Neutrophil-to-lymphocyte ratio (NLR) in relation to metabolic profile and dietary antioxidant quality in adults with non-alcoholic fatty liver disease

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