In the fully adjusted model 3, we adjusted for parameters including age, ALP, GGT, TC, ALB, DBIL, CR and BUN, and the HRs of the ZJU index and NAFLD in Q2, Q3 and Q4 were 3.67 (95% CI 2.43 to 5.55), 9.82 (95% CI 6.67 to 14.45) and 21.67 (95% CI 14.82 to 31.69). This evidence concerns the gene ALB and metabolic dysfunction-associated steatotic liver disease.