Dietary Polyphenol Intake Inversely Associates with Fibrosis Scores in Individuals with MASLD

Background & aims. Plant-based dietary patterns, such as the Mediterranean diet, are considered protective against MASLD. The Mediterranean diet is rich in polyphenols (PP), plant-derived metabolites that exhibit anti-fibrotic effects in experimental models. This study aimed to evaluate the association between dietary polyphenol intake and fibrosis scores in patients with MASLD. Methods. The study population comprised two retrospective cohorts, MICOL and NUTRIHEP, from southern Italy. Polyphenol intake was assessed using the EPIC food frequency questionnaire, and the food content of polyphenols was quantified using Phenol-Explorer. Liver fibrosis severity was assessed by MAF-5 and FIB-4. Results. In a multivariable regression analysis adjusted for several potential confounders, comparing 381 patients with MAF-5 < 0 vs. 94 with MAF-5 > 1, consumption of total PP above the median (382.0-1356.8 mg/day) was associated with lower odds of high MAF-5 (OR 0.49; 95% CI 0.25-0.94; p = 0.031). Regarding PP subclasses, individuals with higher intakes of anthocyanins (15.00-252.00 mg/day) and stilbenes (0.04-0.55 mg/day) had lower odds of MAF-5 > 1 (OR 0.52; 95% CI 0.27-0.99; p = 0.045 and OR 0.49; 95% CI 0.27-0.92; p = 0.025, respectively). Considering PP sources, total flavonoid intake from fruit (≥60 mg/day) was associated with reduced high MAF-5 odds (OR 0.49; 95% CI: 0.24-0.99; p = 0.045), driven by fruit-derived anthocyanins (OR 0.52; 95% CI: 0.28-0.97; p = 0.04). A higher intake of PP from extra virgin olive oil was also associated with a 50% reduction in the odds of MAF-5 > 1 (OR 0.50; 95% CI: 0.26-0.96; p = 0.037). Conclusions. In this exploratory study, a higher dietary polyphenol intake may protect against fibrosis in patients with MASLD.