Advanced lung Cancer inflammation index (ALI), Metabolic dysfunction-associated fatty liver disease (MAFLD), Cross-sectional study, National health and nutrition examination survey (NHANES), All-cause mortality, Cardiovascular disease (CVD) mortality, Diseases of the digestive system. Gastroenterology, RC799-869

Abstract Background Metabolic dysfunction-associated fatty liver disease (MAFLD) is a prevalent chronic liver disease globally, with inflammation and nutrition playing key roles in its progression. The Advanced Lung Cancer Inflammation Index (ALI) is a novel biomarker reflecting nutritional and inflammatory status. This study aims to explore the association between ALI and the risk of liver fibrosis and prognosis in MAFLD patients. Methods This cross-sectional study analyzed NHANES data from the 1999–2018 on adult participants in the US. Weighted logistic regression assessed the association between ALI and liver fibrosis risk. Mortality outcomes, including all-cause, cardiovascular disease (CVD), and cancer mortality, analyzed using weighted Kaplan-Meier and Cox proportional hazards models. Restricted cubic splines (RCS) and threshold effect analyses were uesd to explore non-linear relationships. Receiver operating characteristic (ROC) curve evaluated the prognostic value of ALI, and stratified analyses examined subgroup differences. Results A total of 6,858 MAFLD patients (mean age 51.38 ± 17.22 years, 54% male) were included. A non-linear relationship was found between ALI and liver fibrosis risk, with a threshold at 5.68, beyond which the risk increased significantly (OR = 2.35, 95% CI: 1.89–2.95). Stronger associations were observed in subgroups with central obesity and prediabetes (P for interaction