Refined Carbohydrate, Different Staple Foods Intake and Risk of Metabolic Dysfunction-Associated Steatotic Liver Disease: A Prospective Community-Based Cohort Study

INTRODUCTION: Limited evidence exists regarding the association between intake of refined carbohydrates, different staple foods, and the risk of metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: We conducted a prospective cohort study among Chinese adults from Shanghai Suburban Adult Cohort and Biobank to investigate the associations between different carbohydrate foods and MASLD risk. Dietary intake was assessed by a validated food frequency questionnaire. MASLD was diagnosed by B-mode ultrasound with evaluation of cardiometabolic risk factors. RESULTS: A total of 12,134 participants were included. Over the median follow-up period of 4.32 years, there were 4,447 incident MASLD cases. Total refined carbohydrate intake was positively associated with MASLD incidence (hazard ratio [HR] 11+ vs 0-<4 servings per day 1.51, 95% confidence interval [CI] 1.20-1.89; HR per serving per day increase 1.04, 95% CI 1.01-1.06). Rice intake showed positive association (HR 10+ vs 0-<4 servings per day 1.43, 95% CI 1.18-1.74), whereas wheat (0.78, 0.70-0.86), coarse grains (0.86, 0.78-0.94), and yams (0.78, 0.67-0.90) showed inverse associations. When stratified by sex, the above significant associations remained in women but not in men. Replacing 1 serving of rice per day with wheat (0.92, 0.88-0.97) or coarse grain (0.94, 0.91-0.97) was associated with lower risk of MASLD. Low rice pattern score was negatively related with MASLD (Q4 vs Q1: 0.78, 0.71-0.86). DISCUSSION: Higher intake of total refined carbohydrate and rice was positively related with MASLD, and higher intake of wheat, coarse grains, and yams might mitigate the risk of MASLD in Chinese population. These results underscored the significance of dietary patterns in preventing MASLD.