This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Jun 27, 2025; 17(6): 107931 Published online Jun 27, 2025. doi: 10.4254/wjh.v17.i6.107931
Dietary ω-3 polyunsaturated fatty acid intake improves skeletal muscle mass in patients with metabolic dysfunction-associated fatty liver disease: A nationwide cross-sectional study
Li-Zhan Bie, Chao Wu, Jia-Lu Wang
Li-Zhan Bie, Department of Cardiology, Affiliated Hospital 6 of Nantong University, Yancheng Third People’s Hospital, Yancheng 224000, Jiangsu Province, China
Chao Wu, Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
Jia-Lu Wang, Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Co-first authors: Li-Zhan Bie and Chao Wu.
Author contributions: Wang JL and Bie LZ designed the study, analysis and interpretation, and were primarily responsible for drafting and revising the manuscript; Wang JL, Wu C and Bie LZ were responsible for statistical analysis and methodology; Bie LZ and Wu C were deeply involved in data analysis and interpretation; Wang JL providing significant review and editing contributions. All authors were involved in data interpretation, reviewed the manuscript, and approved the final version.
Supported by The National Natural Science Foundation of China, No. 82103356.
Institutional review board statement: This study was approved by the National Center for Health Statistic Ethics Review Board.
Informed consent statement: This study was approved by the National Center for Health Statistic Ethics Review Board.
Conflict-of-interest statement: The authors declare no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: March 31, 2025 Revised: April 22, 2025 Accepted: June 4, 2025 Published online: June 27, 2025 Processing time: 86 Days and 1.3 Hours
Abstract
BACKGROUND
Improving our understanding of whether increased dietary intake of ω-3 polyunsaturated fatty acids (PUFAs) is beneficial for increasing skeletal muscle mass in patients with metabolic dysfunction-associated fatty liver disease (MAFLD) could provide an important clinical evidence base for the development of relevant nutritional guidelines.
AIM
To investigate the effect of total dietary ω-3 PUFAs and their subtypes on skeletal muscle mass in MAFLD.
METHODS
This cross-sectional study involved 2316 participants from four National Health and Nutrition Examination Survey cycles between 2011 and 2018. Dietary intake of ω-3 PUFAs was collected through 24-hour dietary recall interviews. Appendicular skeletal muscle mass index (ASMI) was calculated by dividing ASM in kilograms by height squared.
RESULTS
The multiple linear regression model showed significant relationships for dietary intake of total ω-3 PUFAs with higher ASMI (β: 0.06, 95%CI: 0.01–0.11) in MAFLD patients. Dietary a-linolenic acid (ALA) (β: 0.06, 95%CI: 0.01–0.12), docosapentaenoic acid (β: 1.28, 95%CI: 0.01–2.54), and docosahexaenoic acid (DHA) (β: 0.19, 95%CI: 0.01–0.37) were significantly associated with higher ASMI, while intake of stearidonic acid and eicosapentaenoic acid did not improve ASMI. In patients with high probability of liver fibrosis, dietary intake of ALA was associated with higher ASMI (β: 0.11, 95%CI: 0.03–0.18). Stratified analysis found that DHA was associated with higher ASMI in patients with obesity and higher metabolic risk.
CONCLUSION
Increasing dietary intake of ω-3 PUFAs improved skeletal muscle health in patients with MAFLD. Patient with obesity and higher metabolic risk were more likely to benefit from intake of DHA.
Core Tip: This study found that dietary intake of ω-3 polyunsaturated fatty acids improved skeletal muscle mass in patients with metabolic dysfunction-associated fatty liver disease, and patients with obesity and higher metabolic risk were more likely to benefit from supplementation with docosahexaenoic acid. These results fill a gap in muscle nutrient metabolism in patients with fatty liver disease.
