Higher Food Inflammation Index Score Tied to Greater MASLD Risk

A comprehensive analysis of over 25,000 adults reveals that a newly developed Food Inflammation Index (FII) demonstrates a significant linear relationship with the risk of metabolic dysfunction-associated steatotic liver disease (MASLD). The findings, published in Food Science & Nutrition, highlight growing evidence that diet‐induced inflammation plays a central role in MASLD pathogenesis and suggest the FII may be a superior dietary metric for assessing inflammatory potential compared with the widely used Dietary Inflammatory Index (DII).1

The link between proinflammatory diets and MASLD is supported by established pathophysiologic mechanisms. | Image credit: Crystal light - stock.adobe.com

The cross-sectional study, which analyzed National Health and Nutrition Examination Survey data collected between 1999 and 2020, found that every 1 standard deviation rise in FII scores corresponded to a 7.9% elevation in MASLD risk following adjustment for demographic characteristics, lifestyle behaviors, comorbid conditions, and medication usage (P = .004). The research included 25,067 participants with a mean age of 49.56 years, of whom 6,708 met MASLD diagnostic criteria based on a Fatty Liver Index score of 60 or higher combined with at least 1 cardiometabolic risk factor.

When comparing quartiles of FII scores, participants in the highest quartile demonstrated a 30.8% increased risk of MASLD compared to those in the lowest quartile (P < .001). This dose-response relationship remained linear across the entire spectrum of FII scores, with no threshold effects observed (P [overall] < .001, P [nonlinearity] = .545).

Compared to the well-established DII, the FII offers a refined approach, integrating 39 food components and accounting for intra-food group variability. The FII emphasizes multiple anti-inflammatory bioactive fatty acids, including various monounsaturated fatty acids and omega-3 polyunsaturated fatty acids such as alpha-linolenic acid, eicosapentaenoic acid, and docosahexaenoic acid. These specific fatty acids play crucial roles in the pathophysiology of MASLD.

The FII demonstrated equivalent discriminatory capacity to the DII for identifying MASLD risk, with virtually identical receiver operating characteristic curve areas of 0.867 and 0.866, respectively (P = .272). Despite this similarity in overall performance, the FII provided enhanced predictive accuracy, improving risk reclassification by 5.56% (P = .002) and enhancing discrimination by 0.05% (P = .015). “These findings indicate greater sensitivity to dietary inflammatory potential and establish the FII as a valuable tool for evaluating dietary contributions to MASLD, providing a basis for targeted nutritional interventions to reduce disease risk,” the investigators note.

The link between proinflammatory diets and MASLD is supported by established pathophysiologic mechanisms. Research has demonstrated that diets rich in proinflammatory saturated fats and refined carbohydrates promote oxidative stress, NF‐κB activation, and trigger cytokine release, accelerating the development of hepatic steatosis and fibrosis. Conversely, anti-inflammatory compounds such as flavonoids and dietary fiber, which receive emphasis in the FII, lower serum cholesterol levels and enhance insulin sensitivity, potentially slowing the progression of MASLD. The inclusion of monounsaturated and polyunsaturated fatty acids in the FII, compared to their limited representation in the DII, adds significant clinical nuance, recognizing their protective effects in MASLD and related metabolic disorders.

MASLD is a global public health challenge, with more than one-third of adults affected worldwide.2 Given that MASLD remains a condition with rising prevalence and no approved pharmacotherapy, tools like the FII could enable personalized nutrition counseling, particularly for patients with metabolic risk factors. “We recommend reducing high-FII foods (e.g., red meat, refined sugars) and increasing low-FII foods (e.g., vegetables, fruits) to lower MASLD risk,” investigators explain.

However, the study acknowledges several limitations, including its cross-sectional design, which precludes causal inference, reliance on the Fatty Liver Index rather than liver biopsy for MASLD diagnosis, and potential recall bias from 24-hour dietary assessments. While future longitudinal studies and randomized controlled trials examining FII-guided interventions will be necessary to establish causality and validate clinical utility across diverse populations, the investigators note that “The incorporation of the FII into personalized nutritional strategies may open new avenues for alleviating the global burden of MASLD and other inflammation-related diseases.”

References

1. Yang Q, Cai X, Xiao Z. Higher food inflammation index is linearly associated with higher risk of MASLD: A cross-sectional study based on the NHANES (1999-2020). Food Sci Nutr. 2025;13(9):e70865. doi:10.1002/fsn3.70865

2.Huang DQ, Wong VWS, Rinella ME, et al. Metabolic dysfunction-associated steatotic liver disease in adults. Nat Rev Dis Primers. 2025;11(1):14. doi:10.1038/s41572-025-00599-1