
models before. How were those formed and according to what?
-  Before interpreting these results; validation of this ratio in a normal healthy cohort should be
done. OR, inclusion of a control group without NAFLD. This is important because as stated in
the manuscript this ration can be affected by many other factors and conditions.
Discussion:
Discussion should explain how this ratio can help in the management of NAFLD, and how does
it differ from other scores and ratios present in the literature.
---------------------------------------------------------------------
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: 01 Jul 2024
Reviewer's report:
The present study is a retrospective analysis of a large data set from a nationally conducted
survey in the US (as authors stated).
The large number of NAFLD patients (4602 patients) and its dependence on VCTE for
diagnosing NAFLD give this study a strong impact. However, few points should be addressed:
Study design:
- Kindly replace "materials and methods" with "Patients and methods".
- It was mentioned that the study is based on a US population surveys and that the data set is
from 2017 - 2020referred as ref. (25). however, this reference is since 2012. Kindly revise.
- Before doing VCTE or any other test for MAFLD, we need an abdominal ultrasound first.
Kindly correct this. Abdominal US is the first step in suspecting the presence of NAFLD.
- In the calculation of the ratio; kindly add that HDL was measured while fasting or not. Also,
what was the reference value of this ratio? and what was meant by the last sentence in this
section?
- In section 2.4 Covariates: If the ration is affected by all these variables it would not be an
accurate test for diagnosis. Also, this should had been stated in the introduction.
Results:
- What is meant by the abbreviation PIR?
- There is a repetition of an error sentence in many areas of the manuscript. Kindly explain and
correct this.
- Suddenly from section 3.2 there is a talk about "models"! there were not mention of these
models before. How were those formed and according to what?
-  Before interpreting these results; validation of this ratio in a normal healthy cohort should be
done. OR, inclusion of a control group without NAFLD. This is important because as stated in
the manuscript this ration can be affected by many other factors and conditions.
Discussion:
Discussion should explain how this ratio can help in the management of NAFLD, and how does
it differ from other scores and ratios present in the literature.
---------------------------------------------------------------------
assistant