ArticleInternational journal of endocrinology2026
Inverse Association of the Life's Crucial 9 Score With MAFLD: An Exploratory Mediation Analysis of the C-Reactive Protein-Albumin-Lymphocyte (CALLY) Index.
Article in International journal of endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) is strongly associated with cardiovascular disease. Life's Crucial 9 (LC9), an expanded cardiovascular health metric incorporating psychological health, may provide a multidimensional measure of cardiometabolic health. The CALLY index integrates inflammatory, immune, and nutritional information and has been associated with MAFLD. However, whether ln(CALLY) statistically accounts for part of the association between LC9 and MAFLD remains unclear. This study aimed to examine the association between LC9 and MAFLD and to explore the statistical indirect association through ln(CALLY). Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2016. Weighted logistic regression, restricted cubic spline (RCS) modeling, subgroup analysis, and weighted quantile sum (WQS) regression were used to assess the relationship between LC9 and MAFLD. Exploratory mediation analysis was performed to evaluate the statistical indirect association through ln(CALLY). Sensitivity and supplementary analyses were conducted to assess the robustness of the findings with respect to missing data, alternative disease definitions, definitional overlap, alternative cardiovascular health metrics, individual LC9 components, and mediator choice. Results: This study included 3841 participants. Higher LC9 scores were significantly associated with lower odds of prevalent MAFLD. Specifically, every 10-point increase in the LC9 score was associated with lower odds of MAFLD (OR = 0.51, 95% CI: 0.47-0.56, Conclusion: Higher LC9 scores were associated with lower odds of prevalent MAFLD. Exploratory mediation analysis suggested a statistical indirect association through ln(CALLY), although causal or temporal mediation cannot be inferred. Further prospective studies are needed to confirm these findings.
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