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Association of dietary phytosterols with prevalence of metabolic dysfunction-associated fatty liver disease in adult population of Northeastern China: An internet-based cross-sectional study
doi: 10.1515/fzm-2025-0005
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Abstract:
Objective The benefits of phytosterols have attracted growing interest, but their association with Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) has rarely been reported in population-based studies. This research aimed to investigate the correlation between dietary phytosterols and MAFLD. Methods Phytosterols intake was evaluated using an internet-based dietary questionnaire targeted at the Chinese population. Conditional logistic regression models were employed to investigate dose-response relationships between phytosterol intake and MAFLD, as well as the potential preventive role of phytosterols. Restricted Cubic Spline (RCS) analyses were conducted to examine associations between phytosterols intake and MAFLD. Additionally, a quantile-based g-computation (qgcomp) method was applied to explore the combined effect of campesterol, stigmasterol, β-sitostelane, campestane, and β-sitosterol on MAFLD. Results Significant inverse relationships were found between total phytosterols and MAFLD (OR, 0.19; 95% CI, 0.11-0.32; P < 0.001), campesterol (OR, 0.22; 95% CI, 0.13-0.37; P < 0.001), stigmasterol (OR, 0.17; 95% CI, 0.10-0.30; P < 0.001), β-sitostelane (OR, 0.26; 95% CI, 0.16-0.45; P < 0.001), campestane (OR, 0.23; 95% CI, 0.14-0.39; P < 0.001), and β-sitosterol (OR, 0.17; 95% CI, 0.10-0.29; P < 0.001). The qgcomp analysis showed a significant negative association between the five phytosterols and MAFLD (OR, 0.58; 95% CI, 0.50-0.67; P < 0.001). Additionally, the qgcomp analysis revealed that the combination of these five phytosterols was inversely associated with MAFLD, with stigmasterol contributing the most (weight = 0.70). Conclusion Higher intake of phytosterols was associated with a reduced prevalence of MAFLD, with stigmasterol showing the most significant inverse relationship. Further research is needed to clarify the relationship between phytosterols and MAFLD. -
Figure 2. Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI) for MAFLD by quartile of phytosterols dietary intake
All models were adjusted for energy intake, age, gender, BMI, alcohol consumption, smoking, work intensity, education level, and income.
Figure 3. Restricted multivariable cubic spline plots illustrating the association between phytosterols intake and the risk of MAFLD
(A) Total phytosterols; (B) Campesterol; (C) Sigmasterol; (D) β-Sitostelane; (E) Campestane; (F) β-Sitosterol. All models were adjusted for energy intake, age, gender, BMI, alcohol consumption, smoking, work intensity, education level, and income.
Figure 4. Qgcomp model regression index weights for each phytosterol in relation to MAFLD
The model was adjusted by energy intake, age, gender, BMI, alcohol consumption, smoking, work intensity, education levels, and income.
Table 1. Basic demographic information and nutrients intake of the subjects
Variable Control (n = 1216) MAFLD (n = 304) P value Demographic factors Age, year 53.01 ± 12.59 52.98 ± 12.57 0.97 Male, n (%) 456 (37.50) 114 (37.50) Female, n (%) 740 (66.07) 185 (66.07) BMI, kg/m2 24.11 ± 2.96 27.22 ± 3.59 < 0.01 Smoking, (%current) 164 (13.49) 30(9.87) 0.11 Drinking, (%current) 191 (15.71) 25(8.22) < 0.01 Income per month, Yuan, n (%) < 0.01 < 1000 221 (18.17) 52(17.11) 1000-2000 296 (24.34) 58(19.08) 2000-3000 359 (29.52) 77(25.33) 3000-4000 192 (15.79) 42(13.82) 4000-5000 88 (7.24) 27(8.88) 5000-6000 33 (2.71) 26(8.55) > 6000 27 (2.22) 22(7.24) Education levels, n (%) < 0.01 Junior school and below 533 (43.83) 94(30.92) Senior high school or equivalent 257 (21.13) 78(25.66) College or equivalent 399 (32.81) 117 (38.49) Postgraduate or above 27 (2.22) 15(4.93) Work intensity, n (%) Light 780 (64.14) 249 (81.91) < 0.001 Medium 168 (13.82) 31(10.20) Heavy 268 (22.04) 24(7.89) Dietary factors Energy, kcal/day 2150.37 ± 773.51 2072.02 ± 707.80 0.11 Protein, g/day 80.46 ± 14.75 82.75 ± 16.68 < 0.05 Fat, g/day 66.00 ± 20.75 62.38 ± 19.75 < 0.01 Carbohydrates, g/day 311.41 ± 52.13 318.08 ± 46.88 < 0.05 β-Sitosterol, mg/day 629.26 ± 548.63 453.11 ± 553.48 < 0.01 Campesterol, mg/day 63.20 ± 44.14 48.76 ± 43.94 < 0.01 Stigmasterol, mg/day 60.99 ± 37.88 44.61 ± 39.16 < 0.01 β-Sitostelane, mg/day 65.69 ± 75.18 48.66 ± 70.32 < 0.01 Campestane, mg/day 164.43 ± 193.50 120.61 ± 179.37 < 0.01 Total phytosterols, mg/day 1009.44 ± 813.08 725.43 ± 846.66 < 0.01 The P values were determined using the Chi-squared test for categorical variables, Student's t-test for continuous variables. Data were expressed as mean ± SD, and as frequencies and percentages where appropriate; MAFLD: non-alcoholic fatty liver disease. 
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