Nuts and Seeds Consumption Mitigates Mortality Risk in MAFLD: A Comprehensive Cohort Analysis with Optimal Intake Insights

Abstract

Abstract Background Recently, the designation "Metabolic Associated Fatty Liver Disease" (MAFLD) has emerged to more holistically depict the disease's multifaceted nature. Within this framework, patients are stratified as either metabolically healthy (MH) or metabolically unhealthy (MU). The unique nutrient composition of nuts and seeds (NUTSDS) suggests potential health advantages, potentially mitigating premature mortality risks.This research delves into the impact of NUTSDS consumption on all-cause mortality within the diverse MAFLD categories. Methods We embarked on a prospective cohort investigation involving 13,762 participants, drawn from a nationally representative pool of the National Health and Nutrition Examination Survey. Mortality events and underlying causes were tracked through a linkage with death records until December 31, 2019. To elucidate the connection between NUTSDS intake and mortality across MAFLD categories, we employed both the Weighted Cox proportional hazards regression and Restricted Cubic Spline (RCS) analytical methods.The robustness of our results is further buttressed by a series of stratified and sensitivity assessments. Results Out of the 13,762 studied participants, representing a weighted national estimate of 58,212,532individuals, 62.73% were MAFLD-diagnosed. Among them, 7.79% were MH-MAFLD, and 54.95% were MU-MAFLD. Over 135,552.9 person-years (median follow-up of 9.58 years), there were 1,558 recorded deaths. The fully adjusted Cox model demonstrated a 15% reduced risk of all-cause mortality with NUTSDS intake (HR, 0.85; 95%CI, 0.74–0.97) in the MAFLD group and a similar risk reduction in the MU-MAFLD group (HR, 0.86; 95%CI, 0.76–0.98). Notably, no such associations were found in the Non-MAFLD and MH-MAFLD groups. RCS analyses suggested a U-shaped mortality curve with optimal NUTSDS consumption levels at 3.79 oz/day for MAFLD and 3.87 oz/day for MU-MAFLD. Conclusions These insights accentuate the prospective protective effects of NUTSDS consumption against all-cause mortality in MAFLD individuals, especially salient in the MU-MAFLD demographic.