The association of nutritional and inflammatory status with cardiovascular and all-cause mortality risk among US patients with metabolic syndrome

To investigate the relationship between nutritional and inflammatory status and all-cause and cardiovascular mortality in the U.S. population with cardiometabolic syndrome (CMS) and to identify the optimal nutrition-inflammation index for assessing long-term prognosis. Health data from the 1999-2010 National Health and Nutrition Examination Survey (NHANES) were used. Kaplan-Meier analysis explored associations between nutrition-inflammation indices and mortality in the CMS population. Significant indices were selected for ROC curve analysis, and the most effective index was analyzed using COX regression models. Restricted cubic splines (RCS) analyzed nonlinear associations, and a recursive algorithm determined inflection points. Subgroup and sensitivity analyses assessed the stability of the model. The study included data from 5,969 participants (2,900 males, 3,069 females), with 1,753 all-cause deaths and 607 cardiovascular deaths. Kaplan-Meier analysis indicated that good nutrition and low inflammation were linked to better long-term outcomes. The Advanced Lung Cancer Inflammation Index (ALI) was the most effective assessing index. COX regression showed a negative association between ALI and both mortality types. RCS analysis revealed a U-shaped relationship for all-cause mortality and an L-shaped curve for cardiovascular mortality, with an inflection point at 106.24. Subgroup analysis and sensitivity analysis confirmed the robustness of ALI in assessing the mortality risk in the CMS population. ALI is an ideal indicator for evaluating the relationship between nutritional and inflammatory status and both all-cause and cardiovascular mortality in the CMS population. Maintaining an appropriate ALI level can help reduce the risk of all-cause and cardiovascular mortality in CMS patients.