The albumin-to-creatinine ratio predicts and explores potential mediation of mortality in metabolic dysfunction-associated steatotic liver disease in U.S. adults: evidence from NHANES 1999-2018.

Across FLI, USFLI, and HSI cohorts, variables such as ACR, age, and eGFR remained highly significant, supporting the robustness of the machine learning selected predictors in a nationally representative context.

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Overall, although most subgroup interactions did not reach statistical significance, certain populations—including non-diabetic individuals, females, those with pre-existing CVD, and those at high risk of liver fibrosis–may be more sensitive to the detrimental effects of elevated ACR, providing potential clues for targeted interventions.

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