Association between dietary flavonoids intake and metabolic dysfunction-associated steatotic liver disease especially in non-smokers: a cross-sectional study in US adults

Abstract

Abstract Background The association between dietary flavonoids and fatty liver disease is still controversial. This study investigated the link between dietary flavonoids intake and metabolic-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD). Methods The study utilized data from the National Health and Nutrition Examination Survey cycles of 2007–2010 and 2017–2018. The relationship between dietary flavonoids intake and the prevalence of MAFLD/MASLD was evaluated using multivariate logistic regression models. Subgroup and population attributable fraction were employed to investigate the prevalence of MAFLD/MASLD in different smoking status groups. Results The study included 5,645 participants. The fully adjusted multivariate logistic regression model indicated no significant association between ln flavonoids and MAFLD/MASLD (p > 0.05). Restricted cubic spline analysis identified a nonlinear relationship between ln flavonoids and MAFLD/MASLD, with 4.747 and 4.409 as the turning points, respectively. Subgroup and population attributable fraction analyses revealed that the negative association between flavonoids and MAFLD/MASLD is particularly significant in non-smokers. Mediation analysis indicated that the low-grade inflammation played a crucial role in the association. The study’s robustness was validated through sensitivity analyses. Conclusions Our study highlighted a U-shaped association between ln flavonoids and MAFLD/MASLD, influenced by low-grade inflammation. Encouraging a flavonoid-rich diet is crucial for managing MAFLD/MASLD in non-smokers.

Keywords

• Flavonoids
• Metabolic-associated fatty liver disease
• Metabolic dysfunction-associated steatotic liver disease
• NHANES
• Low-grade inflammation
• Smoking status