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<p>Systemic inflammation plays a key role in the pathogenesis of metabolic dysfunction-associated fatty liver disease (MAFLD). The red blood cell distribution width (RDW) and serum albumin levels are well-recognized biomarkers reflecting inflammatory and nutritional status. This study systematically investigates the association between the RDW-to-albumin ratio (RAR) and MAFLD, while further analyzing the dose-response relationship between RAR and the severity of hepatic steatosis (assessed by Controlled Attenuation Parameter, CAP) and fibrosis (assessed by Liver Stiffness Measurement, LSM). This cross-sectional analysis was based on data from the National Health and Nutrition Examination Survey (NHANES) 2017–2020. MAFLD was diagnosed in accordance with the 2020 global consensus, combining evidence of hepatic steatosis (via (CAP ≥ 248 dB/m detected by Vibration-Controlled Transient Elastography [VCTE] or ultrasound) and metabolic dysfunction. Multivariate weighted logistic regression models were used to analyze the association between RAR and MAFLD. Restricted Cubic Spline (RCS) analysis was employed to evaluate the dose-response relationships between RAR and CAP, as well as(LSM). Among the 4,453 participants, 2,482 were diagnosed with MAFLD. After full adjustment for confounding factors, each 1-unit increase in RAR was associated with a 69% higher prevalence of MAFLD (OR = 1.69, 95% CI: 1.24–2.31). When RAR was categorized into tertiles, compared with the lowest tertile (RAR &lt; 3.10), the highest tertile (RAR &gt; 3.40) was associated with a 66% increased prevalence of MAFLD (OR = 1.66, 95% CI: 1.09–2.53). RCS analysis revealed a significant linear dose-response relationship between RAR and MAFLD prevalence (<i>P</i>-overall &lt; 0.001, <i>P</i>-nonlinear = 0.09), and significant nonlinear dose-response relationships between RAR and CAP (<i>P</i>-overall &lt; 0.01, <i>P</i>-nonlinear = 0.004) as well as LSM (<i>P</i>-overall &lt; 0.01, <i>P</i>-nonlinear = 0.05). CAP and LSM values increased significantly with elevated RAR. RAR is significantly positively associated with MAFLD prevalence in a linear manner among the U.S. population, and is closely correlated with the severity of hepatic steatosis and fibrosis.</p>

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Association of the RDW-to-albumin ratio with MAFLD and hepatic fibrosis in the U.S. population: a national cross-sectional study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月11日

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  • Xueqin He,
  • Qingfeng Zeng,
  • Weibin Liu,
  • Yu Liu,
  • Meilian Ning,
  • Xianghui Zeng,
  • Jianping Luo

摘要

Systemic inflammation plays a key role in the pathogenesis of metabolic dysfunction-associated fatty liver disease (MAFLD). The red blood cell distribution width (RDW) and serum albumin levels are well-recognized biomarkers reflecting inflammatory and nutritional status. This study systematically investigates the association between the RDW-to-albumin ratio (RAR) and MAFLD, while further analyzing the dose-response relationship between RAR and the severity of hepatic steatosis (assessed by Controlled Attenuation Parameter, CAP) and fibrosis (assessed by Liver Stiffness Measurement, LSM). This cross-sectional analysis was based on data from the National Health and Nutrition Examination Survey (NHANES) 2017–2020. MAFLD was diagnosed in accordance with the 2020 global consensus, combining evidence of hepatic steatosis (via (CAP ≥ 248 dB/m detected by Vibration-Controlled Transient Elastography [VCTE] or ultrasound) and metabolic dysfunction. Multivariate weighted logistic regression models were used to analyze the association between RAR and MAFLD. Restricted Cubic Spline (RCS) analysis was employed to evaluate the dose-response relationships between RAR and CAP, as well as(LSM). Among the 4,453 participants, 2,482 were diagnosed with MAFLD. After full adjustment for confounding factors, each 1-unit increase in RAR was associated with a 69% higher prevalence of MAFLD (OR = 1.69, 95% CI: 1.24–2.31). When RAR was categorized into tertiles, compared with the lowest tertile (RAR < 3.10), the highest tertile (RAR > 3.40) was associated with a 66% increased prevalence of MAFLD (OR = 1.66, 95% CI: 1.09–2.53). RCS analysis revealed a significant linear dose-response relationship between RAR and MAFLD prevalence (P-overall < 0.001, P-nonlinear = 0.09), and significant nonlinear dose-response relationships between RAR and CAP (P-overall < 0.01, P-nonlinear = 0.004) as well as LSM (P-overall < 0.01, P-nonlinear = 0.05). CAP and LSM values increased significantly with elevated RAR. RAR is significantly positively associated with MAFLD prevalence in a linear manner among the U.S. population, and is closely correlated with the severity of hepatic steatosis and fibrosis.