Skip to main content
Download PDF
Download ePub

Predictive effects of advanced lung cancer inflammation index and serum vitamin D on mortality in patients with asthma

Nutrition Journal volume 24, Article number: 26 (2025) Cite this article

Abstract

Background

Changes in systemic inflammation, nutritional status and serum vitamin D level are important characteristics of asthma. However, role and importance of nutritional inflammatory indicators or serum vitamin D concentrations in predicting the prognosis of asthma remain unclear. The advanced lung cancer inflammation index (ALI), based on body mass index (BMI), serum albumin and neutrophil–lymphocyte ratio (NLR), is a comprehensive index to assess systemic inflammation and nutrition. This study aimed to evaluate their independent and combined predictive value of mortality in asthma patients.

Methods

This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2001–2018. Cox regression analysis was used to assess the independent or joint effect of ALI and serum vitamin D on mortality risks of asthma. Receiver operator characteristic curve analysis was used to compare the prognostic ability of ALI with its component factors, including NLR, albumin, neutrophil, lymphocyte and BMI.

Results

A total of 2870 eligible asthma patients were included. After adjustment, higher ALI correlated significantly with reduced all-cause and respiratory disease mortality (adjusted hazard ratio [aHR] = 0.64 and 0.34; P < 0.05). Meanwhile, vitamin D deficiency correlated significantly with increased all-cause and respiratory disease mortality (aHR = 2.06 and 2.73; P < 0.05). The area under the curve of ALI in predicting 1-year, 5-year or 10-year all-cause mortality surpassed that of its five component indices. Joint analyses showed that individuals with higher levels of ALI and vitamin D had the lowest risks of all-cause and respiratory disease mortality (aHR = 0.31 and 0.17; P < 0.05).

Conclusions

ALI and serum vitamin D are robust independent and combined predictors of mortality in asthma patients. ALI offers superior predictive capability over its components, and sufficient vitamin D levels are beneficial for survival outcomes. The synergistic effect of high ALI and adequate vitamin D highlights the benefit of integrating both metrics into clinical practice for enhanced prognostic accuracy.

Peer Review reports

Background

Asthma is one of the most common chronic respiratory diseases, contributing significantly to the global burden of illness and mortality. According to the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, the number of global asthma cases was estimated to be 262.4 million in 2019 and has steadily increased from 1990 to 2019 [1]. The risk of death for asthma patients is 2 to 3 times higher than that of patients without asthma [2]. Therefore, it is essential to identify more alterable risk factors for the prevention, reduction or delay of asthma progression and related death.

Asthma is a chronic respiratory inflammatory disease, as evidenced by the involvement of many kinds of inflammatory cells and cytokines in different stages of the disease course [3]. Inflammation plays a pivotal role in the occurrence and development of asthma, as well as associated with lung function impairment and poor disease outcomes [4, 5]. The neutrophil-to-lymphocyte ratio (NLR), an easily measurable parameter of systemic inflammation, has been proven to be a critical element in the progression and prognosis of asthma patients, with higher NLR levels correlated with severe exacerbations and increased mortality risks [6, 7]. Besides, nutrition is also thought to play a crucial role in asthma progression by changing immune and metabolic responses [8]. Reduction of serum albumin concentration has been reported in patients with severe asthma [9]. Therefore, a composite index that reflect both inflammatory and nutritional status may provide sufficient accuracy to estimate the prognosis of patients with asthma.

The advanced lung cancer inflammation index (ALI), calculated by body mass index (BMI), albumin and NLR, can access changes in inflammation and nutrition simultaneously. Several studies have already demonstrated that elevated ALI was linked to higher mortality rates in lung cancer, gastrointestinal cancer or hepatocellular carcinoma [10,11,12]. The predictive ability of ALI was thought to be better than many common inflammatory indicators in lung cancer [13]. Due to the comprehensive function of ALI, researches also utilized ALI to assess the mortality risk of chronic inflammation-related diseases, such as diabetes, hypertension, heart failure, and coronary artery disease [14,15,16,17]. However, research on the association between ALI and the mortality risk of asthma is scarce, and it is unknown whether ALI has better predictive power.

In addition, vitamin D is a potential influential factor in asthma pathogenesis [18]. Compared to patients without asthma, the prevalence of vitamin D deficiency was significantly higher among asthma patients [18, 19]. Serum vitamin D levels have been inversely associated with total IgE levels and blood eosinophil counts in asthma [20]. A longitudinal study found that in children with asthma, lower vitamin D levels were linked to higher odds of hospitalization or emergency department visits [21]. Furthermore, vitamin D deficiency was related to the decreased lung function, airway hyperresponsiveness or poor glucocorticoid response [20, 22]. Taken together, these results suggested that vitamin D deficiency was associated with poor outcomes of asthma. However, the association between serum vitamin D level and mortality risk has not been clearly elucidated in asthma patients.

Hence, using data from the 2001–2018 National Health and Nutrition Examination Survey (NHANES), this study aimed to evaluate the prognostic value of ALI and serum vitamin D in asthma. Meanwhile, we further assessed the joint effect of the above two indicators on the risk of mortality. We provided new insight on prognosis assessment for asthma.

Methods

Study design and population selection

This retrospective cohort study included participants who consented to participate in the NHANES, a nationwide survey to monitor the health and nutritional status of adults and children in the United States. It used a stratified and multistage probability design to recruit a representative sample of American populations. This survey was reviewed and approved by the Ethics Review Board of the National Center of Health Statistics (see details at https://www.cdc.gov/nchs/nhanes/irba98.htm). Our center’s Ethics Review Board exempted this study.

Nine cycles (2001–2018) of NHANES survey data were pooled for this study. We enrolled participants with asthma aged 20 and above, who answered affirmatively to the following two questions: “Has a doctor or other health professional ever told you that you have asthma?” and “Do you still have asthma?”. Participants who self-reported as pregnant, had no follow-up information, or lacked data on complete blood count, albumin, BMI, vitamin D or any of the covariates were excluded.

ALI and serum vitamin D

ALI was calculated as follows: ALI = BMI (kg/m2) * albumin level (g/dL) / NLR, where the NLR was calculated as neutrophil counts divided by lymphocyte counts, as described by Jafri et al. in 2013 [10]. In this study, serum vitamin D referred to the sum of 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3, which are the major circulating forms of vitamin D. Its concentration in serum reflects the status of vitamin D. According to the recommendations of the Institute of Medicine of the National Academies in US, serum vitamin D levels ≥ 50 nmol/L were deemed sufficient, 30–50 nmol/L were insufficient, and < 30 nmol/L were deficient [23].

Other covariates and outcomes

Standardized questionnaires collected information on sociodemographic characteristics (age, sex, race, education level, and poverty income ratio [PIR]), smoking status, drinking status, and the history of hypertension, diabetes and cancer. The PIR is a measure expressing a family’s income relative to the poverty threshold. The higher the ratio, the further family’s income is from the poverty level. We classified PIR into three groups: less than 1.0, between 1.0 and 3.0 (inclusive), and greater than 3.0. Never smokers were defined as those who reported smoking < 100 cigarettes in their lifetime; former smokers smoked > 100 cigarettes but had quit smoking; current smokers smoked > 100 cigarettes and still smoked sometimes or every day. Drinking status was divided into two categories: yes (≥ 12 alcohol drinks per year) and no (< 12 alcohol drinks per year). Hypertension and cancer were self-reported. Diabetes was assessed based on one of the following criteria: (1) self-reported doctor diagnosis of diabetes; (2) use of diabetes medication or insulin; (3) fasting plasma glucose ≥ 7.0 mmol/L; (4) two-hour blood glucose ≥ 11.1 mmol/L from an oral glucose tolerance test; (5) glycohemoglobin (HbA1c) ≥ 6.5%. BMI was calculated during the physical examination. Blood cell counts, albumin, serum creatinine (Scr), glycohemoglobin and blood glucose were collected from laboratory test results. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI 2021) Scr-based equation was used to calculate the estimated glomerular filtration rate (eGFR).

The primary outcome was all-cause mortality, and the secondary outcome was respiratory disease mortality. Mortality information was obtained from the public-use 2019 linked mortality files (https://www.cdc.gov/nchs/data-linkage/mortality-public.htm). The follow-up time was defined as the period between the date of interview until the date of death or December 31, 2019. The cause-of-death was recorded based on the 10th revision of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD-10) guidelines. All-cause mortality was defined as death from any reasons. Respiratory disease mortality was defined as death from chronic lower respiratory disease(J40-J47) or pneumonia and influenza(J09-J18).

Statistical analysis

Due to the complex sampling design of NHANES, the sampling weights were considered during the analysis. The optimal cutoff point for ALI was determined using maximally selected rank statistics, which was used to divide participants into two groups. Continuous variables are described as weighted means and standard deviation (SD), while categorical variables are described as unweighted numbers and weighted proportions. The student t test and the chi-square test were employed to compare differences in baseline characteristics.

Multivariate Cox proportional hazards regression analyses were conducted to assess the association of the ALI and/or vitamin D with all-cause and respiratory disease mortality, with results shown as Hazard Ratio (HR) and 95% Confidence Interval (CI). Last stage multivariable models were adjusted for age, sex, race, education level, PIR, smoking status, drinking status, hypertension, diabetes, cancer and eGFR. We also estimated mortality risks with every 10-unit (or nmol/L) increment in ALI or vitamin D. Time-dependent receiver operating characteristic (ROC) curve analysis was conducted to compare the ability of ALI and its component factors in predicting the mortality of asthma patients. In joint analyses, participants were classified based on both ALI and vitamin D groups. Vitamin D levels were categorized into two groups (≥ 50 nmol/L and < 50 nmol/L) when respiratory disease mortality was analyzed, owing to the limited case numbers of the target outcome. To examine the robustness of results, stratified analysis was applied based on age and sex, and multivariate Cox analyses were performed again after excluding participants who died during the initial 2-year follow-up period. Finally, restricted cubic splines (RCS) were used for the multivariate Cox regression models to visualize the relationship between ALI or vitamin D and HRs of all-cause mortalities. All analyses were performed using R Statistical Software, version 4.3.2. Two‐sided P < 0.05 was regarded as statistical significance.

Results

Baseline characteristics

The study initially included 91,351 patients from the NHANES 2001–2018 cohorts. We removed 41,150 participants younger than 20 and 1,258 participants who were pregnant. 132 individuals were excluded due to incomplete mortality data. Subsequently, we excluded participants who were not compatible with the diagnostic criteria for asthma (n = 44,926), and those who lacked complete other parameters (n = 1,015). Finally, a total of 2870 participants diagnosed with asthma were enrolled in this study, representing a population of 13,992,436 asthma patients in the US (Fig. 1).

Fig. 1
figure 1

Flowchart of participants inclusion and exclusion. Abbreviations: NHANES: the National Health and Nutrition Examination Survey; ALI: advanced lung cancer inflammation index

Full size image

Among these 2870 participants, the weighted average age was 47.33 years; a majority were females (weighted proportion, 63.96%); the weighted average was 68.97 for ALI and 66.87 nmol/L for serum vitamin D concentration. Participants were classified into the higher group (ALI > 50.07, n = 1976) and the lower group (ALI ≤ 50.07, n = 894) by using the optimal cutoff value of 50.07 for the ALI (Additional file 1: Fig. S1). Participants in the higher ALI group were younger; had a higher proportion of Black race; were more likely to be never smokers; had a lower white blood cell count, neutrophil count, serum vitamin D and serum creatinine; and had a higher lymphocyte count, BMI and eGFR. More characteristics of the participants are outlined in Table 1.

Table 1 Baseline characteristics of patients with asthma stratified by ALI
Full size table

Association of ALI with mortality and ROC analysis of the predictive ability

During a median follow-up of 91 months (interquartile range (IQR), 50.0–145.0 months), 467 (16.27%) of the 2870 patients with asthma died, with 78 (2.72%) deaths attributed to respiratory diseases. The Cox regression analyses demonstrated a significant reduction in the risks of all-cause and respiratory disease mortality in the higher ALI group (Table 2). After multivariable adjustment, the hazard ratios (HRs) for all-cause and respiratory disease mortality in the higher ALI group compared with the lower ALI group were 0.64 (95% CI, 0.53–0.78; p < 0.001) and 0.34 (95% CI 0.21–0.55, p < 0.001), respectively. When considered as a continuous variable, for every 10-unit increase in ALI, the multivariable-adjusted HR for all-cause mortality was 0.97 (95% CI, 0.94-1.00; p = 0.032), and for respiratory disease mortality, it was 0.85 (95% CI, 0.77–0.93; p < 0.001).

Table 2 Multivariable analysis on the association of ALI and vitamin D with all-cause and respiratory disease mortality among US patients with asthma aged 20 years or older, NHANES, 2001–2018
Full size table

We used time-dependent ROC curves to compare the predictive ability of ALI and its component factors at 1-year, 5-year, and 10-year time points. For 1-year, 5-year and 10-year all-cause mortality, the area under the curve (AUC) values of ALI were superior to the component factors, including NLR, albumin, neutrophil, lymphocyte and BMI. The results showed that the AUC of ALI was 74.05% (95% CI 64.39–83.71), 65.99% (95% CI 61.70–70.28), and 62.91% (95% CI 59.28–66.54) for 1-year, 5-year and 10-year all-cause mortality, respectively (Fig. 2; Table 3).

Fig. 2
figure 2

Comparison of the ability of ALI with its component factors in predicting the survival outcome of patients with asthma using ROC curves. Abbreviations: ROC: receiver operating characteristics curve; ALI: advanced lung cancer inflammation index; NLR: neutrophil-lymphocyte ratio; ALB: albumin; NEU: neutrophil; LYM: lymphocyte; BMI: body mass index; AUC: area under the curve

Full size image
Table 3 Time-dependent AUC values of the ALI and its component factors for predicting all-cause mortality
Full size table

Association of serum vitamin D with mortality

Vitamin D status was significantly associated with all-cause and respiratory disease mortality in asthma patients. After adjusting for multiple factors, those with vitamin D deficiency had an increased risk of all-cause (HR, 2.06; 95% CI, 1.50–2.83) and respiratory disease (HR, 2.73; 95% CI, 1.24-6.00) mortality compared with those with vitamin D sufficiency. The risks of all-cause and respiratory disease mortality decreased by 8% and 16%, respectively, for each 10-nmol/L increase in the serum vitamin D concentration (Table 2).

Non-linearity/ linearity association between ALI or vitamin D and mortality

We conducted RCS analysis to visualize the relationship of ALI and vitamin D with all-cause mortality. After multivariable adjustment, the RCS analysis (Fig. 3) revealed a nonlinear L-shaped association between ALI levels and all-cause mortality among asthma patients (nonlinear p < 0.0001). With the ALI increasing, the HRs for all-cause mortality gradually decreased and became flat after ALI > 95. However, there was a negative linear association between vitamin D level and all-cause mortality (nonlinear p = 0.2414).

Fig. 3
figure 3

Association of ALI (A) or vitamin D (B) with all-cause mortality among patients with asthma visualized by restricted cubic spline. Hazard ratios were adjusted for age, sex, race, family poverty income ratio, education level, smoking status, drinking status, diabetes, hypertension, cancer and eGFR. The reference values of ALI and vitamin were 63.07 and 60.26, respectively, for estimating all Hazard ratios. The shaded areas indicate the 95% CI. Abbreviations: ALI: advanced lung cancer inflammation index; CI: confidence interval; eGFR: estimated glomerular filtration rate

Full size image

Joint association of ALI and vitamin D with mortality

We attempted to explore the combined effect of ALI and serum vitamin D on mortality to make further stratification in the prognosis of asthma patients. In joint analyses, the combination of higher ALI and higher vitamin D levels could significantly reduce all-cause and respiratory disease mortality risks in patients with asthma (Fig. 4; Table 4). The higher ALI and vitamin D sufficiency subgroup had the best prognosis. Specifically, patients with higher ALI levels (> 50.07) and vitamin D ≥ 50 nmol/L had the lowest risk of all-cause mortality compared to those who were lower ALI levels and vitamin D < 30 nmol/L (HR, 0.31; 95% CI, 0.19–0.52). Similar associations existed in respiratory disease mortality. The HR (95% CI) for the higher ALI and vitamin D sufficiency subgroup were 0.17 (0.09–0.34), compared to the lower ALI (≤ 50.07) and lower vitamin D levels (< 50 nmol/L) subgroup. The combination of ALI and vitamin D predicts mortality risks more accurately than either alone.

Fig. 4
figure 4

Joint association of ALI and serum vitamin D level with all-cause and respiratory disease mortality among US asthma patients aged 20 years or older, NHANES, 2001–2018. (A) All-cause mortality. (B) Respiratory disease mortality. The solid symbols indicate HRs, and the error bars indicate 95% CIs. Abbreviations: ALI: advanced lung cancer inflammation index; NHANES: the National Health and Nutrition Examination Survey; HR: hazard ratio; CI: confidence interval

Full size image
Table 4 Multivariable analysis on the joint association of ALI and vitamin D with all-cause and respiratory disease mortality among US asthma patients aged 20 years or older, NHANES, 2001–2018
Full size table

Sensitivity analyses

In sensitivity analyses, when subgroup analyses were conducted based on age (< 60 or ≥ 60 years) and sex (male or female), the inverse associations of ALI and vitamin D with mortality risks remained consistent (Additional file 1: Table S1-S2). Similar results were observed after excluding participants who died within two years of follow-up (Additional file 1: Table S3-S4). Asthma patients with ALI > 50.07 and vitamin D ≥ 50 nmol/L still had reduced all-cause (HR, 0.41; 95% CI, 0.23–0.75) and respiratory disease (HR, 0.29; 95% CI, 0.13–0.66) mortality risks.

Discussion

This study offers valuable insights into the role of the advanced lung cancer inflammation index (ALI) and serum vitamin D levels in predicting mortality in asthma patients. Our findings demonstrate that both ALI and serum vitamin D have significant independent and combined effects on mortality risks in asthma patients, offering potential for enhanced prognostic assessment in asthma management.

Previous studies showed that individuals with severe asthma had a significantly higher level of inflammatory cells and cytokines in blood and airway tissues [24, 25]. The changes of inflammation were related to the exacerbation and control in asthma [5]. Additionally, systemic inflammation can reduce serum albumin concentrations by increasing capillary permeability and hypoalbuminemia is often present in chronic inflammatory diseases [26]. A prospective cohort study showed that malnutrition was a significant predictor of mortality for inpatients [27]. Thus, inflammation and malnutrition may adversely affect the prognosis for asthma patients. The BMI and albumin are commonly used in the clinic to evaluate the nutritional status of patients. Studies have found that low body mass index and low albumin were associated with worse overall survival in oesophageal cancer patients [28]. The ALI, which integrates BMI, serum albumin, and the neutrophil-lymphocyte ratio (NLR), can show better prognostic performance by assessing inflammation and nutritional status, as evidenced by the superior AUC value of ALI in our analysis. Whether as a continuous or a categorical variable, ALI was an independent prognostic factor for asthma patients. This underscores the importance of using composite indices to better capture the multifaceted nature in asthma.

Vitamin D deficiency and insufficiency is a global health issue, and it affects many asthma patients [18, 19]. Similarly, our study found that the prevalence of vitamin D deficiency and insufficiency (< 50nmol/L) in asthma patients (≥ 20 years old) was 27.31%. Besides, most observational studies have revealed an inverse association between vitamin D status and mortality among general population, while the impact of vitamin D on mortality among asthma patients remains inconclusive [29,30,31]. Our study, focusing on the asthma population, revealed that reduced vitamin D concentrations were associated with an increased risk of overall and respiratory disease mortality. Similar results were observed in chronic obstructive pulmonary disease (COPD) that patients with lower serum vitamin D levels had an increased risk of death [32]. It is indicated that serum vitamin D is an effective complementary index for prognosis assessment in asthma.

Interestingly, the joint analysis of ALI and vitamin D levels sheds new light on their synergistic prognostic value in asthma. The combination of ALI and vitamin D stratify the prognosis more precisely, highlighting the potential for using these metrics together in clinical practice. For instance, patients with both high ALI and sufficient vitamin D levels exhibited the lowest risks of all-cause and respiratory disease mortality. This can be attributed to the immune-modulatory and anti-inflammatory effects of vitamin D, which include the induction of regulatory T cells, suppression of Th2 and Th17 responses, enhancement of IL-10 production, and inhibition of airway remodeling [33, 34]. Vitamin D can exert a beneficial effect on asthma through diverse mechanisms.

An L-shaped non-linear correlation was observed between ALI levels and all-cause mortality, manifesting that the RCS curve flattened gradually in the latter. This may be due to the impact of BMI. Evidence suggests that obesity is a risk factor for asthma, both in children and adults [35]. In this study, the average BMI level in the higher ALI group was significantly higher than the lower ALI group. Hence, although maintaining an appropriate BMI can bolster resistance to diseases, an excessively high BMI may have an adverse effect on the prognosis of asthma. On the other hand, the linear relationship between vitamin D levels and mortality underscores the need for continuous monitoring and potential supplementation to maintain optimal vitamin D status.

Our sensitivity analyses confirm the robustness of our findings across different age groups and sexes, and even when excluding patients who died within two years of follow-up. This reinforces the reliability of ALI and vitamin D as prognostic tools, applicable across diverse patient subgroups.

While this study provides new insights, there are limitations to consider. The observational nature of the NHANES data inherently introduces the possibility of reporting errors or recall bias, and the study’s reliance on baseline measurements may not account for changes in ALI and vitamin D levels over time. Future studies should explore longitudinal changes in these indices and their impact on mortality. Additionally, research focusing on mechanisms underlying the observed associations could provide further understanding of how ALI and vitamin D influence asthma outcomes.

Conclusions

In conclusion, our study highlights the significant prognostic value of ALI and serum vitamin D in asthma patients. Both ALI and vitamin D are valuable individually, but their combined assessment offers a more comprehensive mortality prediction tool. These findings advocate for integrating ALI and vitamin D measurements into routine clinical practice to enhance the prognostic evaluation and management of asthma patients.

Data availability

All data analyzed during this study are publicly available on the NHANES website (https://www.cdc.gov/nchs/nhanes/index.htm).

Abbreviations

ALI:

Advanced lung cancer inflammation index (calculated by multiplying BMI by albumin and dividing by NLR)

AUC:

Area under the curve

BMI:

Body mass index

CI:

Confidence interval

eGFR:

Estimated glomerular filtration rate

HR:

Hazard ratio

NHANES:

National Health and Nutrition Examination Survey

NLR:

Neutrophil-to-lymphocyte ratio

PIR:

Poverty income ratio

ROC:

Receiver operating characteristics curve

References

  1. Collaborators GOCRRF. Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the global burden of disease study 2019. EClinicalMedicine. 2023;59:101936.

    Article  Google Scholar 

  2. Ulrik CS, Frederiksen J. Mortality and markers of risk of asthma death among 1,075 outpatients with asthma. Chest. 1995;108(1):10–5.

    Article  CAS  PubMed  Google Scholar 

  3. Luo W, Hu J, Xu W, Dong J. Distinct spatial and temporal roles for TH1, TH2, and TH17 cells in asthma. Front Immunol. 2022;13:974066.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Abdo M, Pedersen F, Kirsten AM, Veith V, Biller H, Trinkmann F, et al. Longitudinal impact of sputum inflammatory phenotypes on small airway dysfunction and disease outcomes in asthma. J Allergy Clin Immunol Pract. 2022;10(6):1545–53.

    Article  PubMed  Google Scholar 

  5. Wang R, Usmani OS, Chung KF, Sont J, Simpson A, Bonini M, et al. Domiciliary fractional exhaled nitric oxide and spirometry in monitoring asthma control and exacerbations. J Allergy Clin Immunol Pract. 2023;11(6):1787–95.

    Article  CAS  PubMed  Google Scholar 

  6. Ke J, Qiu F, Fan W, Wei S. Associations of complete blood cell count-derived inflammatory biomarkers with asthma and mortality in adults: a population-based study. Front Immunol. 2023;14:1205687.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Mochimaru T, Ueda S, Suzuki Y, Asano K, Fukunaga K. Neutrophil-to-lymphocyte ratio as a novel independent predictor of severe exacerbation in patients with asthma. Ann Allergy Asthma Immunol. 2019;122(3):337–9.

    Article  PubMed  Google Scholar 

  8. Alwarith J, Kahleova H, Crosby L, Brooks A, Brandon L, Levin SM, et al. The role of nutrition in asthma prevention and treatment. Nutr Rev. 2020;78(11):928–38.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Picado C, Deulofeu R, Lleonart R, Agustí M, Casals E, Quintó L, et al. Lipid and protein metabolism in asthma. Effects of diet and corticosteroid therapy. Allergy. 1999;54(6):569–75.

    Article  CAS  PubMed  Google Scholar 

  10. Jafri SH, Shi R, Mills G. Advance lung cancer inflammation index (ALI) at diagnosis is a prognostic marker in patients with metastatic non-small cell lung cancer (NCLC): a retrospective review. BMC Cancer. 2013;13:158.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Liu XR, Wang LL, Zhang B, Liu XY, Li ZW, Kang B, et al. The advanced lung cancer inflammation index is a prognostic factor for gastrointestinal cancer patients undergoing surgery: a systematic review and meta-analysis. World J Surg Oncol. 2023;21(1):81.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Li Q, Ma F, Wang JF. Advanced lung cancer inflammation index predicts survival outcomes of hepatocellular carcinoma patients receiving immunotherapy. Front Oncol. 2023;13:997314.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Song M, Zhang Q, Song C, Liu T, Zhang X, Ruan G, et al. The advanced lung cancer inflammation index is the optimal inflammatory biomarker of overall survival in patients with lung cancer. J Cachexia Sarcopenia Muscle. 2022;13(5):2504–14.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chen Y, Guan M, Wang R, Wang X. Relationship between advanced lung cancer inflammation index and long-term all-cause, cardiovascular, and cancer mortality among type 2 diabetes mellitus patients: NHANES, 1999–2018. Front Endocrinol. 2023;14:1298345.

    Article  Google Scholar 

  15. Tu J, Wu B, Xiu J, Deng J, Lin S, Lu J, et al. Advanced lung cancer inflammation index is associated with long-term cardiovascular death in hypertensive patients: National health and nutrition examination study, 1999–2018. Front Physiol. 2023;14:1074672.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yuan X, Huang B, Wang R, Tie H, Luo S. The prognostic value of advanced lung cancer inflammation index (ALI) in elderly patients with heart failure. Front Cardiovasc Med. 2022;9:934551.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Wang X, Wei C, Fan W, Sun L, Zhang Y, Sun Q, et al. Advanced lung cancer inflammation index for predicting prognostic risk for patients with acute coronary syndrome undergoing percutaneous coronary intervention. J Inflamm Res. 2023;16:3631–41.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Li F, Peng M, Jiang L, Sun Q, Zhang K, Lian F, et al. Vitamin D deficiency is associated with decreased lung function in Chinese adults with asthma. Respiration. 2011;81(6):469–75.

    Article  CAS  PubMed  Google Scholar 

  19. Freishtat RJ, Iqbal SF, Pillai DK, Klein CJ, Ryan LM, Benton AS, et al. High prevalence of vitamin D deficiency among inner-city African American youth with asthma in Washington, DC. J Pediatr -US. 2010;156(6):948–52.

    Article  Google Scholar 

  20. Brehm JM, Celedón JC, Soto-Quiros ME, Avila L, Hunninghake GM, Forno E, et al. Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Am J Respir Crit Care Med. 2009;179(9):765–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Brehm JM, Schuemann B, Fuhlbrigge AL, Hollis BW, Strunk RC, Zeiger RS, et al. Serum vitamin D levels and severe asthma exacerbations in the childhood asthma management program study. J Allergy Clin Immunol. 2010;126(1):52–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Sutherland ER, Goleva E, Jackson LP, Stevens AD, Leung DY. Vitamin D levels, lung function, and steroid response in adult asthma. Am J Respir Crit Care Med. 2010;181(7):699–704.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Ross AC, Taylor CL, Yaktine AL, editors. Dietary reference intakes for calcium and vitamin D. Washington (DC): National Academies (US); 2011. pp. 13–4.

    Google Scholar 

  24. Jatakanon A, Uasuf C, Maziak W, Lim S, Chung KF, Barnes PJ. Neutrophilic inflammation in severe persistent asthma. Am J Respir Crit Care Med. 1999;160(5 Pt 1):1532–9.

    Article  CAS  PubMed  Google Scholar 

  25. Zhang Q, Fu X, Wang C, Shen H, Zhu L, Shi G, et al. Severe eosinophilic asthma in Chinese C-BIOPRED asthma cohort. Clin Transl Med. 2022;12(2):e710.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN J Parenter Enter Nutr. 2019;43(2):181–93.

    Article  CAS  Google Scholar 

  27. Lim SL, Ong KC, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31(3):345–50.

    Article  PubMed  Google Scholar 

  28. Chen N, Yu Y, Shen W, Xu X, Fan Y. Nutritional status as prognostic factor of advanced oesophageal cancer patients treated with immune checkpoint inhibitors. Clin Nutr. 2024;43(1):142–53.

    Article  CAS  PubMed  Google Scholar 

  29. Song S, Lyu J, Song BM, Lim JY, Park HY. Serum 25-hydroxyvitamin D levels and risk of all-cause and cause-specific mortality: a 14-year prospective cohort study. Clin Nutr. 2024;43(9):2156–63.

    Article  CAS  PubMed  Google Scholar 

  30. Zittermann A, Iodice S, Pilz S, Grant WB, Bagnardi V, Gandini S. Vitamin D deficiency and mortality risk in the general population: a meta-analysis of prospective cohort studies. Am J Clin Nutr. 2012;95(1):91–100.

    Article  CAS  PubMed  Google Scholar 

  31. Durazo-Arvizu RA, Dawson-Hughes B, Kramer H, Cao G, Merkel J, Coates PM, et al. The reverse j-shaped association between serum total 25-hydroxyvitamin D concentration and all-cause mortality: the impact of assay standardization. Am J Epidemiol. 2017;185(8):720–6.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Færk G, Çolak Y, Afzal S, Nordestgaard BG. Low concentrations of 25-hydroxyvitamin D and long-term prognosis of COPD: a prospective cohort study. Eur J Epidemiol. 2018;33(6):567–77.

    Article  PubMed  Google Scholar 

  33. Litonjua AA, Weiss ST. Is vitamin D deficiency to blame for the asthma epidemic? J Allergy Clin Immunol. 2007;120(5):1031–5.

    Article  CAS  PubMed  Google Scholar 

  34. Salameh L, Mahmood W, Hamoudi R, Almazrouei K, Lochanan M, Seyhoglu S et al. The role of vitamin D supplementation on airway remodeling in asthma: a systematic review. Nutrients. 2023;15(11).

  35. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(4):1169–79.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors appreciate all participants who contributed to the NHANES data we analyzed. We also appreciate funders for providing the financial support to conduct the present study.

Funding

This work was supported by the National Natural Science Foundation of China (82270089, 81870068, 82070063, 81900066), National College Students’ Innovation and Entrepreneurship Training Program (202312121006), Guangdong Basic and Applied Basic Research (2014A030313269), Southern Medical University Nanfang Hospital Education Research (22NJ-YB03), and Guangzhou Science and Technology Plan Project (202201010990).

Author information

Author notes

  1. Ting Li and Qi Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou North Road, Guangzhou, 510515, China

    Ting Li, Qi Wang, Manyu Chen, Bihua Deng, Lin Liang, Weixian Lin, Yuying Lin & Ying Meng

  2. Department of Respiratory and Critical Care Medicine, Ganzhou Hospital-Nanfang Hospital, Ganzhou, 341000, China

    Ting Li

  3. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China

    Yuhan Li

  4. Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Wenyong Zhang

Authors
  1. Ting Li
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Qi Wang
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Yuhan Li
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Wenyong Zhang
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Manyu Chen
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Bihua Deng
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Lin Liang
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Weixian Lin
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Yuying Lin
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. Ying Meng
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

Y. M. contributed to the study design and revised the manuscript. T. L. and Q. W. conducted analyses and drafted the manuscript. T. L., Y. Li and M. C. were responsible for investigation and methodology. Y. Li, W. Z. and B. D. conducted data interpretation. L.L., W.L. and Y. Lin were responsible for supervision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ying Meng.

Ethics declarations

Ethics approval and consent to participate

The protocols of NHANES were approved by the Institutional Review Board of the National Center of Heath Statistics (https://www.cdc.gov/nchs/nhanes/irba98.htm). All participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, T., Wang, Q., Li, Y. et al. Predictive effects of advanced lung cancer inflammation index and serum vitamin D on mortality in patients with asthma. Nutr J 24, 26 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12937-024-01065-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12937-024-01065-6

Keywords

Nutrition Journal

ISSN: 1475-2891

Contact us