Search Results (3,455)

Metabolic syndrome came to the attention of the scientific community several decades ago, and its definition has undergone multiple changes over time. It is currently defined by the coexistence of hypertension, central obesity, dyslipidemia, and impaired glucose metabolism, with insulin resistance, chronic inflammation, and oxidative stress representing important underlying pathophysiological mechanisms. The latter two processes are major promoters of the onset and progression of atherosclerosis. In parallel, many individuals develop metabolic dysfunction-associated steatotic liver disease (MASLD), formerly called non-alcoholic fatty liver disease (NAFLD). Growing evidence indicates that MASLD may interact bidirectionally with cardiovascular, renal, and metabolic dysfunction and may contribute to cardiometabolic risk. These observations have prompted proposals for a broader cardio–reno–hepato–metabolic axis. However, MASLD is not currently included in the established cardiovascular-kidney-metabolic (CKM) definition or staging system, and its incorporation remains an evolving conceptual extension. Prediabetes is a reversible condition characterized by abnormal glucose levels that do not meet the diagnostic criteria for diabetes. The American Diabetes Association defines prediabetes as glycated hemoglobin (HbA1c) = 5.7–6.4%, fasting plasma glucose = 100–125 mg/dL, or two-hour plasma glucose during an oral glucose tolerance test = 140–199 mg/dL. This comprehensive review examines traditional and genetic risk determinants, shared pathophysiological mechanisms, diagnostic strategies, clinical manifestations, emerging phenotypes, circulating microRNAs as non-invasive biomarkers, complications, and the principal therapeutic strategies, including diet, exercise, and pharmacotherapy. Particular attention is given to the recent approvals of resmetirom and semaglutide for metabolic dysfunction-associated steatohepatitis and to the expanding roles of sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists and non-steroidal mineralocorticoid receptor antagonists. Cardiovascular, renal, metabolic, and hepatic disorders are frequently present in the same patient. Other individuals may develop this high-risk cluster over time. The aim of this article is to define the interplay between different metabolic conditions and to outline the best approach to diagnosis, monitoring, and effective integrated therapy. Full article

Background: Non-alcoholic fatty liver disease (NAFLD), now largely encompassed by the metabolic dysfunction-associated steatotic liver disease (MASLD) framework, is a leading cause of chronic liver disease worldwide and is closely linked to obesity, insulin resistance, type 2 diabetes (T2D), and cardiometabolic dysfunction. Although hepatic lipid accumulation and metabolic injury remain central to its pathogenesis, increasing evidence implicates the intestinal microbiota as a modulator of disease onset and progression through the gut–liver axis. Objectives: This narrative review summarizes current evidence linking gut microbiota to NAFLD/MASLD, with emphasis on functional microbial alterations relevant to the gut–liver axis, disease severity, microbiota-related biomarkers, and microbiota-targeted interventions. Methods: The literature search for this narrative review was mainly performed using PubMed/MEDLINE (which produced 200 results since 2023). The search addressed the relationship between gut microbiota, NAFLD/MASLD, and gut–liver axis dysfunction. Results: Early studies mainly focused on disease-associated bacterial taxa; however, no consistent microbial signature has been reproduced across populations, disease stages, and methodological platforms. This limitation supports a shift from a taxonomic view of dysbiosis toward a functional interpretation. Different microbial communities may converge on shared pathogenic outputs, including impaired epithelial barrier integrity, microbial translocation, lipopolysaccharide-driven Toll-like receptor 4 activation, bile acid remodelling, altered short-chain fatty acid production, endogenous ethanol generation, choline and trimethylamine-N-oxide metabolism, and tryptophan-derived indole signalling. These mechanisms may influence hepatic steatosis, inflammatory activation, and fibrogenesis. Conclusions: Current data support the microbiota as a biologically plausible disease modifier, but not yet as a standalone diagnostic or therapeutic target; clinical translation will require longitudinal, multi-omics, and function-oriented studies. Full article

Background: Non-alcoholic fatty liver disease (NAFLD), which is recognized under the updated nomenclature as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), is increasingly prevalent in the United States and worldwide. Emerging evidence links NAFLD to an elevated risk of atrial fibrillation (AF), yet data regarding the impact of NAFLD on inpatient outcomes among patients admitted for AF remain limited. Methods: The National Inpatient Sample (NIS) from 2016 to 2019 was used to identify adult patients with a primary discharge diagnosis of AF (ICD-10: I48.x). Patients with concurrent NAFLD were compared to those without. Multivariable linear and logistic regression analyses were performed, adjusting for age, sex, race, insurance status, and Charlson Comorbidity Index. The primary outcome was inpatient all-cause mortality. Secondary outcomes included length of stay, inflation-adjusted hospital costs, discharge disposition, and in-hospital complications. Results: Of 1,891,479 weighted AF admissions, 13,840 carried a concurrent NAFLD diagnosis. Concurrent NAFLD was associated with longer length of stay (3.99 vs. 3.35 days, p < 0.001) (which is statistically significant though might be clinically insignificant) and higher hospital costs ($13,841.65 vs. $12,154.55, p = 0.046). No significant difference in inpatient mortality was observed. Conclusions: Concurrent NAFLD among AF hospitalizations is associated with greater resource utilization without a significant mortality difference, highlighting the importance of addressing this comorbidity to reduce the economic burden of AF-related hospitalizations. Full article

Medicinal plants of the genus Atractylodes, primarily including Atractylodes lancea (Thunb.) DC., Atractylodes chinensis (DC.) Koidz., and Atractylodes macrocephala Koidz., are important traditional Chinese medicinal herbs that are widely recognized for their functions of “strengthening the spleen and drying dampness” and have traditionally been used to treat digestive and metabolic disorders. In recent years, with the increasing global burden of liver diseases, Atractylodes species have attracted growing attention for their potential pharmacological value in liver disease management due to their abundant bioactive compounds and diverse pharmacological activities. This review summarizes reported biological and hepatoprotective effects and proposed mechanisms of Atractylodes medicinal plants and their bioactive compounds in liver-related experimental models, including models relevant to MASLD, ALD, hepatic fibrosis, and HCC. Preclinical studies have reported changes in lipid metabolism, oxidative-stress-related markers, inflammatory responses, fibrotic indices, and tumor-cell phenotypes, accompanied by modulation of signaling pathways including AMPK/SIRT1, PPAR, Nrf2/HO-1, TLR4/MyD88/NF-κB, NLRP3, and TGF-β1/Smad. However, much of the mechanistic evidence is based on pathway-associated changes rather than direct compound–target validation, and clinical evidence remains limited. Overall, the available findings provide a preclinical pharmacological rationale for further investigation of Atractylodes-derived compounds in liver diseases, while their clinical efficacy and therapeutic roles remain to be established. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), has become one of the most common chronic liver diseases worldwide, representing a major global health challenge closely linked to metabolic syndrome, obesity, and type 2 diabetes mellitus (TD2M). The condition is characterized by a multisystem nature driven by complex multifactorial mechanisms, including insulin resistance, lipotoxicity, mitochondrial dysfunction, genetic predispositions, and gut-liver axis alterations. Although liver biopsy remains the gold standard, non-invasive markers and advanced imaging methods are of key importance for early risk stratification. Furthermore, while liver-related complications such as fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) are significant, cardiovascular disease remains the leading cause of mortality in patients with MASLD. Current management relies primarily on lifestyle modifications, targeted pharmacotherapy (such as pioglitazone, GLP-1 receptor agonists, SGLT-2 inhibitors), and novel experimental therapies. Consequently, MASLD requires a multidisciplinary approach emphasizing early diagnosis, risk stratification, and comprehensive treatment of both hepatic and extrahepatic manifestations. Full article

Background/Objectives: Polycystic ovary syndrome (PCOS) is closely associated with insulin resistance, metabolic syndrome (MetS), and non-alcoholic fatty liver disease (NAFLD); however, whether fatty pancreas disorder is also more common in PCOS remains insufficiently clarified. This study aimed to compare the frequency of hepatic and fatty pancreas disorder and tissue stiffness between women with PCOS and a healthy control group and to determine the relationship of these findings with metabolic and biochemical parameters. Methods: In this retrospective case–control study, 40 women diagnosed with PCOS according to the 2003 Rotterdam criteria and 40 age- and body mass index (BMI)-matched healthy women were evaluated by abdominal ultrasonography and two-dimensional shear wave elastography (2D-SWE) of the liver and pancreas. Four validated non-invasive indices of hepatic steatosis (NAFLD liver fat score, lipid accumulation product [LAP], hepatic steatosis index [HSI], FIB-4, APRI) were calculated and correlated with clinical, anthropometric, and biochemical data. MetS was defined according to International Diabetes Federation (IDF) criteria. Results: Fatty pancreas disorder was detected in 47.5% of PCOS patients versus 17.5% of controls (p = 0.008); hepatic steatosis was found in 37.5% and 15%, respectively (p = 0.04); these differences were observed despite similar age and BMI between groups. LAP and HSI scores were higher in the PCOS group (p = 0.02 and p = 0.005, respectively), as were serum triglyceride and total testosterone levels (p = 0.001 and p = 0.005, respectively). Overall MetS frequency did not differ between the PCOS and control groups (p = 0.61) but was significantly higher among participants with fatty pancreas disorder (p = 0.009) and hepatic steatosis (p = 0.05). Hepatic and pancreatic 2D-SWE values were significantly higher in participants with steatosis than in those without (p = 0.02 and p = 0.04, respectively), and both correlated positively with BMI (p < 0.001 and p = 0.003, respectively). Conclusions: The frequency of fatty pancreas disorder and hepatic steatosis is increased in women with PCOS independent of obesity, and both are associated with a higher frequency of MetS; the association between fatty pancreas disorder and PCOS remained significant in a multivariable analysis adjusted for BMI. Fatty pancreas disorder showed a stronger association with MetS, suggesting that it may serve as an early, low-cost, ultrasound-detectable marker of metabolic risk in PCOS and warrants systematic evaluation alongside hepatic steatosis. Full article

Non-alcoholic fatty liver disease (NAFLD) affects one-quarter of the global population. The disease may progress from simple steatosis to non-alcoholic steatohepatitis (NASH), fibrosis, and hepatocellular carcinoma. Unfortunately, lifestyle interventions and pharmacotherapies provide limited benefits to NAFLD patients. This systematic review which was conducted according to PRISMA 2020 guidelines, study selection, and data extraction, evaluated preclinical studies published between 1 January 2021 and 4 April 2026 that investigated liposome-based nanocarriers for NAFLD/NASH. Out of 477 records identified, 19 studies met the eligibility criteria and were included in the review. The included studies demonstrated that liposomal formulations prepared using thin-film hydration exhibited characteristics such as particle sizes of 80–160 nm, low polydispersity, zeta potentials of −55 to +35 mV (depending on surface modification), encapsulation efficiencies exceeding 75%, and sustained biphasic release profiles. Mechanistically, these nanocarriers targeted pathways by suppressing de novo lipogenesis through inhibition of FASN and SREBP-1c, enhancement of fatty acid oxidation through activation of AMPK signaling, mitigation of oxidative stress through Nrf2-mediated antioxidant responses, suppression of inflammation via NF-κB and TLR4 signaling, and attenuation of hepatic fibrosis via inhibition of the TGF-β/Smad pathway. Selected formulations also achieved adipose tissue targeting, thereby highlighting their potential to modulate liver–adipose tissue metabolic crosstalk. Despite these promising preclinical findings, clinical translation remains limited by methodological heterogeneity, inconsistent stability assessment, insufficient safety data, absence of clinical trials, biological barriers such as rapid mononuclear phagocyte system clearance, protein corona formation, and restricted penetration through the fibrotic extracellular matrix. Moreover, there are challenges in large-scale manufacturing and batch-to-batch reproducibility. Thus, rigorous toxicological evaluation and well-designed clinical trials are essential for facilitating the clinical translation of liposomal nanomedicines for treatment of liver diseases. Full article

Autophagy plays a central role in cellular homeostasis and metabolic adaptation, and its dysregulation has been implicated in metabolic disorders, including non-alcoholic fatty liver disease (NAFLD). This study investigated the biological effects of a chemically characterised multi-component nutraceutical formulation using an integrated in vitro gut–liver–muscle axis model under lipotoxic and inflammatory conditions induced by free fatty acids (FFAs) and lipopolysaccharide (LPS). The principal bioactive constituents were quantified in both the individual extracts and the final formulation before biological testing. Caco-2, HepG2, and C2C12 cells were sequentially exposed to conditioned media to reproduce inter-organ metabolic interactions. The Supplement preserved intestinal barrier integrity by maintaining transepithelial electrical resistance and tight junction protein expression. In HepG2 cells, it preserved telomerase levels, improved markers of cellular metabolic adaptation, modulated AMPK/mTOR and SIRT1 signalling, and promoted autophagy-related responses, including increased LC3-II/I ratio, reduced p62 accumulation, and preservation of lysosomal markers. In skeletal muscle cells, exposure to conditioned medium derived from formulation-treated compartments was associated with improved cellular bioenergetics, reduced oxidative stress and inflammatory mediators, and enhanced ATP and glycogen levels under exercise-like conditions. Overall, these findings provide preliminary evidence that the chemically characterised formulation modulates interconnected pathways involved in intestinal barrier function, hepatic autophagy-related processes, and skeletal muscle metabolic adaptation under the experimental conditions employed. Full article

Background/Objectives: Chronic liver diseases (CLDs), including viral hepatitis, alcohol-related liver disease, non-alcoholic fatty liver disease, hepatic fibrosis, and hepatocellular carcinoma, account for approximately two million deaths annually and remain a global health challenge. Although phytochemicals exhibit antioxidant, anti-inflammatory, antifibrotic, and metabolic regulatory activities through modulation of Nrf2/Keap1, NF-κB/MAPK, TGF-β/Smad, and lipid metabolism pathways, their therapeutic translation is hindered by poor aqueous solubility, extensive first-pass metabolism, and low oral bioavailability. This review evaluates the potential of liposomal delivery systems to overcome these limitations and improve hepatic drug targeting. Methods: A structured narrative review was conducted using systematic literature search principles. PubMed/MEDLINE, Scopus, and Web of Science databases were searched for studies published between January 2000 and March 2025. Original research articles evaluating liposomal formulations of hepatoprotective phytochemicals were assessed with emphasis on formulation strategies, pharmacokinetics, therapeutic efficacy, targeting approaches, and translational potential. Results: Liposomal encapsulation frequently improved systemic exposure and, in several preclinical studies, increased oral bioavailability relative to free phytochemicals, although the magnitude of improvement varied substantially according to the compound, formulation, route of administration, and experimental model. Liposomal encapsulation also improved formulation stability and enabled controlled release in several studies. Surface engineering using polyethylene glycol and receptor-specific ligands, including galactose, lactobionic acid, glycyrrhetinic acid, and vitamin A, further improved circulation time and cell-specific hepatic delivery. Emerging technologies such as microfluidic manufacturing, biomimetic liposomes, and multifunctional formulations show promise for improving formulation reproducibility and therapeutic performance, although clinical evidence remains limited. Conclusions: Liposomal delivery represents a promising strategy for enhancing the pharmacokinetic performance and therapeutic efficacy of hepatoprotective phytochemicals. However, additional well-designed clinical studies, scalable manufacturing approaches, and regulatory standardization are required to facilitate successful clinical translation. Full article

With the advent of the new definition, fatty liver disorders have been reframed into metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-related liver disease (ALD), and the mixed phenotype referred to as MetALD (MASLD and increased alcohol intake). This change reflects the real-world clinical practice, where metabolic dysfunction and alcohol frequently coexist and synergize to increase risks of steatohepatitis, fibrosis, and hepatocellular carcinoma (HCC). While conventional non-invasive tests (NITs) remain the backbone of risk stratification, lipidomics and metabolomics can capture biological information on disease mechanisms and may improve early detection and prognosis. Here, we summarize the current evidence on circulating and tissue lipidomic and metabolomic signatures across MASLD, ALD and MetALD, discuss how the new definitions affect clinical risk assessment, and highlight recent studies which partially distinguish molecular fingerprints for mixed etiology disease. Full article

Non-alcoholic fatty liver disease (NAFLD) is a prevalent metabolic disorder that can progress to non-alcoholic steatohepatitis (NASH), in which lipotoxicity, oxidative stress, apoptosis, and impaired autophagy contribute to liver injury. 14-Deoxy-11,12-didehydroandrographolide (deAND), a bioactive diterpenoid from Andrographis paniculata, has shown anti-inflammatory and antioxidant activities, but its role in NASH-associated lipotoxicity remains unclear. This study investigated the protective effects and underlying mechanisms of deAND using palmitic acid (PA)-treated AML12 hepatocytes and a choline-deficient, L-amino acid-defined, high-fat-diet (CDAHFD)-induced mouse model of NASH. In AML12 cells, PA impaired autophagic flux and reduced the expression of the mitophagy-associated proteins PINK1 and Parkin and increased p62, LC3-II, reactive oxygen species production, and apoptotic signaling. deAND treatment restored autophagic flux and increased PINK1 and Parkin expression, enhanced antioxidant defense-related proteins, including HO-1, GCLM, and GPX2, and reduced oxidative stress and apoptosis. The protective effects of deAND were attenuated by autophagy inhibitors, supporting the involvement of autophagy regulation. In CDAHFD-fed mice, deAND reduced hepatic steatosis, inflammation, fibrosis, apoptosis, and autophagy dysregulation. These findings suggest that deAND alleviates lipotoxic liver injury by restoring autophagic homeostasis and reducing oxidative stress. Full article

Background: Hyperlipidemia is a major risk factor for cardiometabolic disorders, including non-alcoholic fatty liver disease (NAFLD), and is closely associated with oxidative stress. Opuntia ficus-indica (OFI) cladodes are recognized as a rich source of bioactive phytochemicals; however, the molecular mechanisms underlying their metabolic benefits remain incompletely understood. Objectives: This study aimed to comprehensively evaluate the hypolipidemic and hepatoprotective potential of a polyphenol-rich O. ficus-indica cladode extract (OCE) using an integrated approach combining in vivo evaluation, untargeted metabolomics (UHPLC-Orbitrap-MS/MS), molecular docking, and ADMET prediction. Methods: Hyperlipidemic mice fed a high-fat diet (HFD) were treated with OCE, while molecular docking was performed on ten major annotated phytochemicals against twelve key proteins involved in lipid metabolism and cholesterol homeostasis, including HMGCR, FAS, PPARα, PCSK9, and NPC1L1, using simvastatin as the reference compound. Results: OCE treatment significantly improved plasma and hepatic lipid profiles, improved glucose homeostasis, and markedly reduced hepatic malondialdehyde (MDA) levels, indicating attenuation of oxidative stress. Histopathological analysis further supported a pronounced hepatoprotective effect, with a substantial reduction in hepatic steatosis. Untargeted metabolomics enabled the annotation of 102 metabolites, putatively identifying piscidic acid as the predominant phenolic constituent together with a diverse profile of flavonoids and phenolic acids. Molecular docking supported the potential contribution of these phytochemicals to the regulation of lipid metabolism through favorable interactions with multiple therapeutic targets, while ADMET prediction suggested an overall favorable pharmacokinetic and toxicity profile despite the lower intestinal permeability predicted for glycosylated derivatives. Conclusions: Overall, these findings support O. ficus-indica cladodes as a promising source of dietary bioactive compounds with potential applications in the nutritional management and prevention of hyperlipidemia and related cardiometabolic disorders. Full article

Metabolic dysfunction-associated steatohepatitis (MASH) is the progressive inflammatory and fibrotic subtype of metabolic dysfunction-associated steatotic liver disease (MASLD), and its treatment landscape is rapidly moving from nonspecific liver fat reduction towards mechanism-based drug positioning. Since 2024, resmetirom and semaglutide have received U.S. Food and Drug Administration accelerated approval for non-cirrhotic MASH with moderate-to-advanced fibrosis, while tirzepatide, survodutide, and fibroblast growth factor 21 analogues have shown biopsy-based phase 2 or 2b efficacy signals. This narrative review organises approved and emerging pharmacotherapies within a pathogenesis-informed three-axis framework: the weight-insulin resistance-substrate load axis, the intrahepatic lipid reprogramming axis, and the inflammation-fibrosis transition and multi-axis integration axis. We further grade evidence maturity from regulatory or phase 3 histological evidence to phase 2 biopsy-based evidence and earlier imaging- or biomarker-based signals. This framework is intended to support phenotype-sensitive treatment positioning rather than a fixed therapeutic sequence. In particular, weight-centred treatment should not be assumed to apply to all patients, including normal-weight or lean MASH. Overall, future MASH therapy will likely depend on matching drug mechanisms, fibrosis stage, cardiometabolic phenotype, and treatment goals. Full article

Background/Objectives: Lifestyle modification is central to non-alcoholic fatty liver disease, now termed metabolic dysfunction-associated steatotic liver disease (NAFLD/MASLD), yet comparable health-promoting lifestyle (HPL) data for patients and family members are limited. This study compared two independent samples and examined psychosocial correlates. Methods: Two convenience samples recruited at one tertiary hospital were analyzed: 305 adults with NAFLD/MASLD and 299 adult family members of affected patients. A self-administered electronic questionnaire comprised the Health-Promoting Lifestyle Profile II (HPLP-II), the Self-Rated Abilities for Health Practices scale, autonomous-motivation items from the Treatment Self-Regulation Questionnaire, the Medical Outcomes Study Social Support Survey, and sociodemographic items. Group comparisons used parametric and non-parametric tests. HPL correlates were examined using complete-case regression, HC3 inference, and rank-based sensitivity analysis. Cross-sectional indirect-association decompositions used 5000 bootstrap resamples. Results: HPLP-II scores were 102.2 ± 17.5 in patients and 104.2 ± 17.4 in family members (p = 0.171; Mann–Whitney p = 0.166); the adjusted patient-minus-family difference was −1.14 (HC3 95% CI −3.89 to 1.60; p = 0.413). Physical activity was the lowest-scoring dimension. Self-efficacy was the most robust correlate in both samples; social support was associated in the primary models but weakened under rank transformation in family members. Group-by-correlate interactions were not significant. Exploratory indirect associations through self-efficacy were 0.355 (95% bootstrap CI 0.234–0.512) in patients and 0.163 (0.071–0.287) in family members; reverse-order models were also non-zero. Conclusions: The independent unmatched samples reported similar moderate, physically inactive lifestyles. The results identify associations, not shared-household effects or causal mechanisms; objectively characterized, dyad-matched longitudinal studies are needed. Full article

Background and aims. Nonalcoholic fatty liver disease (NAFLD) is a prevalent chronic liver disease associated with cirrhosis, hepatocellular carcinoma, and increased risks of liver-related and cardiovascular mortality. Many patients, however, remain asymptomatic until advanced stages. The gamma-glutamyl transferase to high-density lipoprotein cholesterol (GGT/HDL-C) ratio is a simple, noninvasive marker reflecting hepatic dysfunction and cardiometabolic imbalance. This study assessed its association with NAFLD and determined an optimal cutoff for identifying NAFLD. Methods. We conducted a cross-sectional analysis of 575 adults undergoing routine health examinations at the University of Medicine and Pharmacy Hospital in Ho Chi Minh City between 2021 and 2023. Participants with significant alcohol intake, viral hepatitis, or other chronic liver diseases were excluded. NAFLD was diagnosed by standardized abdominal ultrasonography based on increased hepatic echogenicity relative to the renal cortex or spleen. Associations between GGT/HDL-C and NAFLD were assessed by logistic regression (both as a continuous variable and by quartiles), and diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. Statistical significance was defined as a two-tailed p-value < 0.05. Results. Individuals with NAFLD showed significantly higher BMI, prevalence of hypertension and diabetes, and elevated glucose, HbA1c, AST, ALT, GGT, cholesterol, triglycerides, and LDL-C, along with lower HDL-C. Each unit increase in the GGT/HDL-C ratio was associated with a 2% increase in the odds of NAFLD based on univariate logistic regression analysis. However, after adjustment for demographic and metabolic covariates, the GGT/HDL-C ratio was no longer independently associated with NAFLD. The highest quartile had an odds ratio of 7.05 (95% CI: 4.2–11.83) compared to the lowest. The area under the ROC curve for GGT/HDL-C was 0.72, outperforming GGT or HDL-C alone. A cutoff of 32.47 UI/mmol had 72.4% sensitivity and 63.3% specificity. Conclusions. The GGT/HDL-C ratio showed a significant unadjusted association with NAFLD and moderate discriminatory performance. However, because the association was no longer significant after full adjustment, the ratio should currently be considered a simple laboratory-based screening marker that requires further validation before routine clinical application. Full article