Metabolic associated steatotic liver disease in Qatar: Analysis of dietary patterns and nutrient intake

Table 1 Sample characteristics of study patients, n (%)

Variable	Males (n = 34)	Females (n = 60)	Total (n = 94)	P value
Age (years)	47.9 (10.4)	50.6 (9.6)	49.6 (9.9)	0.216
Waist circumference (cm)	111.1 (13.1)	101.7 (21.2)	105.1 (19.2)	0.037a
Weight (kg)	96.5 (16.3)	85.4 (17.2)	89.4 (17.6)	0.003a
Body mass index	31.6 (5.0)	33.9 (6.5)	33.1 (6.1)	0.077
Body mass index classifications
Normal	3 (8.8)	3 (5.0)	6 (6.4)	0.763
Overweight	9 (26.5)	16 (26.7)	25 (26.6)
Obese	22 (64.7)	41 (68.3)	63 (67.0)
Nationality
Qatari	3 (8.8)	20 (33.3)	23 (24.5)	0.008a
Non-Qatari	31 (91.2)	40 (66.7)	71 (75.5)
Marital status
Single	1 (2.9)	3 (5.0)	4 (4.3)	0.548
Married	32 (94.1)	51 (85.0)	83 (88.3)
Divorced	1 (2.9)	4 (6.7)	5 (5.3)
Widowed	0 (0.0)	2 (3.3)	2 (2.1)
Education level
High school	6 (17.6)	22 (36.7)	28 (29.8)	0.030
Diploma	6 (17.6)	16 (26.7)	22 (23.4)
Bachelor or above	22 (64.7)	22 (36.7)	44 (46.8)
Work status
Work	32 (94.1)	28 (46.7)	60 (63.8)	< 0.001a
Don’t work	2 (5.9)	32 (53.3)	34 (36.2)
Work timings
Morning shift	25 (78.1)	23 (82.1)	48 (80.0)	0.180
Evening shift	0 (0.0)	2 (7.1)	2 (3.3)
Split shift	7 (21.9)	3 (10.7)	10 (16.7)
Special diet status
Yes	6 (17.6)	11 (18.3)	17 (18.1)	0.934
No	28 (82.4)	49 (81.7)	77 (81.9)
Meals consumed
1 meal	3 (8.8)	4 (6.7)	7 (7.4)	0.269
2 meals	23 (67.6)	30 (50.0)	53 (56.4)
3 meals	8 (23.5)	25 (41.7)	33 (35.1)
> 3 meals	0 (0.0)	1 (1.7)	1 (1.1)

^aP < 0.05.

Adapted from Eljazzar et al[26]. Copyright© 2025 Sereen Eljazzar, Souraia Mezhoud, Reema Tayyem. This work is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/Licenses/by/4.0/).

Table 2 Health-related characteristics of the study patients, n (%)

Variable		Male (n = 34)	Female (n = 60)	Total (n = 94)	P value
Health-related variables
Smoking status	Yes	11 (32.4)	1 (1.7)	12 (12.8)	< 0.001
	No	16 (47.1)	52 (86.7)	68 (72.3)
	Ex-smoker	7 (20.6)	7 (11.7)	14 (14.9)
Chronic disease status	Yes	25 (73.5)	48 (80.0)	73 (77.7)	0.469
	No	9 (26.5)	12 (20.0)	21 (22.3)
Prediabetes	Yes	32 (94.1)	48 (80.0)	80 (85.1)	0.065
	No	2 (5.9)	12 (20.0)	14 (14.9)
T2DM	No	17 (50.0)	36 (60.0)	53 (56.4)	0.348
	Yes	17 (50.0)	24 (40.0)	41 (43.6)
CVD	No	13 (38.2)	26 (43.3)	39 (41.5)	0.630
	Yes	21 (61.8)	34 (56.7)	55 (58.5)
HTN	No	22 (64.7)	41 (68.3)	63 (67.0)	0.719
	Yes	12 (35.3)	19 (31.7)	31 (33.0)
Thyroid	No	32 (94.1)	50 (83.3)	82 (87.2)	0.132
	Yes	2 (5.9)	10 (16.7)	12 (12.8)
Biochemical values
Hgb (gm/dL)		14.6 ± 1.6	12.7 ± 1.4	13.3 ± 1.7	< 0.001a
Ferritin (μg/L)		171.7 ± 212.3	70.5 ± 66.9	104.7 ± 141.7	0.003a
FBS (mmol/L)		7.0 ± 2.7	6.3 ± 1.7	6.6 ± 2.1	0.169
HbA1c (%)		6.3 ± 1.3	6.2 ± 1.1	6.2 ± 1.2	0.605
Cholesterol (mmol/L)		4.7 ± 1.1	4.9 ± 1.2	4.8 ± 1.2	0.296
TG (mmol/L)		2.2 ± 1.1	1.6 ± 0.7	1.8 ± 0.9	0.002a
HDL (mmol/L)		1.1 ± 0.4	1.4 ± 0.3	1.3 ± 0.4	< 0.001a
LDL (mmol/L)		2.7 ± 1.1	2.9 ± 1.1	2.8 ± 1.1	0.346
ALK (U/L)		84.7 ± 61.9	86.5 ± 41.0	85.9 ± 49.2	0.862
ALT (U/L)		35.8 ± 20.2	29.6 ± 28.0	31.9 ± 25.5	0.261
AST (U/L)		25.4 ± 10.1	22.9 ± 16.5	23.8 ± 14.5	0.431
Vitamin D (ng/mL)		28.5 ± 13.0	28.1 ± 12.1	28.2 ± 12.3	0.886
Vitamin B12 (pml/L)		312.1 ± 100.8	378.8 ± 252.2	356.8 ± 216.0	0.183
TSH (mIU/L)		1.9 ± 1.3	2.8 ± 5.7	2.5 ± 4.7	0.408
FT4 (pmol/L)		15.5 ± 1.6	14.5 ± 2.1	14.8 ± 2.0	0.024a
Uric acid (μmol/L)		376.6 ± 105.8	301.5 ± 69.6	326.1 ± 89.6	0.002a

^aP < 0.05.

T2DM: Type 2 diabetes mellitus; CVD: Cardiovascular disease; HTN: Hypertension; Hgb: Hemoglobin; FBS: Fasting blood sugar; HbA1c: Glycated hemoglobin; TG: Triglycerides; HDL: High density lipoprotein; LDL: Low-density lipoprotein; ALK: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TSH: Thyroid stimulating hormone; FT4: Free thyroxine 4. Adapted from Eljazzar et al[26]. Copyright© 2025 Sereen Eljazzar, Souraia Mezhoud, Reema Tayyem. This work is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/Licenses/by/4.0/).

Table 3 Mean intake of energy, macronutrients and micronutrients and others compared to recommended dietary allowance in patient with metabolic dysfunction-associated steatotic liver disease, mean ± SD

Nutrients	Males (n = 34)	Recommendations (males)1	Females (n = 60)	Recommendations (females)1	Total (n = 94)	P value
Energy (kcal)
Total calories	2307.4 ± 519.3	-	1897.2 ± 436.0	-	2045.5 ± 505.5	< 0.001a
Calories from fat	914.3 ± 325.3	-	713.4 ± 195.6	-	786.1 ± 266.9	< 0.001a
Calories from saturated fat	269.7 ± 150.3	-	224.4 ± 77.7	-	240.8 ± 111.0	0.057
Macronutrients
Protein (g)	100.3 ± 26.1	-	79.2 ± 26.3	-	86.8 ± 28.0	< 0.001a
Carbohydrate (g)	257.7 ± 63.9	-	222.5 ± 66.5	-	235.2 ± 67.4	0.014a
Total fiber (g)	18.8 ± 7.5	-	16.5 ± 11.6	-	17.4 ± 10.3	0.318
Soluble fiber (g)	0.8 ± 0.8	-	0.8 ± 0.8	-	0.8 ± 0.8	0.909
Sugar (g)	83.4 ± 36.7	-	79.4 ± 39.5	-	80.8 ± 38.3	0.632
Added sugar (g)	29.7 ± 22.7	-	23.5 ± 17.3	-	25.7 ± 19.6	0.138
Fat (g)	102.7 ± 36.7	-	79.8 ± 22.2	-	88.1 ± 30.2	< 0.001a
Saturated fat (g)	30.0 ± 16.7	30	24.9 ± 8.6	20	26.8 ± 12.3	0.057
Mono-unsaturated fatty acids (g)	29.5 ± 15.3	-	21.4 ± 9.4	-	24.3 ± 12.4	0.002a
Poly-unsaturated fatty acids (g)	15.0 ± 6.0	8	10.8 ± 4.5	6	12.3 ± 5.5	< 0.001a
Trans fatty acid (g)	0.1 ± 0.3	0	0.2 ± 0.2	0	0.2 ± 0.3	0.764
Cholesterol (mg)	394.0 ± 226.9	300	287.5 ± 155.4	300	326.0 ± 190.3	0.008a
Omega-3 (g)	1.5 ± 0.8	1.6	1.2 ± 0.5	1.1	1.3 ± 0.6	0.011a
Omega-6 (g)	12.9 ± 5.3	≤ 50 years: 17; > 50 years: 14	9.1 ± 3.8	≤ 50 years: 12; > 50 years: 11	10.5 ± 4.8	< 0.001a
Micronutrients
Vitamins (μg)
Retinol (μg)	487.7 ± 1305.8	900	228.5 ± 368.0	700	322.3 ± 840.6	0.152
Beta-caroten (μg)	1778.0 ± 2215.4	900	2329.9 ± 2796.9	700	2130.3 ± 2602.9	0.326
Vitamin B1 (μg)	1.1 ± 0.3	1.2	0.9 ± 0.3	1.1	0.9 ± 0.3	0.003a
Vitamin B2 (μg)	1.4 ± 0.7	1.3	1.1 ± 0.4	1.1	1.2 ± 0.6	0.012a
Vitamin B3 (μg)	22.7 ± 9.3	16	17.2 ± 9.3	14	19.2 ± 9.6	0.007a
Vitamin B6 (μg)	1.6 ± 0.7	≤ 50 years: 1.3; > 50 years: 1.7	1.3 ± 0.6	≤ 50 years: 1.3; > 50 years: 1.5	1.4 ± 0.6	0.048a
Vitamin B12 (μg)	4.7 ± 8.2	2.4	2.9 ± 4.9	2.4	3.5 ± 6.3	0.189
Biotin (μg)	4.8 ± 7.7	30	2.9 ± 2.3	30	3.5 ± 4.8	0.098
Vitamin C (mg)	86.3 ± 83.1	90	68.6 ± 44.6	75	75.0 ± 61.5	0.182
Vitamin D (μg)	3.4 ± 3.8	15	2.9 ± 3.6	15	3.1 ± 3.7	0.594
Vitamin E (mg)	6.4 ± 2.2	15	5.4 ± 2.6	15	5.8 ± 2.5	0.073
Folate (μg)	324.2 ± 179.2	400	251.2 ± 112.0	400	277.6 ± 143.5	0.017
Vitamin K (μg)	76.4 ± 96.5	120	89.9 ± 143.6	90	85.0 ± 128.1	0.628
Minerals
Calcium (mg)	657.8 ± 222.2	1000	644.5 ± 240.8	≤ 50 years: 1000; > 50 years: 1200	649.3 ± 233.1	0.792
Copper (mg)	1.0 ± 0.7	0.9	1.1 ± 1.1	0.9	1.1 ± 1.0	0.639
Chromium (μg)	1.3 ± 1.1	35	1.0 ± 0.9	25	1.1 ± 1.0	0.204
Iodine (μg)	2.5 ± 3.9	150	4.9 ± 6.1	150	4.1 ± 5.5	0.073
Iron (mg)	12.3 ± 4.2	8	9.6 ± 2.8	8-18	10.6 ± 3.6	< 0.001a
Magnesium (mg)	220.1 ± 70.4	420	183.7 ± 76.4	320	196.9 ± 76.0	0.025a
Manganese (mg)	0.7 ± 0.5	2.3	0.6 ± 0.4	1.8	0.7 ± 0.5	0.328
Phosphate (mg)	1011.1 ± 321.9	700	789.9 ± 257.2	700	869.9 ± 300.3	< 0.001a
Potassium (mg)	2275.5 ± 644.4	3400	1963.8 ± 688.4	2600	2076.5 ± 686.0	0.034a
Selenium (μg)	96.3 ± 48.2	55	73.3 ± 42.4	55	81.7 ± 45.7	0.018a
Sodium (mg)	3234.3 ± 769.6	1500	2687.1 ± 927.6	1500	2885.1 ± 908.8	0.004a
Zinc (mg)	8.0 ± 2.8	8	6.5 ± 3.1	11	7.0 ± 3.1	0.020a
Other
Caffeine (mg)	65.2 ± 100.4	400	43.3 ± 80.0	400	51.2 ± 88.0	0.248

^aP < 0.05.

¹Recommendations are based on the acceptable macronutrient distribution ranges for saturated fats and polyunsaturated fats, on recommended dietary allowance/adequate Intake for omega 3, omega 6, cholesterol, vitamins and minerals, and on United States Food and Drug Administration for caffeine.

Table 4 Factor loadings for three predicted dietary patterns

Food	Traditional Qatari	Prudent	Fast-foods
Fruits	-0.0602	-0.0086	-0.4032
Legumes	0.0411	0.37671	-0.3503
Qatari food	0.44331	0.1427	-0.2807
Oils and fats	0.1923	-0.1697	-0.2594
Karak	0.27331	-0.1567	-0.2086
Tea and coffee	0.1127	0.22871	-0.1998
Non-starchy vegetables	-0.4634	0.40141	-0.1951
Sugar and added sugar	0.50921	0.0671	-0.1688
Sweetener	-0.2552	-0.2798	-0.1493
Soups	-0.1231	0.46881	-0.1159
Starchy vegetables	0.1763	0.53001	-0.0818
Whole grains	-0.6551	-0.0678	-0.0223
Dairy	0.0687	0.65301	0.0533
Nuts	-0.1304	0.1328	0.0836
Pasta	0.36991	-0.0906	0.0841
Grains	0.81861	0.0822	0.1096
Sweets and sacks	0.62691	0.0283	0.1190
Meat and poultry	0.0349	0.60881	0.20051
Juice and drinks	0.57171	-0.3041	0.28511
Sauces and dressings	0.33791	0.0092	0.57791
Fish and seafood	-0.2757	0.33281	0.59611
Fast-foods	0.29531	-0.0753	0.73741

¹Primary factor loading.

Kaiser-Meyer-Olkin for factor analysis is 0.5325.

Table 5 Associations between body mass index and dietary patterns

Dietary patterns	Model 1		Model 2		Model 3
	Coef. (95%)	P value	Coef. (95%)	P value	Coef. (95%)	P value
Traditional Qatari food	0.01 (-1.25 to 1.26)	0.988	-0.02 (-1.31 to 1.26)	0.966	0.01 (-1.38 to 1.40)	0.987
Prudent	-0.62 (-1.88 to 0.63)	0.326	-0.62 (-1.93 to 0.69)	0.351	-1.01 (-2.42 to 0.39)	0.156
Fast-foods	-0.77 (-2.03 to 0.48)	0.223	-0.58 (-1.94 to 0.76)	0.389	-0.70 (-2.09 to 0.69)	0.320

Values are beta [Coef. (95%)] from linear regression. Model 1 was unadjusted; model 2 was adjusted for age and sex; model 3 was adjusted for age, sex, educational level, and energy.

Table 6 Associations between low-density lipoprotein and dietary patterns

Dietary patterns	Model 1		Model 2		Model 3
	Coef. (95%)	P value	Coef. (95%)	P value	Coef. (95%)	P value
Traditional Qatari food	0.05 (-0.18 to 0.29)	0.643	0.002 (-0.23 to 0.24)	0.985	0.03 (-0.23 to 0.27)	0.874
Prudent	-0.06 (-0.29 to 0.16)	0.595	0.003 (-0.23 to 0.24)	0.976	0.01 (-0.24 to 0.26)	0.957
Fast foods	0.05 (-0.23 to 0.33)	0.717	-0.03 (-0.33 to 0.27)	0.839	-0.09 (-0.39 to 0.21)	0.546

Values are beta [Coef. (95%)] from linear regression. Model 1 was unadjusted; model 2 was adjusted for age and sex; model 3 was adjusted for age, sex, educational level, and energy.