Association between provitamin A carotenoid-rich foods intake and metabolic dysfunction-associated steatotic liver disease risk: mediating effects of socioeconomic status and healthy lifestyle

Metabolic dysfunction-associated steatotic liver disease (MASLD) was very common worldwide and was associated with metabolic syndrome, modifiable lifestyle factors, and socioeconomic status (SES). Although provitamin A carotenoid-rich foods have shown potential protective effects against MASLD, there was limited population-based evidence in this regard, and the mediating role of healthy lifestyle and SES in the association of carotenoids induced MASLD was still unclear. This study aimed to assess the association of provitamin A carotenoid-rich foods intake with MASLD risk, and the mediating effects of healthy lifestyle and SES. Provitamin A carotenoid-rich foods intake was assessed using a 24-hour recall data from the National Health and Nutrition Examination Survey (NHANES). The United States Fatty Liver Index (USFLI) value ≥30 was used to define the MASLD status. SES (education/income) and healthy lifestyle (smoking/drinking/physical activity) were categorized via latent class analysis. Multivariable logistic regression and mediation analysis were used for analyses. A total of 6613 participants (mean [SD] age 50.8 [17.7] years; 53.6% female) were included. Provitamin A carotenoid-rich foods intake was inversely associated with MASLD risk (adjusted OR, 0.684; 95% CI: 0.532-0.879). SES (mediation proportion, 12.92%) and healthy lifestyle (16.84%) exerted significant mediating effects. Subgroup analyses showed stronger associations in females (OR, 0.572; 95% CI: 0.406-0.805) and adults aged <45 years (OR, 0.519; 95% CI: 0.367-0.734). Higher provitamin A carotenoid-rich foods intake was associated with lower MASLD risk, partially mediated by SES and healthy lifestyle. This provided a feasible dietary strategy for MASLD prevention, especially in females and younger adults.