Metabolic dysfunction-associated fatty liver disease and liver fibrosis: predictive value of the CALLY index

The C-reactive protein-albumin-lymphocyte (CALLY) index reflects inflammation, nutrition, and immunity. This study investigates its association with metabolic dysfunction-associated fatty liver disease (MASLD) and liver fibrosis to assess its potential role as a non-invasive biomarker in a U.S. national cohort. This study included 4951 U.S. adults from the NHANES survey (2017–2020). Weighted multivariable logistic regression and restricted cubic spline (RCS) analyses were used to assess associations between CALLY, MASLD, and liver fibrosis. Stratified analyses by gender, age, diabetes, hypertension, smoking status, and physical activity were conducted. Predictive accuracy was evaluated using ROC curves. MASLD was present in 36.69% of participants, and liver fibrosis in 6.93%. CALLY was negatively correlated with MASLD and liver fibrosis, especially in females (p < 0.05). Risk of MASLD and fibrosis decreased with increasing CALLY quartiles (P < 0.05). The relationship deviated significantly from linearity, as indicated by the RCS analysis (p < 0.05). CALLY outperformed other inflammatory markers (SIRI, SII, and PLR) in predicting MASLD and fibrosis (AUCs: 0.78 and 0.81, respectively). The CALLY index validates its role as a practical, non-invasive clinical tool, with higher values consistently indicating lower risks of MASLD and liver fibrosis in this extensive U.S. cohort.