What question did this study set out to answer?

This research aims to explore the relationship between varying degrees of food processing and metabolic dysfunction-associated steatotic liver disease (MASLD).

April 23, 2026Nutrition & Metabolism0 citationsOpen Access

Food intakes based on degree of processing and metabolic dysfunction-associated steatotic liver disease (MASLD): the Tehran Lipid and Glucose Study (TLGS)

NMNazanin Moslehi FHFarhad Hosseinpanah PMParvin Mirmiran

Key Points

This research aims to explore the relationship between varying degrees of food processing and metabolic dysfunction-associated steatotic liver disease (MASLD).
Conducted a cross-sectional study among 2,376 adults participating in the Tehran Lipid and Glucose Study.
Food intake assessed via food frequency questionnaire using NOVA classification of food processing.
Logistic regression analyzed odds of MASLD related to food processing and energy substitution.
About 29.8% of participants had MASLD, with higher intake of ultra-processed foods linked to greater odds (OR = 1.24).
Higher consumption of minimally processed and processed culinary ingredients (MPF + PCI) associated with lower odds (OR = 0.77).
Substituting MPF + PCI with processed food increased odds of MASLD (OR = 1.14).

Abstract

Current evidence on the association between food processing and metabolic dysfunction-associated steatotic liver disease (MASLD) is limited to the intake of ultra-processed food (UPF). We investigated the associations between different degrees of food processing and MASLD. This cross-sectional study was conducted among 2,376 adults aged ≥ 18 years who participated in the third examination of the Tehran Lipid and Glucose Study. Food intake was assessed using a food frequency questionnaire and classified according to the NOVA definitions into unprocessed or minimally processed food (MPF), processed culinary ingredients (PCI), processed food (PF), and UPF. MASLD was defined as the fatty liver index combined with cardiometabolic criteria. Using logistic regression, we determined the odds of MASLD across age- and sex-specific tertiles of each food group. Substitution analyses were also conducted to estimate the odds of MASLD associated with the iso-caloric replacement of 10% of energy from one NOVA food group with 10% of energy from another food group. PF and UPF subgroup analyses were also performed. About one-third (29.8%) of the participants had MASLD. After adjusting for demographic, lifestyle, and eGFR variables, the highest tertile of MPF + PCI was associated with lower odds of MASLD ( (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.61, 0.97), while the highest UPF tertile was associated with higher odds, compared to the lowst tertile (OR = 1.24; 95% CI = 1.00, 1.57). These associations were attenuated after inclusion of total energy intake and healthy-eating index score (OR = 0.78; 95% CI = 0.61, 1.00 for MPF + PCI and OR = 1.22; 95% CI = 0.97, 1.54 for UPF). Among the UPF subgroups, ready-to-eat foods, salty snacks, and soft drinks were associated with higher odds of MASLD, while sweets were associated with lower odds. No significant association was found between PF or its subtypes and MASLD. However, replacing MPF + PCI with PF was associated with a higher odds of MASLD (OR = 1.14; 95% CI = 1.03, 1.25). High consumption of MPF + PCI was associated with lower odds of MASLD, whereas high consumption of certain UPFs was associated with higher odds.

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