Elena S. George, Ayesha Sualeheen, Christine Freer, Ekavi N Georgeousopoulou, Stuart K Roberts, Robin M Daly, Sze‐Yen Tan
Abstract Mediterranean diet (MedDiet) is central to metabolic dysfunction-associated steatotic liver disease (MASLD) management; however, evidence in non-Mediterranean populations is limited. This study examined the association between MedDiet adherence and MASLD, hospitalisation and mortality in a non-Mediterranean population. This longitudinal study included 119 536 UK Biobank adults with at least one 24-hour dietary recall and available sociodemographic and clinical data. Diet quality was assessed using the Modified-Mediterranean Diet Score (M-MedDietScore). MASLD was determined by fatty liver index (FLI) at baseline and by liver imaging in a subgroup. Hospitalisation and mortality data were obtained from linked records, with MASLD outcomes identified using International Classification of Diseases, 10th Revision codes. Binary logistic regression and Cox proportional hazard models estimated Odds Ratio (OR) for MASLD and hazard ratio (HR) for hospitalisation and mortality. Each five-unit increase in M-MedDietScore was associated with 19 % lower OR of MASLD as identified by FLI and confirmed in the imaging sub-analysis in a multivariate adjusted Model 2. Higher adherence to the MedDiet was associated with lower HR of hospitalisation due to liver-related, CVD, diabetes, respiratory and renal disease (all P < 0·05). During a median follow-up of 9·7 years, 5552 deaths occurred. Higher MedDiet adherence was associated with lower HR of all-cause, CVD and extrahepatic cancer mortality and lower all-cause mortality risk in those with MASLD (HR: 0·94, 95 % CI: 0·90, 0·98). Higher adherence to the MedDiet was associated with lower odds of MASLD and with reduced MASLD-related hospitalisations and mortality and lower all-cause mortality in those with MASLD. These findings support the role of MedDiet in reducing hepatic and cardiovascular burden in non-Mediterranean population.