Substance Use
Healthy Eating Index Modifies the Association Between Cannabis Use and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Cross-Sectional Analysis Using NHANES 2017-2018 Zhiyu Wu* Zhiyu Wu Amy Mahar Murray A. Mittleman
Introduction: Prior studies suggest protective associations of cannabis with metabolic dysfunction-associated steatotic liver disease (MASLD). However, the role of diet in modifying this relationship remains underexplored.
Methods: We analyzed NHANES 2017–2018 data. Participants aged 18-59 years were surveyed for cannabis use categorized as never, former, or current. Those missing liver elastography, cannabis data, diet data, and hepatitis B or C positive were excluded (n= 2,496). MASLD was determined using updated criteria and liver stiffness measurements (≥6.8 kPa) to identify clinically significant fibrosis (CSF). We examined the association between cannabis use and MASLD (none, MASLD with CSF, MASLD without CSF) using survey-weighted multinomial logistic regression adjusted for age, sex, self-reported race, BMI, education, and alcohol and included interaction terms for the Healthy Eating Index (HEI) to evaluate effect modification.
Results: The sample included 2,496 participants aged 18-59 (mean = 39 years); 45% never cannabis users, 18% current users, and 37% former users. We found that 65% had no MASLD, 13% had MASLD with CSF, and 22% had MASLD without CSF.
In our adjusted model, the conditional odds ratio (cOR) of having MASLD with CSF compared to no MASLD was:
- Current vs. never cannabis users: cOR=1.32 (95% CI 0.67–2.57, p=0.43)
- Former vs. never users: cOR=1.33 (95% CI 0.84–2.11, p=0.22).
The cOR of having MASLD without CSF compared to no MASLD was:
- Current vs. never users: cOR=1.34 (95% CI 0.60–2.99, p=0.48)
- Former vs. never users: cOR=1.23 (95% CI 0.64–2.39, p=0.53).
Table 1 shows that HEI score significantly modified the association between cannabis use (former vs. never) and MASLD status (MASLD without CSF vs. no MASLD) on the multiplicative scale (cOR 1.23 vs. 0.47 for those with HEI score ≤50 vs. >50, pinteraction=0.002).
Conclusion: HEI scores modify the association between cannabis use (former vs. never) and MASLD without CSF compared to no MASLD.
