Association of serum carotenoids, steatotic liver disease, and metabolic dysfunctions with all-cause and cardiovascular disease mortality.

Carotenoids have been associated with a lower risk of mortality in the general population. However, their association with mortality among individuals with steatotic liver disease is unclear. This study investigated the relationship between serum carotenoids with all-cause and cardiovascular disease (CVD) mortality among individuals with and without steatotic liver disease and whether the presence of metabolic dysfunctions might modify this association. This study used data from the Third National Health and Nutrition Examination Survey, with mortality follow-up through 31 December 2019. Total serum carotenoids were calculated based on the serum levels of α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin, and lycopene. Cox proportional hazards regression models were employed to assess the association between serum carotenoids and all-cause and CVD mortality in individuals with and without steatotic liver disease, in unadjusted and adjusted models for metabolic dysfunctions (obesity, diabetes, CVD). The results showed that higher serum levels of total and most individual carotenoids were associated with a lower risk of all-cause and CVD mortality, independent of steatotic liver disease. Furthermore, steatotic liver disease was also independently associated with all-cause mortality. These associations were generally consistent after adjusting for metabolic dysfunctions, though β-carotene was no longer associated with CVD mortality, and the association between steatotic liver disease and all-cause mortality was no longer significant. Findings from this study demonstrated that total and most individual serum carotenoids were associated with a lower risk of all-cause and CVD mortality in both individuals with and without steatotic liver disease, even after adjusting for metabolic dysfunctions.