ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutritional Epidemiology
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1607486
Association between Neutrophil-Percentage-to-Albumin Ratio and mortality among US adults with non-alcoholic fatty liver disease
Provisionally accepted
- 1School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- 2School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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There are no studies discussing the relationship between NPAR and mortality among individuals with non-alcoholic Fatty Liver Disease (NAFLD) has not been studied. We aimed to evaluate the correlation between NPAR and all-cause and cardiovascular (CVD) mortality in NAFLD patients in the U.S. Methods: Based on the National Health and Nutrition Examination Survey (NHANES) database from 2003 to 2018, a total of 4,906 participants aged 20 years and older with NAFLD were enrolled in this study. The survival data came from the National Death Index (NDI), which was followed up to 2019. Multivariable cox proportional hazard models were used to explore the relationship between NPAR and all-cause mortality and cardiovascular (CVD) mortality.Restricted cubic spline analysis and threshold effect analysis were applied to assess the nonlinear association between NPAR and all-cause and CVD mortality. Results: After adjusting for multiple covariates, compared to participants with the lowest NPAR reference group (<12.63), those in the highest NPAR group (15.96-26.83) have the hazard ratio for all-cause mortality was 1.979 (95%CI, 1.436-2.729) with P values < 0.001 and for CVD mortality was 2.678(95%CI, 1.428-5.024) with P values < 0.001. A J-shaped relationship between NPAR and all-cause mortality risk was observed among patients with NAFLD (P for nonlinear = 0.003), whereas there was no nonlinear association with CVD mortality (P for nonlinear = 0.121). Conclusion: The study identified a significant association between elevated levels of NPAR and an increased risk of all-cause and CVD mortality in the United States NAFLD patients.
Keywords: Non-alcoholic fatty liver disease (NAFLD)1, Neutrophil-Percentage-to-Albumin Ratio (NPAR)2, National Health and Nutrition Examination Survey (NHANES)3, all-cause mortality4, CVD mortality5
Received: 07 Apr 2025; Accepted: 26 Aug 2025.
Copyright: © 2025 Zhu, Zhao, Zhu, Zhao, Shen, Shou, Mai and Rong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fen Rong, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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