Association Between Alpha-1-Acid Glycoprotein and Non-Alcoholic Fatty Liver Disease and Liver Fibrosis in Adult Women

<b>Background:</b> Alpha-1-acid glycoprotein (AGP) is a glycoprotein synthesized mainly by the liver. Nonalcoholic fatty liver disease (NAFLD) and liver fibrosis (LF) are associated with metabolic disorders. The aim of this study was to examine the potential correlation between AGP and both NAFLD and LF. <b>Methods:</b> The data were derived from the 2017-2023 National Health and Nutrition Examination Survey (NHANES). The linear association between AGP and NAFLD and LF was examined by multivariate logistic regression models. Non-linear relationships were described by fitting smoothed curves and threshold effect analysis. Subgroup analysis was also performed to assess potential regulatory factors. <b>Results:</b> The study included 2270 females. AGP was found to be significantly and positively associated with NAFLD [OR = 12.00, 95% CI (6.73, 21.39), <i>p</i> < 0.001] and LF [OR = 2.20, 95% CI (1.07, 4.50), <i>p</i> = 0.042]. Furthermore, the association between AGP and NAFLD was significantly different in the diabetic subgroup (<i>p</i> < 0.05 for interaction). Additionally, we found an inverted U-shaped relationship between AGP and controlled attenuation parameter (CAP), with an inflection point at 1.20 g/L. <b>Conclusions:</b> We found a significant positive correlation between AGP and both NAFLD and LF, and there was an inverted U-shaped relationship between AGP and CAP.