Potential Relevance of Amazonian Diet Components in Parkinson's Disease: An Integrative Review with Multivariate Analysis.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), has emerged as the most prevalent chronic liver disease worldwide, affecting over 30% of the global population [, ]. MASLD can progress to hepatic fibrosis, an irreversible form of liver damage, and may eventually lead to end-stage liver diseases such as cirrhosis, which can significantly reduce patients’ quality of life []. The rising global prevalence of obesity and diabetes has contributed to a corresponding increase in MASLD incidence [], imposing a substantial burden on healthcare systems worldwide []. In response to this escalating public health concern, early identification of high-risk individuals and timely intervention are essential to improving clinical outcomes. Red blood cell distribution width (RDW) is a simple hematological parameter that reflects the variability in red blood cell size, calculated based on the mean corpuscular volume, and regulated in part by erythropoietin activity []. Although traditionally used in the differential diagnosis of anemia [], elevated RDW levels have also been associated with a wide range of clinical conditions, including cardiovascular disease (CVD), thrombotic disorders, malignancies, diabetes, liver disease, kidney disease, and pulmonary disorders []. These associations may be mediated through mechanisms involving inflammation and oxidative stress [–]. Serum albumin, the most abundant protein in plasma, plays a critical role in maintaining oncotic pressure and fluid distribution across compartments []. It also serves as a marker of nutritional status and hepatic synthetic function [, ]. In chronic liver diseases, serum albumin levels often decrease due to inflammation, malnutrition, or impaired hepatic function [, ]. The RDW to albumin ratio (RAR) integrates these two parameters, providing a composite index that reflects the interplay between inflammation and nutritional status, both of which are critical in the progression of MASLD. Previous studies have demonstrated the prognostic value of RAR in various diseases, including CVD [, ], diabetes [], and cancer []. However, little is known about the prognostic utility of RAR in patients with MASLD, particularly in relation to all-cause and cardiovascular mortality. Given the increasing burden of MASLD and the need for risk stratification tools, this study aimed to investigate the association of RAR with both all-cause and cardiovascular mortality among adults with MASLD using data from a nationally representative cohort. The National Health and Nutrition Examination Survey (NHANES) is a continuous national surveillance program conducted by the Centers for Disease Control and Prevention to assess the health and nutritional status of individuals across all age groups in the United States. The survey utilizes a weighted, multi-level cluster sampling framework to achieve demographic representativeness across the country. The survey includes the collection of health and nutrition questionnaire data, biochemical analyses of blood and urine samples, as well as physical examinations and instrumental measurements. Ethical approval for NHANES was granted by the research ethics review board at the National Center for Health Statistics (NCHS), and informed consent was documented for all participants prior to enrollment. The present study was conducted and reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.