Association between carotenoid intake and metabolic dysfunction-associated fatty liver disease among US adults: A cross-sectional study

Abstract

Carotenoids have been recognized for their potential health benefits due to their antioxidant properties. There is limited research on the association between metabolic dysfunction-associated fatty liver disease (MAFLD) and carotenoids. This study aimed to investigate the effect of carotenoid intake on the risk of MAFLD. We retrospectively analyzed 2722 adults aged ≥ 18 from the National Health and Nutrition Examination Survey 2017-2018. Hepatic steatosis was identified by elastography, and carotenoid consumption was evaluated through two 24-hour dietary recall interviews. Weighted logistic regression models, subgroup analyses, and restricted cubic splines were used for analyses. The weighted prevalence of MAFLD was 51.90%. Weighted logistic regression analysis demonstrated that intake of β-carotene, lutein/zeaxanthin, and lycopene was associated with a lower risk of MAFLD after adjusting for various covariates. Compared to the lowest tertile, a significant inverse correlation was observed between the highest total lycopene intake and MAFLD among females in the gender subgroup analysis. Restricted cubic spline regression analysis revealed a U-shaped association between lycopene consumption and MAFLD risk (P < .001), with an inflection point of approximately 9.48 mg/day. Moreover, the nonlinear relationship was particularly significant in females and absent in males. In summary, increased β-carotene, lutein/zeaxanthin, and lycopene consumption was associated with a decreased risk of MAFLD. The relationship between total lycopene intake and MAFLD was nonlinear, primarily in females. These findings have significant implications for the potential prevention and management of MAFLD.

Figure 1.

Flowchart of the sample selection from NHANES 2017–2018. BMI = body mass index, CAP = controlled attenuation parameter, IQR = interquartile range, NHANES = National Health and Nutrition Examination Survey, MEC = mobile examination center, VCTE = vibration-controlled transient elastography, PIR = poverty-income ratio.

Figure 2.

Weighted logistic regression analysis models showing the association between MAFLD risk and carotenoid intake. Crude model: Unadjusted model. Model 1: Adjusted for age, gender, race/ethnicity, educational level, and poverty-income ratio. Model 2: Additionally adjusted for body mass index, waist circumference, physical activity, sedentary behavior, smoking status, hypertension, diabetes mellitus, metabolic syndrome, ALT, AST, γ-GT, TG, LDL-C, FINS, FPG, HbA1c, Hs-CRP, and total calories. γ-GT = gamma-glutamyl transferase, ALT = alanine aminotransferase, AST = aspartate aminotransferase, FINS = fasting insulin, FPG = fasting plasma glucose, HbA1c = glycohemoglobin, Hs-CRP = high-sensitivity C-reactive protein, LDL-C = low-density lipoprotein cholesterol, MAFLD = metabolic dysfunction-associated fatty liver disease, OR = odd ratio, TG = triglyceride.

Figure 3.

Restricted cubic spline depicts the association between total lycopene intake and MAFLD: (A) Restricted cubic spline analysis among all survey subjects, (B) restricted cubic spline analysis across gender subgroups. The red, blue, and purple lines represent ORs, and the red, blue, and purple transparent areas represent 95% CIs. Restricted cubic spline models are adjusted for age, gender, race/ethnicity, educational level, poverty-income ratio, body mass index, waist circumference, physical activity, sedentary behavior, smoking status, hypertension, diabetes mellitus, metabolic syndrome, ALT, AST, γ-GT, TG, LDL-C, FINS, FPG, HbA1c, Hs-CRP, and total calories. γ-GT = gamma-glutamyl transferase, ALT = alanine aminotransferase, AST = aspartate aminotransferase, CI = confidence interval, FINS = fasting insulin, FPG = fasting plasma glucose, HbA1c = glycohemoglobin, Hs-CRP = high-sensitivity C-reactive protein, LDL-C = low-density lipoprotein cholesterol, MAFLD = metabolic dysfunction-associated fatty liver disease, TG = triglyceride.

Figure 4.

Restricted cubic spline demonstrates the association between total lycopene intake and MAFLD in sensitivity analysis: (A) Restricted cubic spline analysis among all survey subjects, (B) restricted cubic spline analysis across gender subgroups. The red, blue, and purple lines represent ORs, and the red, blue, and purple transparent areas represent 95% CIs. Restricted cubic spline models are adjusted for age, gender, race/ethnicity, educational level, poverty-income ratio, body mass index, waist circumference, physical activity, sedentary behavior, smoking status, hypertension, diabetes mellitus, metabolic syndrome, ALT, AST, γ-GT, TG, LDL-C4, FINS, FPG, HbA1c, Hs-CRP, and total calories. γ-GT = gamma-glutamyl transferase, ALT = alanine aminotransferase, AST = aspartate aminotransferase, CI = confidence interval, FINS = fasting insulin, FPG = fasting plasma glucose, HbA1c = glycohemoglobin, Hs-CRP = high-sensitivity C-reactive protein, LDL-C = low-density lipoprotein cholesterol, MAFLD = metabolic dysfunction-associated fatty liver disease, TG = triglyceride.