Retrospective analysis of platelet to high-density lipoprotein cholesterol ratio in obese children with metabolic dysfunction-associated fatty liver disease.

BACKGROUND: The platelet-to-high-density lipoprotein cholesterol ratio (PHR) is an emerging biomarker for identifying systemic inflammation and a hypercoagulable state. Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver conditions closely associated with metabolic dysfunction and is recognised as the hepatic manifestation of metabolic syndrome. In 2020, an international consensus panel proposed "metabolic dysfunction-associated fatty liver disease" (MAFLD) as an alternative nomenclature for NAFLD, better reflecting the disease's pathophysiology. MAFLD development is closely linked to inflammation and hypercoagulability, and this study aimed to investigate the association between PHR levels and MAFLD in children with obesity. METHODS: A total of 209 obese children aged 6 to 14 years who visited the Children's Medical Center of the Affiliated Hospital of Nantong University were enrolled in this study. Obesity was defined as a body mass index (BMI) ≥95th percentile (P95) for the same age and sex. All participants underwent ultrasound to determine the presence of hepatic steatosis, and data on physical examination and biochemical parameters were collected. The platelet-to-HDL cholesterol ratio (PHR) was calculated based on platelet (PLT) count and high-density lipoprotein cholesterol (HDL-C) using the following formula: PHR = PLT (1,000 cells/µL)/HDL-C (mmol/L). Multivariable logistic regression analysis was applied to evaluate the association between PHR and MAFLD. Restricted cubic spline (RCS) analysis was performed to characterize the dose-response relationship. RESULTS: Children with MAFLD had significantly higher PHR levels than obese children without MAFLD (289.48±81.15 vs. 233.86±60.57, t=-5.67, P<0.001). Multivariable regression analysis demonstrated that the highest quartile of PHR (Q4) was significantly associated with an increased risk of MAFLD after adjustment for gender, age, BMI-standard deviation score (BMI-SDS) and multiple metabolic indices [odds ratio (OR) = 6.28, 95% confidence interval (CI): 2.14-18.45, P<0.001]. The dose-response curve indicated a linear positive association between PHR and the risk of MAFLD (overall P<0.001, non-linearity P=0.77). CONCLUSIONS: Elevated PHR level is an independent risk factor for MAFLD in obese children and may serve as a potential biomarker for the early screening of pediatric MAFLD.