Association between dietary patterns and cardiovascular mortality in patients with metabolic dysfunction-associated steatotic liver disease.

Purpose: Given the heightened cardiovascular risk in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), identifying dietary patterns associated with reduced cardiovascular risk is essential. This study aimed to investigate the association between adherence to various dietary patterns and cardiovascular disease (CVD) mortality in a middle-aged Korean MASLD population.

Methods: Baseline data from 32,091 adults aged 40 years and older enrolled in the Korean Genome and Epidemiology Study (KoGES) between 2004 and 2013 were analyzed. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire, and principal component analysis was applied to identify distinct dietary patterns. The primary outcome was CVD mortality, assessed using Cox proportional hazards models adjusted for confounders, including age, sex, body mass index, smoking status, alcohol intake, physical activity, total calorie intake, hypertension, diabetes, and dyslipidemia.

Results: Adherence to the Korean Mediterranean-style diet was associated with a significantly reduced risk of CVD mortality in MASLD patients, with those in the highest Korean Mediterranean-style diet pattern quartile having a 33% lower risk than those in the lowest quartile (hazards ratio: 0.67, 95% confidence interval: 0.45-1.00, p = 0.048). Other dietary patterns, including the processed food and dairy diet, animal protein-rich diet, grain-based diet, as well as refined carbohydrate and fat-rich diet, were not significantly associated with CVD mortality.

Conclusions: Adherence to Korean Mediterranean-style diet pattern was associated with a lower risk of CVD mortality in Korean adults with MASLD, highlighting its potential as an effective dietary strategy for managing cardiovascular risk in MASLD patients, even in non-Western populations.