Monocyte-to-HDL-Cholesterol Ratio, Vitamin D Status, and Metabolic Profile across Ultrasonographic Grades of Hepatic Steatosis: A Retrospective Cross-Sectional Study

INTRODUCTION: This study was designed to examine the relationship of hepatic steatosis severity with biochemical parameters, serum vitamin D levels, and the monocyte-to-HDL cholesterol ratio (MHR), and to evaluate whether the MHR may serve as a supportive biomarker in hepatic steatosis
METHODS: In this retrospective cross-sectional study, 201 adults evaluated between 2020 and 2025 were included. Hepatic steatosis and its severity were assessed by hepatobiliary ultrasonography, and biochemical, hematological, and metabolic parameters, including serum vitamin D levels and the MHR, were analyzed.
RESULTS: The mean age was 41.04 ± 16.49 years. Mean vitamin D level was 16.44 ± 9.86 ng/mL, and the mean MHR was 0.01398 ± 0.00616. Vitamin D levels were not significantly correlated with the MHR (r=0.019, p=0.790). In contrast, the MHR showed a weak but significant positive correlation with steatosis grade on ultrasonography (r=0.151, p=0.033). ROC analysis demonstrated poor discriminatory performance of the monocyte-to-HDL ratio for hepatic steatosis (AUC = 0.592, 95% CI: 0.513–0.672, p = 0.026). Age, HbA1c, glucose, AST, ALT, GGT, triglycerides, HDL cholesterol, lymphocyte count, hemoglobin, and hematocrit differed significantly across steatosis grades (p<0.05), whereas vitamin D levels did not (p=0.357).
DISCUSSION AND CONCLUSION: Hepatic steatosis was associated with markers of glucose metabolism, liver injury, and lipid profile. HbA1c, glucose, AST, ALT, GGT, and triglycerides increased with steatosis severity, while HDL cholesterol showed an inverse relationship. The MHR showed a weak but statistically significant association with hepatic steatosis severity; however, its diagnostic performance was poor, limiting its value as a stand-alone marker.

Keywords: Hepatic steatosis, vitamin D, MHR