{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T05:36:20Z","timestamp":1791005780282,"version":"4.1.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The objective of this study was to examine the correlation between the albumin-corrected anion gap (ACAG) and non-alcoholic fatty liver disease (NAFLD) using data from the National Health and Nutrition Examination Survey (NHANES) 2017\u20132018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional analysis was conducted, comprising 4,379 participants, who were stratified into two groups: those with NAFLD and those without NAFLD. The baseline characteristics were compared using the most appropriate statistical tests. The relationship between ACAG levels and NAFLD was assessed using generalized linear models, with adjustments made for potential confounding factors. The analysis of threshold effects was conducted using piecewise regression. Furthermore, the relationship between ACAG and NAFLD was investigated in different age groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean age of participants with non-alcoholic fatty liver disease (NAFLD) was significantly higher than that of non-NAFLD participants (48.88 vs. 43.46 years, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). The presence of NAFLD was associated with higher levels of ACAG (18.80\u202f\u00b1\u202f0.24 vs. 18.10\u202f\u00b1\u202f0.19, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). In fully adjusted models, each 1-unit increase in ACAG was associated with a significantly increased risk of NAFLD in participants under 60\u202fyears old (<jats:italic>\u03b2<\/jats:italic>: 0.87, 95% CI: 0.05, 1.69, <jats:italic>p<\/jats:italic> &amp;lt;\u202f0.05). In younger participants, elevated NAFLD risk was observed in those with higher ACAG quartiles (<jats:italic>P<\/jats:italic> for trend &amp;lt;0.05). In contrast, no significant associations were identified in participants aged 60\u202fyears and older (<jats:italic>P<\/jats:italic> for trend &amp;gt;0.05), suggesting the presence of age-specific differences in the relationship between ACAG and NAFLD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The impact of ACAG on NAFLD is significantly correlated, especially in the age group, where elevated levels of ACAG are associated with increased risk of NAFLD in young people. ACAG may be a potential and reliable biomarker for predicting NAFLD risk in clinical assessment, but its implementation should consider the patient\u2019s age factor.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1518540","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T11:33:21Z","timestamp":1741779201000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Relationship between albumin-corrected anion gap and non-alcoholic fatty liver disease: a cross-sectional analysis of NHANES 2017\u20132018"],"prefix":"10.3389","volume":"12","author":[{"given":"Ning","family":"Bai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Ying","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dejian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiguo","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"4077","DOI":"10.3390\/nu13114077","article-title":"Impact of genetic polymorphism on response to therapy in non-alcoholic fatty liver disease","volume":"13","author":"Mart\u00ednez-Montoro","year":"2021","journal-title":"Nutrients"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"856","DOI":"10.3390\/jcm12030856","article-title":"Non-alcoholic fatty liver disease in patients with polycystic ovary syndrome: a systematic review, meta-analysis, and meta-regression","volume":"12","author":"Manzano-Nunez","year":"2023","journal-title":"JCM"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1111\/liv.13301","article-title":"Pathology of non-alcoholic fatty liver disease","volume":"37","author":"Bedossa","year":"2017","journal-title":"Liver Int"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e30387","DOI":"10.1016\/j.heliyon.2024.e30387","article-title":"From NAFLD to NASH: understanding the spectrum of non-alcoholic liver diseases and their consequences","volume":"10","author":"Samy","year":"2024","journal-title":"Heliyon"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease\u2014Meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1691","DOI":"10.1136\/gutjnl-2020-320622","article-title":"NAFLD and increased risk of cardiovascular disease: clinical associations, pathophysiological mechanisms and pharmacological implications","volume":"69","author":"Targher","year":"2020","journal-title":"Gut"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1136\/gutjnl-2020-323082","article-title":"Non-alcoholic fatty liver disease and risk of incident chronic kidney disease: an updated meta-analysis","volume":"71","author":"Mantovani","year":"2022","journal-title":"Gut"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2167","DOI":"10.1111\/liv.15643","article-title":"Non-alcoholic fatty liver disease mediates the effect of obesity on arterial hypertension","volume":"43","author":"Pirola","year":"2023","journal-title":"Liver Int"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1016\/j.jhep.2020.01.013","article-title":"NAFLD as a driver of chronic kidney disease","volume":"72","author":"Byrne","year":"2020","journal-title":"J Hepatol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"101215","DOI":"10.1016\/j.diabet.2020.101215","article-title":"NAFLD, and cardiovascular and cardiac diseases: factors influencing risk, prediction and treatment","volume":"47","author":"Targher","year":"2021","journal-title":"Diabetes Metab"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"242","DOI":"10.31083\/j.fbl2708242","article-title":"Antioxidants rich herbal formula Ger-gen-Chyn-Lian-tang protects lipotoxicity and ameliorates inflammation signaling through regulation of mitochondrial biogenesis and Mitophagy in nonalcoholic fatty liver disease mice","volume":"27","author":"Wang","year":"2022","journal-title":"Front Biosci"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"665987","DOI":"10.3389\/fendo.2021.665987","article-title":"Gene-environmental interactions as metabolic drivers of nonalcoholic steatohepatitis","volume":"12","author":"Albhaisi","year":"2021","journal-title":"Front Endocrinol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1186\/s12967-022-03693-0","article-title":"Mitochondrial transplantation: opportunities and challenges in the treatment of obesity, diabetes, and nonalcoholic fatty liver disease","volume":"20","author":"Chen","year":"2022","journal-title":"J Transl Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.34067\/KID.0003562021","article-title":"Obesity, Anion accumulation, and anion gap metabolic acidosis: a cohort study","volume":"2","author":"Lambert","year":"2021","journal-title":"Kidney360"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1186\/s12916-023-03080-6","article-title":"Multi-system diseases and death trajectory of metabolic dysfunction-associated fatty liver disease: findings from the UK biobank","volume":"21","author":"Jia","year":"2023","journal-title":"BMC Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1700","DOI":"10.3390\/jpm13121700","article-title":"Evaluation of the Acid\u2013Base status in patients admitted to the ICU due to severe COVID-19: physicochemical versus traditional approaches","volume":"13","author":"Sotiropoulou","year":"2023","journal-title":"JPM"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1186\/s12872-023-03200-3","article-title":"Association between albumin corrected anion gap and 30-day all-cause mortality of critically ill patients with acute myocardial infarction: a retrospective analysis based on the MIMIC-IV database","volume":"23","author":"Jian","year":"2023","journal-title":"BMC Cardiovasc Disord"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"23","DOI":"10.5005\/jp-journals-10071-24077","article-title":"Utility of Stewart's approach to diagnose missed complex acid&ndash;base disorders as compared to bicarbonate-anion gap-based methodology in critically ill patients: an observational study, Indian","volume":"26","author":"Divatia","year":"2022","journal-title":"J Crit Care Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"2415","DOI":"10.2147\/JIR.S412860","article-title":"Albumin corrected anion gap and the risk of in-hospital mortality in patients with acute pancreatitis: a retrospective cohort study","volume":"16","author":"Li","year":"2023","journal-title":"JIR"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1186\/s40001-024-01811-w","article-title":"Relationship between albumin-corrected anion gap and non-alcoholic fatty liver disease varied in different waist circumference groups: a cross-sectional study","volume":"29","author":"Lu","year":"2024","journal-title":"Eur J Med Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1053\/j.gastro.2018.12.036","article-title":"Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease","volume":"156","author":"Castera","year":"2019","journal-title":"Gastroenterology"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1053\/j.gastro.2019.01.042","article-title":"Accuracy of FibroScan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease","volume":"156","author":"Eddowes","year":"2019","journal-title":"Gastroenterology"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1486","DOI":"10.1002\/hep.29302","article-title":"Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: a meta-analysis","volume":"66","author":"Xiao","year":"2017","journal-title":"Hepatology"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1136\/adc.87.6.526","article-title":"Correction of the anion gap for albumin in order to detect occult tissue anions in shock","volume":"87","author":"Hatherill","year":"2002","journal-title":"Arch Dis Child"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"387","DOI":"10.62347\/KMSA5983","article-title":"Non-alcoholic fatty liver disease: pathogenesis and models","volume":"16","author":"Zhong","year":"2024","journal-title":"Am J Transl Res"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"22385","DOI":"10.1038\/s41598-024-72909-8","article-title":"Altered gut microbial profile accompanied by abnormal short chain fatty acid metabolism exacerbates nonalcoholic fatty liver disease progression","volume":"14","author":"Yang","year":"2024","journal-title":"Sci Rep"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"BSR20194345","DOI":"10.1042\/BSR20194345","article-title":"Dysregulation of miR-192-5p in acute pancreatitis patients with nonalcoholic fatty liver and its functional role in acute pancreatitis progression","volume":"40","author":"Hu","year":"2020","journal-title":"Biosci Rep"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"15844","DOI":"10.1002\/jcb.28855","article-title":"Effect of microRNA-27a-5p on apoptosis and inflammatory response of pancreatic acinar cells in acute pancreatitis by targeting PTEN","volume":"120","author":"Kong","year":"2019","journal-title":"J Cell Biochem"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"10541","DOI":"10.3390\/ijms221910541","article-title":"A distinctive NAFLD signature in adipose tissue from women with severe obesity","volume":"22","author":"Osorio-Conles","year":"2021","journal-title":"IJMS"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1934578X221111033","DOI":"10.1177\/1934578X221111033","article-title":"Tyrosol ameliorates liver inflammatory response in a mouse model of nonalcoholic fatty liver disease (NFALD) by regulating JAK1\/STAT3","volume":"17","author":"Huang","year":"2022","journal-title":"Nat Prod Commun"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1518540\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T11:33:24Z","timestamp":1741779204000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1518540\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,12]]},"references-count":31,"alternative-id":["10.3389\/fmed.2025.1518540"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1518540","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,12]]},"article-number":"1518540"}}