AUTHOR=Lu Yuexia , Yuan Shuaipeng , Xu Huazhao , Ouyang Jiqi , Dong Jinsheng , Jiang Xin , Shao Xiao , Zhang Runshun 

TITLE=The advanced lung cancer inflammation index has an L-shaped association with prognosis in American adults with metabolic dysfunction-associated fatty liver disease: a cohort study

JOURNAL=Frontiers in Nutrition

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2025.1571511

DOI=10.3389/fnut.2025.1571511

ISSN=2296-861X

ABSTRACT=BackgroundRegular monitoring and follow-up of patients with metabolic dysfunction-associated fatty liver disease (MAFLD) are of paramount importance in ensuring effective management of the condition. The ALI was assessed as a composite measure reflecting nutritional status and systemic inflammation. It was calculated as body mass index (BMI) (kg/m2) × serum albumin (g/dL)/neutrophil-to-lymphocyte ratio (NLR). Our study aims to find the relationship between advanced lung cancer inflammation index (ALI) levels and the prognosis of patients with MAFLD and to determine the predictive value of ALI in this context.MethodsMultivariate-adjusted Cox regression models were used to analyze the association between ALI and all-cause, cardiovascular, cancer, and diabetes-related mortalities in patients with MAFLD. Kaplan–Meier curves showed the association of ALI with all-cause and cardiovascular mortalities in patients with MAFLD. Follow-up time for this study was calculated from the date of examination to the date of death or to 31 December 2019, and mortality was ascertained using the International Classification of Diseases, 10th Revision codes. Restricted cubic spline (RCS) analysis was conducted to assess the potential non-linear relationship between ALI level and MAFLD prognosis. The predictive ability of ALI was observed using receiver operating characteristic (ROC) curves. Stratified and sensitivity analyses were used to enhance the reliability and robustness.ResultsThis study included 2,908 patients with MAFLD from the National Health and Nutrition Examination Survey (NHANES) database between 2003 and 2018. The median follow-up period for the 2,908 participants was 10.3 years, during which 636 deaths occurred. In the Cox regression model, the HRs (95%CIs) for all-cause, cardiovascular, cancer, and diabetes-related mortalities in the last quartile compared to the first quartile of ALI levels were 0.62 (0.44–0.85), 0.25 (0.14–0.45), 0.96 (0.51–1.81), and 0.69 (0.25–1.92), respectively. RCS analysis demonstrated a L-shaped non-linear association between ALI levels and both all-cause and cardiovascular mortalities in participants with MAFLD. Subgroup analyses highlighted population heterogeneity in the relationship between ALI and MAFLD prognosis. ROC curve analysis showed that ALI had strong predictive power for all-cause and cardiovascular mortalities, with area under the curve values of 0.80 (0.77–0.83) and 0.82 (0.74–0.89), respectively.ConclusionThere was an L-shaped nonlinear association of the protective effect of ALI: when the indicators are below specific thresholds (all-cause mortality 71.48, cardiovascular mortality 68.54), a higher ALI was significantly associated with reduced mortality risks in MAFLD patients; otherwise the protective effect tended to be consistent. ALI exhibits a robust predictive capability for all-cause and cardiovascular mortalities among participants with MAFLD, providing a valuable prognostic tool for optimizing patient management. We recommend early surveillance and management of patients with MAFLD to improve patient survival.