Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a salient public health concern. Dietary factors, including dairy intake, have been identified as potential risk factors; however, evidence in Asian populations remains limited. This prospective cohort study aimed to examine the association between dairy product consumption and MASLD risk among Korean adults using data from the Health Examinees study. A total of 44,471 participants aged 40-69 years and without any liver disease at baseline were included. Dairy intake for milk, yogurt, and cheese was evaluated using a validated food frequency questionnaire. MASLD was defined by the fatty liver index (FLI) ≥60. Cox proportional hazards models were used to estimate hazard ratio (HR) and 95% confidence interval (CI), with adjustments for sociodemographic, lifestyle, and dietary factors. During an average follow-up of 4.5 years, 760 incident MASLD cases occurred in men and 786 in women. Higher total dairy consumption was associated with a lower risk of MASLD in men. Specifically, those with the highest intake of milk and yogurt had a significantly lower risk compared to those with the lowest intake (total dairy consumption, HR 0.79 [95% CI 0.61-0.98]; milk, HR 0.74 [95% CI 0.57-0.96]; yogurt, HR 0.79 [95% CI 0.64-0.97]). No significant associations were observed for cheese consumption or among women. These findings indicate a potential inverse association between milk and yogurt intake and MASLD risk in Korean men, but not in women, suggesting sex-specific dietary influences on liver health. Given the observational design, causal inference cannot be made.
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