Association Between Spicy Food Consumption and the Risk of Non-Alcoholic Fatty Liver Disease/Metabolic Dysfunction-Associated Steatotic Liver Disease and Liver Fibrosis

Na Zhao^*Huimin LiuYan WangYun HeNing ZhangYuan Li^*

• Second Hospital of Hebei Medical University, Shijiazhuang, China

Abstract Introduction: Evidence suggested that capsaicin may protect against steatotic liver disease (SLD), but these findings lack validation in population-based studies. This research aimed to explore the association between spicy food consumption and the risk of non-alcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) and liver fibrosis. Methods: A total of 23,666 participants aged 25 to 60, free from NAFLD, MASLD, and liver fibrosis, were recruited from a multi-center physical examination database in Shijiazhuang, Hebei Province, China, between 2011 and 2024. Cox proportional hazards regression model assessed the association between spicy food consumption and incident NAFLD/MASLD and advanced liver fibrosis. Restricted cubic spline (RCS) functions estimated the dose-response relationship. Subgroup and sensitive analyses evaluated heterogeneity based on various characteristics, while sensitivity analyses tested the robustness of results. Results: There were 42.2% of participants who reported consuming spicy food at least once per week. In this cohort study, a total of 7,965 patients with NAFLD and 7,311 patients with MASLD were identified after a median follow-up period of 12.6 years. Those who consumed spicy food more than once a week had a significantly lower risk of NAFLD/MASLD compared to non-consumers, indicating a dose-response relationship. However, this association was not observed in advanced liver fibrosis. Conclusion: Weekly spicy food consumption was inversely associated with risk of incident NAFLD/MASLD, but not advanced liver fibrosis.