Dietary fatty acids intake and the risk of advanced cardiovascular-kidney-metabolic syndrome: evidence from NHANES 1999–2018

Cardiovascular-Kidney-Metabolic syndrome (CKM) is a multisystem disorder involving cardiovascular, renal, and metabolic dysfunction, with advanced stages (3-4) linked to high morbidity and mortality. Dietary fatty acids (FA) play critical roles in lipid metabolism, insulin sensitivity, and inflammation, yet their associations with CKM progression remain unclear. Data were from National Health and Nutrition Examination Survey, with stages 3-4 defined as advanced CKM. Dietary intake of total fat acids (TFA), saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) was derived from two 24-h recalls and energy-adjusted using the residual method. Multivariable logistic regression and restricted cubic splines assessed associations between FA and advanced CKM. Sensitivity and subgroup analyses were also performed. Among 27,166 participants (median age: 55.0 years; 52.2% male), 6,634 were classified in advanced CKM stages (3-4). Multivariable logistic regression showed that higher intakes of TFA, SFA, and MUFA were significantly associated with advanced CKM. Compared with the lowest quartile, adjusted odds ratios in the highest quartile were 1.35 (95% CI: 1.05-1.40), 1.26 (95% CI: 1.09-1.37), 1.30 (95% CI: 1.10-1.55), and 1.26 (95% CI: 1.09-1.47), respectively. Restricted cubic spline analyses supported positive linear associations across all four fatty acid categories. Findings remained robust in sensitivity analyses excluding cancer patients, and consistent across key subgroups, with no significant interactions observed. Higher dietary intakes of TFA, SFA, MUFA, and PUFA were associated with greater odds of advanced CKM stages. These findings suggest that dietary fat quantity and composition may be important correlates of CKM severity and warrant further investigation in prospective studies.