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

Table 1 Baseline characteristics of adults by gender from National Health and Nutrition Examination Survey 2011–2018, n (%)/mean ± SD

	Overall (n = 2316)	Male (n = 1107)	Female (n = 1209)	P value1
Age (year)	40.5 ± 11.0	41.5 ± 11.2	40.6 ± 10.9	0.02
Race				< 0.001
Mexican American	381 (11.2)	184 (11.3)	197 (11.0)
Other Hispanic	258 (7.4)	123 (7.4)	135 (7.3)
Non-Hispanic White	879 (63.5)	459 (66.8)	420 (59.8)
Non-Hispanic Black	586 (12.7)	229 (9.2)	357 (16.7)
Other or multiracial	212 (5.2)	112 (5.2)	100 (5.2)
Education level				0.45
Less than high school graduate	412 (11.9)	199 (11.4)	213 (12.6)
High school graduate or equivalent	547 (24.9)	275 (26.2)	272 (23.4)
Some college or above	1357 (63.2)	633 (62.5)	724 (64.0)
PIR				< 0.001
< 1.3	781 (23.1)	308 (18.1)	473 (28.8)
1.3–3.5	906 (37.7)	441 (36.8)	465 (38.8)
> 3.5	629 (39.2)	358 (45.1)	271 (32.4)
Marital status				< 0.001
Married or living with partner	1419 (65.5)	746 (69.8)	673 (60.8)
Divorced, separated, or widowed	363 (14.4)	120 (10.8)	243 (18.0)
Never married	534 (20.1)	241 (19.4)	293 (21.3)
Current smoker				0.79
Yes	524 (21.8)	262 (21.3)	262 (22.3)
No	1792 (78.2)	845 (88.7)	947 (77.7)
Current drinker				< 0.001
Yes	1556 (73.3)	862 (81.0)	694 (64.6)
No	760 (26.7)	242 (19.0)	513 (35.4)
Diabetes				0.47
Yes	440 (15.7)	203 (15.5)	237 (16.0)
No	1876 (84.3)	904 (84.5)	970 (84.0)
Hypertension				0.001
Yes	1165 (48.4)	616 (54.0)	549 (42.0)
No	1151 (51.6)	491 (46.0)	658 (58.0)
BMI, kg/m2	35.0 ± 6.1	33.9 ± 5.8	36.1 ± 6.2	< 0.001
ASMI, kg/m2	9.1 ± 1.6	10.0 ± 1.4	8.3 ± 1.4	< 0.001
Omega-3 PUFAs, g/day	1.9 ± 1.2	2.2 ± 1.3	1.7 ± 1.0	< 0.001
NFS	-1.5 ± 1.3	-1.6 ± 1.3	-1.4 ± 1.3	0.001

¹P value was determined by analysis of variance for continuous variables and ² test for categorical variables.

PUFAs: Polyunsaturated fatty acids; ALA: α-Linolenic acid; SDA: Stearidonic acid; EPA: Eicosapentaenoic acid; DPA: Docosapentaenoic acid; DHA: Docosahexaenoic acid; PIR: Income to poverty ratio; BMI: Body mass index; ASMI: Appendicular skeletal muscle mass index; NFS: Non-alcoholic fatty liver disease fibrosis score.

Table 2 Dietary intake of different ω-3 polyunsaturated fatty acids by gender, median (25^th-75^th percentiles)

	Overall	Male	Female	P value1
ALA, 18:3 (n = 2316)	1.57 (1.05, 2.27)	1.75 (1.21, 2.48)	1.43 (0.93, 2.06)	< 0.001
SDA, 18:4 (n = 1720)	0.01 (0.00, 0.01)	0.00 (0.00, 0.01)	0.00 (0.00, 0.00)	< 0.001
EPA, 20:5 (n = 2252)	0.01 (0.00, 0.02)	0.01 (0.01, 0.02)	0.01 (0.00, 0.02)	< 0.001
DPA, 22:5 (n = 2278)	0.02 (0.01, 0.03)	0.02 (0.01, 0.04)	0.02 (0.01, 0.02)	< 0.001
DHA, 22:6 (n = 2225)	0.02 (0.01, 0.06)	0.03 (0.01, 0.07)	0.02 (0.01, 0.06)	0.001

¹P value was determined by analysis of variance.

ALA: α-Linolenic acid; SDA: Stearidonic acid; EPA: Eicosapentaenoic acid; DPA: Docosapentaenoic acid; DHA: Docosahexaenoic acid.

Table 3 Relationship between different ω-3 polyunsaturated fatty acids intake and appendicular skeletal muscle mass index from National Health and Nutrition Examination Survey 2011-2018 using weighted multiple linear regression analyses¹

	Model 1, β (95%CI)	Model 2, β (95%CI)	Model 3, β (95%CI)
ω-3 PUFAs (n = 2316)	0.19 (0.11, 0.27)	0.07 (0.02, 0.12)	0.06 (0.01, 0.11)
ALA, 18:3 (n = 2316)	0.19 (0.11, 0.28)	0.07 (0.01, 0.12)	0.06 (0.01, 0.12)
SDA, 18:4 (n = 1720)	1.40 (-0.23, 3.10)	0.63 (-0.57, 1.83)	0.53 (-0.69, 1.80)
EPA, 20:5 (n = 2252)	0.49 (-0.34, 1.32)	0.20 (-0.50, 0.90)	0.12 (-0.56, 0.80)
DPA, 22:5 (n = 2278)	4.13 (0.94, 7.41)	1.50 (0.27, 2.73)	1.28 (0.01, 2.54)
DHA, 22:6 (n = 2225)	0.32 (0.04, 0.61)	0.23 (0.05, 0.41)	0.19 (0.01, 0.37)

¹β and their 95%CIs were obtained though weighted multiple linear regression analyses. Model 1 No adjusted. Model 2 Adjusted for age, sex and body mass index. Model 3 Adjusted for age, sex, body mass index, race and ethnicity, education level, marital status, income to poverty ratio, current smoker and current drinker.

PUFAs: Polyunsaturated fatty acids; BMI: Body mass index; PIR: Income to poverty ratio; ALA: α-Linolenic acid; SDA: Stearidonic acid; EPA: Eicosapentaenoic acid; DPA: Docosapentaenoic acid; DHA: Docosahexaenoic acid.

Table 4 Relationship between different ω-3 polyunsaturated fatty acids intake and appendicular skeletal muscle mass index in different probability of advanced liver fibrosis from National Health and Nutrition Examination Survey 2011–2018 using weighted multiple linear regression analyses

	Model 1 β (95%CI)	Model 2 β (95%CI)	Model 3 β (95%CI)
NFS ≥ 1.455 (n = 975)
ω-3 PUFAs	0.28 (0.15, 0.41)	0.16 (0.07, 0.24)	0.11 (0.03, 0.18)
ALA, 18:3	0.29 (0.15, 0.43)	0.17 (0.08, 0.26)	0.11 (0.03, 0.18)
SDA, 18:4	0.87 (-2.30, 4.10)	0.61 (-1.60, 2.80)	0.74 (-1.10, 2.60)
EPA, 20:5	0.85 (-1.10, 2.80)	0.45 (-0.92, 1.80)	0.63 (-0.82, 2.10)
DPA, 22:5	3.50 (-0.31, 7.20)	1.50 (-0.21, 3.10)	1.60 (-0.44, 3.60)
DHA, 22:6	0.33 (-0.02, 0.68)	0.18 (-0.03, 0.39)	0.12 (-0.01, 0.53)
NFS < 1.455 (n = 1341)
ω-3 PUFAs	0.15 (0.07, 0.24)	0.02 (-0.04, 0.08)	0.01 (-0.04, 0.07)
ALA, 18:3	0.14 (0.05, 0.23)	0.01 (-0.05, 0.07)	0.01 (-0.06, 0.07)
SDA, 18:4	2.20 (0.16, 4.30)	1.20 (-0.62, 3.10)	0.60 (-1.10, 2.30)
EPA, 20:5	0.39 (-0.47, 1.20)	0.23 (-0.86, 1.30)	0.08 (-0.61, 0.77)
DPA, 22:5	5.50 (1.10, 9.80)	1.60 (-0.49, 3.70)	1.50 (-0.75, 3.80)
DHA, 22:6	0.32 (-0.16, 0.79)	0.26 (-0.04, 0.56)	0.19 (-0.06, 0.44)

BMI: Body mass index; PIR: Income to poverty ratio; NFS: Non-alcoholic fatty liver disease fibrosis score; PUFAs: Polyunsaturated fatty acids; ALA: α-Linolenic acid; SDA: Stearidonic acid; EPA: Eicosapentaenoic acid; DPA: Docosapentaenoic acid; DHA: Docosahexaenoic acid.