Creatinine-to-cystatin C ratio and all-cause and cardiovascular mortality in U.S. adults with nonalcoholic fatty liver disease: a nationwide cohort study

作者：Yuanyuan Chen, Bing Yang, Huihui Chen, Jun Chen, Jinmin Cao, Huijie Wang, Chuantie Chen · 发表于：Frontiers in Nutrition · 年份：2025 · DOI：10.3389/fnut.2025.1587757 · 被引用次数：4 · 研究领域：Liver Disease Diagnosis and Treatment、Nutrition and Health in Aging、Liver Disease and Transplantation

Background The creatinine-to-cystatin C ratio (CCR) is an emerging marker of muscle mass, which influences the progression of nonalcoholic fatty liver disease (NAFLD). However, the relationship between CCR and long-term all-cause and cardiovascular mortality remains unclear in the US NAFLD population. Methods This nationally representative study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999–2004, with mortality follow-up through December 31, 2019 via linkage to the National Death Index (NDI). NAFLD was determined using the Fatty Liver Index (FLI), while CCR was calculated as serum creatinine to cystatin C ratio. We employed multivariable Cox proportional hazards models to assess associations between CCR and mortality risk, expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). The analytical approach included Kaplan–Meier survival analysis, restricted cubic spline regression for non-linear relationship assessment, and comprehensive subgroup and sensitivity analyses to evaluate result robustness. Results This study included 3,897 participants with NAFLD (53.34% male, mean age 48.98 years), with 1,174 all-cause deaths and 333 cardiovascular deaths over a median follow-up of 206 months. CCR demonstrated significant inverse associations with both all-cause mortality (adjusted HR 0.83; 95% CI 0.78–0.88; p < 0.001) and cardiovascular mortality (adjusted HR 0.80; 95% CI 0.73–0.87; p < 0.001). In tertile analyses, h...