EAT-Lancet Dietary Pattern Adherence and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Cross-Sectional...

Adopting the EAT-Lancet planetary health diet has been proposed as a beneficial approach to addressing the growing global burden of metabolic dysfunction-associated steatotic liver disease (MASLD), although evidence from Middle Eastern populations is limited.

We aimed to examine the association between adherence to the EAT-Lancet planetary health diet and MASLD, while assessing potential dose-response relationships and effect modification by sex.

Data were drawn from the Amol Cohort Study, a population-based cross-sectional investigation in northern Iran. Dietary intake was assessed using a culturally adapted 168-item food frequency questionnaire, from which an adherence score to the EAT-Lancet framework was created. Clinicians diagnosed MASLD using standardized abdominal ultrasonography. Odds ratios (ORs) were estimated using multivariable logistic regression, adjusting for key covariates. Analyses were further stratified by sex, and potential dose-response patterns were examined.

Among 2937 participants, individuals with MASLD (n = 1177; 40%) exhibited less favorable metabolic profiles, including higher BMI and waist circumference, elevated blood pressure, fasting glucose, aminotransferases, and C-reactive protein concentrations (all P < 0.0001). In fully adjusted models, participants in the highest quartile of EAT-Lancet diet adherence had lower odds of prevalent MASLD than those in the lowest quartile (OR: 0.62; 95% confidence interval: 0.48, 0.82; P-trend = 0.004). This inverse association was observed in both sexes, with a greater magnitude among females. Sensitivity analyses, in which each food group was excluded from the score, indicated that fish, legumes, eggs, and potatoes contributed materially to the observed protective association.

Closer adherence to the EAT-Lancet dietary pattern was associated with a lower prevalence of MASLD in this Iranian population, particularly among females. These findings provide observational evidence supporting a potential role of plant-forward dietary patterns in metabolic liver health, while underscoring the need for prospective and interventional studies to clarify causality.