Diagnostic Utility of Simple Inflammatory Markers for Metabolic Dysfunction-Associated Steatotic Liver Disease and...

Background: Obesity markedly increases the risk of metabolic syndrome (MetS) and metabolic dysfunction-associated steatotic liver disease (MASLD), both of which are characterized by persistent low-grade inflammation. This study aimed to evaluate the diagnostic utility of complete blood count-derived inflammatory markers, including neutrophil-percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), for MASLD and MetS in children with obesity. Methods: Children with obesity aged 7-18 years were prospectively enrolled and underwent anthropometric assessment, laboratory evaluation, and transient elastography with controlled attenuation parameter (CAP) measurement. Participants were classified into MASLD (CAP ≥ 250 dB/m) and non-MASLD groups. Children aged ≥10 years were additionally evaluated for MetS according to the International Diabetes Federation criteria. Logistic regression analyses assessed associations between inflammatory markers and MASLD or MetS, while receiver operating characteristic (ROC) analysis evaluated their diagnostic performance. Results: Children with MASLD had significantly higher NLR and lower LMR values than those without MASLD. Higher NLR (OR = 1.946, 95% CI: 1.092-3.467, p = 0.024) and lower LMR (OR = 0.722, 95% CI: 0.539-0.966, p = 0.028) were associated with MASLD, whereas NPAR and PLR were not. After adjustment for age, sex, body mass index and C-reactive protein, both NLR and LMR remained independently associated with MASLD. ROC analysis showed moderate diagnostic performance (AUC = 0.629 for NLR and 0.616 for LMR). None of the evaluated markers were associated with MetS. Conclusions: NLR and LMR were independently associated with MASLD in children with obesity and may represent complementary screening biomarkers for pediatric MASLD. However, given the cross-sectional design and moderate diagnostic performance observed in this study, prospective multicenter studies are needed to validate these findings before clinical implementation.