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Nutritional Epidemiology

Category: Nutritional Epidemiology (II) (Poster Session)

Nutritional Epidemiology (II) (Poster Session)

(P26-15-26) Diet Quality Attenuates the Association Between Flavonoid Intake and Hepatic Steatosis Risk in the Framingham Heart Study

Sunday, July 26, 2026
9:30 AM - 10:30 AM ET
Location: Poster Board C-62

    Presenting Author(s)

  • VG

    Vincent Gao, BS

    Medical Student
    University of Missouri
    St. Louis, Missouri, United States

    • Co-Author(s)

  • PJ

    Paul F. Jacques, DSc

    Professor
    Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University
    Boston, Massachusetts, United States

  • JM

    Jiantao Ma, Ph.D.

    Assistant Professor Division of Nutrition Data Science
    Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy at Tufts University
    Boston, Massachusetts, United States

Disclosure(s):
Vincent Gao, BS: No relevant financial relationship(s) with ineligible companies to disclose.


Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. Flavonoids may offer protective benefits against MASLD, but the role of overall diet quality in modifying this association remains unclear.

Methods: We analyzed 2,907 participants from the Framingham Heart Study Offspring and Third Generation cohorts. Hepatic steatosis was defined by liver-to-phantom ratio < 0.33 using multidetector computed tomography. Dietary intake was assessed using a validated food frequency questionnaire. Intake of six flavonoid subclasses (flavanones, anthocyanins, flavan-3-ols, flavonoid polymers, flavonols, and flavones) and total flavonoid was estimated using the USDA database. Logistic regression models were used to evaluate associations between quartiles of flavonoid intake and hepatic steatosis, adjusted for demographic and lifestyle covariates, with additional models adjusting for Alternative Healthy Eating Index, Dietary Approaches to Stop Hypertension score, or Mediterranean Diet Score.

Results: Higher intake of flavonols, flavan-3-ols, anthocyanidins, flavonoid polymers, and total flavonoids was significantly associated with lower odds of hepatic steatosis (Ptrend < 0.05). Strongest effects were observed in the highest quartiles, with up to 40% reduced odds before adjustment for diet quality. After adjusting for dietary quality scores, these associations were attenuated and lost statistical significance.

Conclusions: The attenuation of associations does not necessarily negate a potential protective effect of flavonoids; it may reflect that higher flavonoid intake is an especially important element of a broader healthy diet. Alternatively, the observed associations could be confounded by other components of a healthy diet which may independently reduce hepatic steatosis risk. Nonetheless, these findings underscore the importance of promoting flavonoid-rich diets in the context of overall healthy diet and support further investigation in prospective and interventional studies targeting MASLD prevention.

Funding Sources: The Framingham Heart Study was supported by NIH contracts N01-HC-25195, HHSN268201500001I, and 75N92019D00031.