Analysis of the correlation and predictive performance of GNRI, CONUT, and PNI with MAFLD in Chinese adult physical examination population

Background: Metabolic-associated fatty liver disease (MAFLD) has become a major global health issue. Although nutrition is known to be associated with MAFLD, indices such as the Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status (CONUT), and Prognostic Nutritional Index (PNI) have been used for prognostic assessment in diseases like cancer and heart disease, but their relevance and predictive performance in MAFLD, especially across different subgroups in China, still need validation. Methods: This study is a retrospective cross-sectional study conducted at the First Affiliated Hospital of the Army Medical University in China. A total of 10,901 cases were included (MAFLD group: 2,426 cases; non-MAFLD group: 8,475 cases). Logistic regression analysis was performed using SPSS 27.0 and R 4.5.1 to determine relevant associations (calculating OR values and 95% confidence intervals). Receiver operating characteristic (ROC) curves were plotted for the three nutritional indices-GNRI, CONUT, and PNI-to predict the occurrence of MAFLD in different sex, BMI, and age groups, and area under the curve (AUC), sensitivity, and specificity were calculated. Stratified analysis was performed to study the interaction between MAFLD and different subgroups. Results: There is a dose-response relationship between GNRI, CONUT, and PNI and MAFLD. In multivariable models, the risk of developing MAFLD in the fourth quartile of GNRI and PNI was 7.01 times (OR = 7.01, 95% CI: 5.08-9.67) and 1.82 times (OR = 1.82, 95% CI: 1.51-2.19) that of the first quartile, respectively Overall, the predictive performance of GNRI was superior to that of CONUT (AUC = 0.909) and PNI (AUC = 0.909), especially in women, individuals with BMI less than 24, and those under 35 years of age. Stratified analysis showed that in individuals under 35 years old without hyperlipidemia and without hyperglycemia, the association between these three nutritional indicators and MAFLD was stronger. Conclusion: GNRI, CONUT, and PNI can all serve as effective indicators for assessing the risk of MAFLD, among which GNRI has the highest application value, especially suitable for female, young people, and individuals with normal weight, and can provide new insights for the clinical screening and intervention of MAFLD.