Abstract / Summary
Abstract Non-alcoholic fatty liver disease (NAFLD) is a common metabolic condition characterized by hepatic steatosis and chronic low-grade inflammation, with oxidative stress playing a pivotal role in its progression. The neutrophil-to-lymphocyte ratio (NLR) has been proposed as an accessible marker reflecting systemic inflammatory status. This study aimed to examine the relationship between NLR, metabolic risk factors, body composition indices, and dietary antioxidant quality in adults with NAFLD. In this cross-sectional study, 257 adults with ultrasound-confirmed NAFLD were enrolled. Anthropometric parameters and body composition were measured using standardized procedures and bioelectrical impedance analysis. Fasting biochemical markers were assessed via enzymatic colorimetric methods. NLR was calculated from complete blood count data. Dietary intake was evaluated using a validated semi-quantitative food frequency questionnaire, and the Dietary Antioxidant Quality Score (DAQS) was derived based on the adequacy of vitamins A, C, and E, selenium, and zinc intake. Comparisons across NLR tertiles were performed using one-way analysis of variance, followed by Tukey’s post hoc test, and multivariable multinomial logistic regression was used to assess associations. Participants in the highest NLR tertile had significantly higher FBS (93.33 ± 11.03 vs. 88.40 ± 9.65 mg/dL), TC (191.81 ± 38.78 vs. 169.58 ± 32.62 mg/dL), and LDL-cholesterol levels (115.26 ± 33.63 vs. 99.11 ± 28.57 mg/dL) compared with those in the lowest tertile (all P < 0.05). Higher NLR levels were significantly associated with lower DAQS values and reduced intake of antioxidant vitamins A and C (p < 0.05). In stratified multinomial logistic regression analyses by physical activity, higher NLR was associated with increased FBS in the low activity group (Third tertile: OR: 1.07, 95% CI: 1.03–1.13, P = 0.003) and with higher TC in the high activity group (second tertile: OR: 1.02, 95% CI: 1.00–1.04, P = 0.05; third tertile: OR:1.02, 95% CI: 1.005–1.04, P = 0.016). Elevated NLR is associated with an unfavorable metabolic profile and poorer dietary antioxidant quality among individuals with NAFLD. These findings support the potential role of NLR as a practical inflammatory marker linked to metabolic risk and highlight the relevance of antioxidant-rich dietary patterns in mitigating inflammation in NAFLD.