Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Role of the advanced lung cancer inflammation index (ALI) in the risk of liver fibrosis and mortality among US adult MAFLD patients: a cross-sectional study of NHANES 1999–2018,” published in the March 2025 issue of BMC Gastroenterology by Yu et al.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a widespread chronic liver condition, with inflammation and nutritional status playing critical roles in its progression. The Advanced Lung Cancer Inflammation Index (ALI) has emerged as a novel biomarker that reflects both nutritional and inflammatory status, yet its relevance in MAFLD prognosis and fibrosis risk remains unclear. This study aimed to investigate the relationship between ALI and liver fibrosis, as well as its prognostic significance in patients with MAFLD. A cross-sectional analysis was conducted using data from the NHANES spanning 1999–2018, including adult participants from the United States. Weighted logistic regression was employed to evaluate the association between ALI and the risk of liver fibrosis, while survival outcomes, including all-cause, cardiovascular disease (CVD), and cancer-related mortality, were assessed using weighted Kaplan-Meier survival analysis and Cox proportional hazards models. 

Additionally, restricted cubic splines (RCS) and threshold effect analyses were utilized to explore potential non-linear relationships, and receiver operating characteristic (ROC) curves were constructed to determine the predictive accuracy of ALI. Subgroup analyses were also performed to identify variations in associations across different patient groups. A total of 6,858 patients with MAFLD (mean age: 51.38 ± 17.22 years; 54% male) were included in the analysis. A non-linear relationship was observed between ALI and liver fibrosis risk, with a critical threshold at 5.68, beyond which the risk of fibrosis increased significantly ([OR] = 2.35, 95% [CI]: 1.89–2.95). Stronger associations were identified in patients with central obesity and prediabetes (P for interaction < 0.05). 

Furthermore, ALI demonstrated an inverse relationship with all-cause mortality ([HR] = 0.64, 95% CI: 0.56–0.72) and CVD-related mortality (HR = 0.57, 95% CI: 0.46–0.65), whereas no significant association was found with cancer-related mortality. RCS analysis indicated an L-shaped non-linear relationship between ALI and all-cause mortality, with a threshold at 5.36, while the association with CVD mortality followed a linear trend. Additionally, factors such as low high-density lipoprotein (HDL) cholesterol levels and excessive alcohol consumption influenced the relationship between ALI and all-cause mortality (P for interaction < 0.05). Among mortality predictors, ALI exhibited the highest predictive accuracy for CVD-related deaths. 

These findings suggest that ALI serves as a valuable biomarker for assessing liver fibrosis risk and prognosis in MAFLD, particularly in predicting CVD-related mortality. Further research is warranted to validate these associations and explore potential clinical applications for ALI in risk stratification and patient management.

Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03762-w