Title: Potential Predictive Role of Non-HDL to HDL Cholesterol Ratio (NHHR) in MASLD:
Focus on Obese and Type 2 Diabetic Populations
Version: 1 Date: 27 Jan 2025
Reviewer:  Ze-Bin Fang
Reviewer's report:
This study makes a significant contribution to our understanding of metabolic dysfunction-
associated steatotic liver disease (MASLD) by identifying a strong and consistent association
between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol
ratio (NHHR) and MASLD, particularly in populations with obesity and type 2 diabetes (T2D).
The use of NHANES 2017-2018 data and the rigorous methodology employed, including
multivariable logistic regression and smooth curve fitting, enhances the reliability of the results.
The findings suggest that NHHR could serve as a valuable screening tool for MASLD in high-
risk groups, offering a simple, accessible method for early detection and intervention. This is
particularly important given the rising global prevalence of obesity and T2D, making early
diagnosis of MASLD critical for preventing its progression to more severe liver disease. I
commend the authors for their thorough analysis and the robustness of their findings. This
manuscript has the potential to significantly impact clinical practice by providing a new, cost-
effective tool for identifying at-risk individuals. However, further longitudinal studies would be
valuable to confirm the causality and explore the underlying mechanisms of the NHHR-MASLD
relationship.
Overall, I fully support the conclusions of this study and recognize its important contribution
to the field. I believe this research will pave the way for future investigations and clinical
applications in MASLD screening.
Title: Potential Predictive Role of Non-HDL to HDL Cholesterol Ratio (NHHR) in MASLD:
Focus on Obese and Type 2 Diabetic Populations
Version: 1 Date: 27 Jan 2025
Reviewer:  Ze-Bin Fang
Reviewer's report:
This study makes a significant contribution to our understanding of metabolic dysfunction-
associated steatotic liver disease (MASLD) by identifying a strong and consistent association
between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol
ratio (NHHR) and MASLD, particularly in populations with obesity and type 2 diabetes (T2D).
The use of NHANES 2017-2018 data and the rigorous methodology employed, including
multivariable logistic regression and smooth curve fitting, enhances the reliability of the results.
The findings suggest that NHHR could serve as a valuable screening tool for MASLD in high-
risk groups, offering a simple, accessible method for early detection and intervention. This is
particularly important given the rising global prevalence of obesity and T2D, making early
diagnosis of MASLD critical for preventing its progression to more severe liver disease. I
commend the authors for their thorough analysis and the robustness of their findings. This
manuscript has the potential to significantly impact clinical practice by providing a new, cost-
effective tool for identifying at-risk individuals. However, further longitudinal studies would be
valuable to confirm the causality and explore the underlying mechanisms of the NHHR-MASLD
relationship.
Overall, I fully support the conclusions of this study and recognize its important contribution
to the field. I believe this research will pave the way for future investigations and clinical
applications in MASLD screening.
Please review this paper.
user
Title: Potential Predictive Role of Non-HDL to HDL Cholesterol Ratio (NHHR) in MASLD:
Focus on Obese and Type 2 Diabetic Populations
Version: 1 Date: 27 Jan 2025
Reviewer:  Ze-Bin Fang
Reviewer's report:
This study makes a significant contribution to our understanding of metabolic dysfunction-
associated steatotic liver disease (MASLD) by identifying a strong and consistent association
between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol
ratio (NHHR) and MASLD, particularly in populations with obesity and type 2 diabetes (T2D).
The use of NHANES 2017-2018 data and the rigorous methodology employed, including
multivariable logistic regression and smooth curve fitting, enhances the reliability of the results.
The findings suggest that NHHR could serve as a valuable screening tool for MASLD in high-
risk groups, offering a simple, accessible method for early detection and intervention. This is
particularly important given the rising global prevalence of obesity and T2D, making early
diagnosis of MASLD critical for preventing its progression to more severe liver disease. I
commend the authors for their thorough analysis and the robustness of their findings. This
manuscript has the potential to significantly impact clinical practice by providing a new, cost-
effective tool for identifying at-risk individuals. However, further longitudinal studies would be
valuable to confirm the causality and explore the underlying mechanisms of the NHHR-MASLD
relationship.
Overall, I fully support the conclusions of this study and recognize its important contribution
to the field. I believe this research will pave the way for future investigations and clinical
applications in MASLD screening.
assistant