Wu Wenhao, Cheng Jiacheng, Hou Zebin, Yan Qi, Wang Xiaojuan, He Junhua, Zhu Yikun, Li Jin
Department of Endocrinology and Metabolism, The Second Hospital of Shanxi Medical University, Shanxi Medical University, 56 Xin Jian Road, Taiyuan, 030000, Shanxi, People's Republic of China.
Department of Thyroid Surgery, Shanxi Provincial People's Hospital, Taiyuan, 030000, Shanxi, People's Republic of China.
Diabetol Metab Syndr. 2025 Jul 11;17(1):263. doi: 10.1186/s13098-025-01846-x.
Nutrient interactions with the gut microbiome modulate the development of metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular disease. The dietary index for gut microbiota (DI-GM) is an innovative and comprehensive diet index to assess quality for health of gut microbiota.
This is a cohort study from the interview date to the date of death or the end of follow-up (December 31, 2019). Involving 13,390 participants in National Health and Nutrition Examination Survey (NHANES), including 3538 with MASLD and 9852 without MASLD. DI-GM was calculated using 14 foods and nutrients with clear positive or negative impacts on gut microbiota, and MASLD was assessed based on liver steatosis and cardiometabolic risk factors, with all-cause and cardiovascular mortality determined through probabilistic matching and death certificate review. Restricted Cubic Spline (RCS) analysis and Cox regression were palyed for the DI-GM-mortality correlation. Subgroup analyses to identify the interactive factors that influence their relationship in MASLD. Six sensitivity analyses reinforced findings.
MASLD participants exhibited lower DI-GM levels, which were statistically associated with higher mortality. Each DI-GM unit increase in MASLD was associated with a 13% lower all-cause mortality (HR = 0.87, 95% CI 0.78-0.98) and a 19.5% lower cardiovascular mortality (HR = 0.805, 95% CI 0.690-0.938). In advanced fibrosis MASLD, this increase was linked to a 20% lower cardiovascular mortality risk (HR = 0.800, 95% CI 0.691-0.927). Age and prediabetes significantly modified DI-GM's effect on mortality risk.
The study revealed a significant inverse correlation between the DI-GM and all-cause/cardiovascular mortality in patients with MASLD, which provide dietary suggestions and guidance for MASLD patients in preventing early mortality. However, limitations such as the cross-sectional design, potential residual confounding, and population-specific generalizability should be considered when interpreting these findings.
营养素与肠道微生物群的相互作用会调节代谢功能障碍相关脂肪性肝病（MASLD）和心血管疾病的发展。肠道微生物群饮食指数（DI-GM）是一种创新的综合饮食指数，用于评估肠道微生物群的健康质量。
这是一项从访谈日期至死亡日期或随访结束（2019年12月31日）的队列研究。纳入了美国国家健康与营养检查调查（NHANES）的13390名参与者，其中包括3538名患有MASLD的参与者和9852名未患有MASLD的参与者。DI-GM通过对肠道微生物群有明确正向或负向影响的14种食物和营养素进行计算，MASLD根据肝脏脂肪变性和心脏代谢危险因素进行评估，全因死亡率和心血管死亡率通过概率匹配和死亡证明审查确定。采用受限立方样条（RCS）分析和Cox回归分析DI-GM与死亡率的相关性。进行亚组分析以确定影响MASLD中它们关系的交互因素。六项敏感性分析强化了研究结果。
MASLD参与者的DI-GM水平较低，这与较高的死亡率在统计学上相关。MASLD中DI-GM每增加一个单位，全因死亡率降低13%（HR = 0.87，95%CI 0.78 - 0.98），心血管死亡率降低19.5%（HR = 0.805，95%CI 0.690 - 0.938）。在晚期纤维化MASLD中，这种增加与心血管死亡风险降低20%相关（HR = 0.800，95%CI 0.691 - 0.927）。年龄和糖尿病前期显著改变了DI-GM对死亡风险的影响。
该研究揭示了DI-GM与MASLD患者的全因/心血管死亡率之间存在显著的负相关，这为MASLD患者预防早期死亡提供了饮食建议和指导。然而，在解释这些发现时，应考虑横断面设计、潜在的残余混杂因素和特定人群的普遍性等局限性。
