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

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.