Exploring racial-specific associations between the food inflammation index(FII) and metabolic dysfunction-associated fatty liver disease (MAFLD) Prevalence: Data from the National Health and Nutrition Examination Survey 1999-2020.

The Food Inflammation Index (FII) is a novel indicator for assessing the impact of diet on systemic inflammation. Unlike the Dietary Inflammation Index, which focuses on nutrients, the FII quantifies specific foods, providing greater applicability to real-world dietary assessments. To date, no study has examined the association between FII and the prevalence of Metabolic dysfunction-associated fatty liver disease (MAFLD). This study aimed to investigate the relationship between FII and MAFLD. This cross-sectional study included 25,067 individuals aged ≥ 20 years from the 1999 to 2020 National Health and Nutrition Examination Survey (NHANES). Univariate and multivariate logistic regression analyses were performed to explore the relationship between FII and MAFLD. Nonlinear associations between FII and MAFLD were examined using restricted cubic spline (RCS) analysis. Subgroup analyses, interaction tests, and threshold effect analyses were conducted to assess differences across groups. The prevalence of MAFLD was 44.45%. FII was positively associated with MAFLD in all models (Models 1, 2, and 3, P < .05). In model 3, individuals in the highest tertile of FII had an odds ratio (OR) of 1.21 [95% confidence interval (CI): 1.11-1.32] for MAFLD, compared to those in the lowest tertile. Subgroup analyses and interaction tests revealed sex- and race-specific associations between FII and MAFLD. Among non-Hispanic whites, the optimal FII threshold for preventing MAFLD was found to be -11.56. A lower FII was associated with a lower prevalence of MAFLD. The impact of FII on MAFLD prevalence was more pronounced among non-Hispanic whites compared to other racial groups. An FII score of < -11.56 for daily food intake was associated with a reduced risk of MAFLD in non-Hispanic whites.