{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:45:13Z","timestamp":1791963913099,"version":"4.3.4"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":285,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82400772"],"award-info":[{"award-number":["82400772"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005230","name":"Natural Science Foundation of Chongqing Municipality","doi-asserted-by":"publisher","award":["CSTB2024NSCQ-MSX0808"],"award-info":[{"award-number":["CSTB2024NSCQ-MSX0808"]}],"id":[{"id":"10.13039\/501100005230","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Endocrinology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Metabolic dysfunction\u2010associated steatotic liver disease (MASLD) is a chronic liver disease that is not related to alcohol and is characterized by excessive accumulation of fat within liver cells. As one of the most common chronic liver diseases worldwide, MASLD affects about a quarter of the world\u2019s population and is expected to become a leading indication for liver transplantation by 2030. The disease not only increases the risk of cirrhosis and hepatocellular carcinoma, but also is closely associated with a variety of extra\u2010hepatic complications such as type 2 diabetes and cardiovascular disease. Although many biomarkers such as N\u2010terminal type III collagen propeptide (PRO\u2010C3), enhanced liver fibrosis (ELF), and Fibrosis\u20104 Score (FIB\u20104) have been used to identify and predict MASLD and metabolic dysfunction\u2010associated steatohepatitis (MASH), their clinical utility remains limited. Recent studies have shown that neutrophils and platelets play a crucial role in the progression of MASLD. The platelet\u2010to\u2010neutrophil ratio (PNR), a novel biomarker, has shown predictive value in ovarian cancer and myocardial infarction. However, PNR has not been fully studied in MASLD. The aim of this study was to investigate the association between PNR and MASLD and to explore its relationship with hepatic steatosis and fibrosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This cross\u2010sectional study included participants from the National Health and Nutrition Examination Survey (NHANES) 2017\u2013March 2020 pre\u2010pandemic dataset. Hepatic steatosis was defined as a controlled attenuation parameter (CAP)\u2009\u2265\u2009274\u2009dB\/m, and MASLD was defined as hepatic steatosis plus at least one cardiometabolic criterion according to the 2023 multisociety steatotic liver disease (SLD) nomenclature. Advanced liver fibrosis was defined as a liver stiffness measurement (LSM)\u2009\u2265\u20098.2\u2009kPa. PNR was calculated as the platelet count divided by the neutrophil count and log2\u2010transformed (log2\u2010PNR). Missing covariates were handled by multiple imputation (\n                      <jats:italic>m<\/jats:italic>\n                      \u2009=\u200920). Survey\u2010weighted logistic regression, natural\u2010spline smoothing, threshold effect analysis, and subgroup analyses were used to evaluate the association between log2\u2010PNR and MASLD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 3437 adults aged 18\u2009years and older were included (mean age 47.5\u2009\u00b1\u200917.5\u2009years; 48.1% male). In the fully adjusted model, higher log2\u2010PNR was inversely associated with MASLD (OR 0.75 per doubling of PNR, 95% CI 0.63\u20130.90), and with hepatic steatosis; participants in the highest PNR quartile had lower odds of MASLD than those in the lowest quartile. Threshold effect analysis identified a breakpoint at PNR approximately 38 for MASLD, with a significant nonlinear pattern. Higher log2\u2010PNR was also inversely associated with advanced fibrosis (OR 0.43, 95% CI 0.33\u20130.57), with no significant nonlinearity. Subgroup analyses showed that the inverse association was more pronounced in males and non\u2010Hispanic White participants for MASLD (P for interaction\u2009=\u20090.009 and 0.037, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher log2\u2010PNR was inversely associated with the cross\u2010sectional presence of MASLD and hepatic steatosis, and with advanced liver fibrosis, in U.S. adults. Log2\u2010PNR, an easily obtained inflammatory marker, is independently associated with MASLD. These findings require validation in prospective cohort studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/ije\/5591067","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:51:48Z","timestamp":1791960708000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of the Platelet\u2010to\u2010Neutrophil Ratio With Metabolic Dysfunction\u2010Associated Steatotic Liver Disease and Liver Fibrosis in U.S. Adults: NHANES 2017\u2013March 2020"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7050-0758","authenticated-orcid":false,"given":"Yuguan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary Surgery the First Affiliated Hospital of Chongqing Medical University  400016 Chongqing China  cqmu.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9520-6090","authenticated-orcid":false,"given":"Huaibin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Hematology the Second Affiliated Hospital of Chongqing Medical University  Chongqing 401336 China  cqmu.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6118-0708","authenticated-orcid":false,"given":"Shanshan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery the First Affiliated Hospital of Chongqing Medical University  400016 Chongqing China  cqmu.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8022-982X","authenticated-orcid":false,"given":"Baoyong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery Bishan Hospital of Chongqing Medical University  Chongqing 402760 China  cqmu.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1627-0633","authenticated-orcid":false,"given":"Zhongjun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery the First Affiliated Hospital of Chongqing Medical University  400016 Chongqing China  cqmu.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4627-7027","authenticated-orcid":false,"given":"Hang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Anorectal Surgery Chongqing Traditional Chinese Medicine Hospital  Chongqing 400021 China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"e_1_2_14_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-1253(22)00317-x"},{"key":"e_1_2_14_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.02.033"},{"key":"e_1_2_14_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)32511-3"},{"key":"e_1_2_14_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.12.012"},{"key":"e_1_2_14_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-021-00448-y"},{"key":"e_1_2_14_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/0148607112467820"},{"key":"e_1_2_14_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/atv.0000000000000153"},{"key":"e_1_2_14_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-021-00639-3"},{"key":"e_1_2_14_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41423-021-00832-3"},{"key":"e_1_2_14_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-022-03134-z"},{"key":"e_1_2_14_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2021.07.036"},{"key":"e_1_2_14_12_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1177403"},{"key":"e_1_2_14_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-025-03859-w"},{"key":"e_1_2_14_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.06.012"},{"key":"e_1_2_14_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2008.07.035"},{"key":"e_1_2_14_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31658"},{"key":"e_1_2_14_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.11.004"},{"key":"e_1_2_14_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31995"},{"key":"e_1_2_14_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.122.060911"},{"key":"e_1_2_14_20_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1514093"},{"key":"e_1_2_14_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.06.003"},{"key":"e_1_2_14_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12011-024-04261-x"},{"key":"e_1_2_14_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.trsl.2020.11.003"},{"key":"e_1_2_14_24_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-019-0379-5"},{"key":"e_1_2_14_25_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-37142-3"},{"key":"e_1_2_14_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.03.038"},{"key":"e_1_2_14_27_2","doi-asserted-by":"publisher","DOI":"10.5483\/BMBRep.2024-0058"},{"key":"e_1_2_14_28_2","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14669"},{"key":"e_1_2_14_29_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12886-025-04001-2"},{"key":"e_1_2_14_30_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i10.2564"},{"key":"e_1_2_14_31_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32204"},{"key":"e_1_2_14_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2020.100067"},{"key":"e_1_2_14_33_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu14061224"},{"key":"e_1_2_14_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.12.034"},{"key":"e_1_2_14_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2022.07.165"}],"container-title":["International Journal of Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ije\/5591067","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/ije\/5591067","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ije\/5591067","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:51:54Z","timestamp":1791960714000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/ije\/5591067"}},"subtitle":[],"editor":[{"given":"Baisakhi","family":"Banerjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/ije\/5591067"],"URL":"https:\/\/doi.org\/10.1155\/ije\/5591067","archive":["Portico"],"relation":{},"ISSN":["1687-8337","1687-8345"],"issn-type":[{"value":"1687-8337","type":"print"},{"value":"1687-8345","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-01-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"5591067"}}