Association between plant-based diets and risk of metabolic dysfunction–associated steatotic liver disease in Korean adults: A prospective cohort study

Abstract

Objectives

Few studies have investigated the correlation between plant-based diet indices (PDIs) and the risk of metabolic dysfunction-associated steatotic liver disease (MASLD) in the Korean population. Therefore, this study aimed to investigate the association between PDIs and the risk of MASLD in Korean adults.

Methods

This cohort study utilized data from the Health Examinees Study conducted in the South Korean population. Dietary and nutrient intake were assessed at baseline and follow-up using a food frequency questionnaire and the Korean Food Consumption Table. Food items were categorized into overall PDI, healthy PDI (hPDI), and unhealthy PDI (uPDI), with MASLD defined using the fatty liver index. Baseline characteristics and food intake groups were evaluated based on PDI quintiles and stratified by sex. Further analyses involved stratification by age, body mass index, alcohol intake, and physical activity in men and women.

Results

Over a median follow-up period of 4.2 y, MASLD occurred in 1532 participants. Both men and women in the highest hPDI quintile had a reduced risk of MASLD (men: HR: 0.71, 95% CI: 0.55–0.91, p = 0.0031; women: HR: 0.61, 95% CI: 0.48–0.78, p < 0.0001). Conversely, the highest uPDI quintile was associated with a higher risk of MASLD.

Conclusions

This cohort study revealed an association of the overall PDI and hPDI with a lower risk of MASLD, highlighting the importance of adhering to these types of plant-based diets to prevent MASLD among Korean adults.