Correlation between serum sugar alcohol concentrations and metabolic dysfunction-associated steatotic liver disease in the overweight/obese population

doi:10.3969/j.issn.1674-8115.2026.07.014

Abstract

Abstract:

Objective ·To investigate the correlation between serum sugar alcohol levels and metabolic dysfunction-associated steatotic liver disease (MASLD) in the overweight/obese population. Methods ·This cross-sectional study enrolled 91 overweight/obese patients [body mass index (BMI)≥25 kg/m²] who visited the Obesity Clinic of Renji Hospital, Shanghai Jiao Tong University School of Medicine from July 2019 to August 2021. The participants were divided into the MASLD group (n=67) and the non-MASLD group (n=24). General data (age, sex, BMI, and blood pressure), blood biochemical parameters (liver function, renal function, blood glucose, lipid profile, insulin, etc.), and serum sugar alcohol levels (erythritol, xylitol, sorbitol, and maltitol) were collected. Serum sugar alcohol levels were quantified by gas chromatography-mass spectrometry. Magnetic resonance imaging-proton density fat fraction was used to measure liver fat content, pancreatic fat content, subcutaneous adipose tissue, and visceral adipose tissue. Spearman correlation analysis was used to analyze the correlation between serum sugar alcohol levels and liver fat content. Univariate and multivariate Logistic regression analyses were conducted to identify factors related with MASLD. Results ·A total of 91 overweight/obese patients were enrolled, with a median age of 34.00 (29.00, 42.00) years and a median BMI of 33.04 (29.60, 36.46) kg/m². Among them, 48.35% were male. The MASLD group showed significantly higher levels of alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, uric acid, triglycerides, fasting insulin, homeostasis model assessment of insulin resistance, glycated hemoglobin, pancreatic fat content, liver fat content, visceral adipose tissue, and erythritol compared with the non-MASLD group (all P<0.05). Spearman correlation analysis showed that serum erythritol levels were positively correlated with liver fat content in the overweight/obese population (r=0.209, P=0.046), while maltitol, xylitol, and sorbitol showed no significant correlations with liver fat content. After adjustment for sex, uric acid, homeostasis model assessment of insulin resistance, and triglycerides, multivariate Logistic regression analysis revealed that elevated serum erythritol levels remained an independent risk factor for MASLD in overweight/obese patients (OR=3.02, 95%CI 1.15‒7.94, P=0.025). Conclusion ·Serum erythritol level is independently and positively associated with the risk of MASLD in the overweight/obese population.

Key words: metabolic dysfunction-associated steatotic liver disease (MASLD), erythritol, overweight, obesity, sugar alcohol

CLC Number:

R575.5

Tan Tao, Yue Jiang, Qi Yicheng, Yang Minglan, Ma Jing. Correlation between serum sugar alcohol concentrations and metabolic dysfunction-associated steatotic liver disease in the overweight/obese population[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(7): 954-960.

Figures/Tables 4

TrendMD

References 26

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Index	Total (n=91)	Non-MASLD (n=24)	MASLD (n=67)	Z/χ²	P value
Age/year	34.00 (29.00, 42.00)	32.50 (28.00, 45.50)	35.00 (29.50, 42.00)	-0.57	0.567
Male/n(%)	44 (48.35)	7 (29.17)	37 (55.22)	4.80	0.028
BMI/(kg·m^-2)	33.04 (29.60, 36.46)	34.28 (28.14, 37.11)	32.77 (29.74, 36.26)	-0.26	0.791
Systolic blood pressure/mmHg	130.00 (121.25, 140.00)	124.00 (116.00, 135.50)	131.50 (123.00, 140.00)	-1.43	0.152
Diastolic blood pressure/mmHg	81.50 (77.00, 89.00)	79.50 (76.00, 89.25)	82.00 (77.00, 88.75)	-0.26	0.795
ALT/(U·L^-1)	29.00 (18.00, 54.50)	16.00 (13.75, 17.25)	44.00 (25.00, 69.00)	-5.88	<0.001
AST/(U·L^-1)	22.00 (16.00, 35.00)	16.00 (13.75, 18.25)	24.00 (20.00, 37.00)	-5.05	<0.001
GGT/(U·L^-1)	33.00 (19.50, 46.50)	19.50 (17.00, 26.00)	39.00 (27.00, 53.00)	-4.56	<0.001
Creatinine/(μmol·L^-1)	68.00 (60.00, 79.00)	66.50 (58.00, 74.75)	68.50 (62.00, 79.75)	-1.00	0.316
Uric acid/(μmol·L^-1)	397.00 (347.25, 475.25)	348.50 (305.00, 393.25)	416.00 (363.00, 524.50)	-3.28	0.001
eGFR/[mL·(min·1.73 m²)^-1]	109.50 (97.25, 116.00)	110.00 (96.25, 114.25)	109.50 (98.00, 118.25)	-0.36	0.718
TG/(mmol·L^-1)	1.76 (1.25, 2.35)	1.50 (0.98, 2.03)	1.86 (1.27, 2.47)	-2.22	0.027
TC/(mmol·L^-1)	5.26 (4.47, 5.80)	5.00 (4.34, 5.42)	5.30 (4.52, 5.87)	-1.29	0.198
HDL-C/(mmol·L^-1)	1.03 (0.89, 1.23)	1.08 (0.92, 1.26)	1.02 (0.89, 1.21)	-0.84	0.401
LDL-C/(mmol·L^-1)	3.19 (2.60, 3.62)	3.11 (2.48, 3.44)	3.24 (2.71, 3.80)	-1.34	0.181
FPG/(mmol·L^-1)	5.03 (4.68, 5.39)	4.80 (4.62, 5.17)	5.13 (4.73, 5.39)	-1.43	0.153
2 h PG/(mmol·L^-1)	7.13 (6.31, 8.27)	6.57 (6.00, 7.70)	7.42 (6.42, 8.47)	-1.90	0.057
FINS/(μIU·mL^-1)	14.21 (10.26, 20.57)	12.30 (9.06, 15.36)	15.61 (10.53, 21.88)	-2.47	0.013
HOMA-IR	3.27 (2.17, 4.49)	2.71 (1.97, 3.40)	3.51 (2.24, 5.18)	-2.45	0.014
HbA1c/%	5.40 (5.10, 5.70)	5.20 (5.00, 5.53)	5.40 (5.30, 5.70)	-1.96	0.049
PFC/%	5.32 (4.22, 9.39)	4.50 (2.45, 5.88)	5.95 (4.47, 10.39)	-2.48	0.013
LFC/%	12.58 (5.86, 22.07)	4.26 (2.87, 5.24)	16.79 (11.11, 25.10)	-7.24	<0.001
SAT/cm²	323.22 (264.22, 435.25)	302.27 (223.59, 446.75)	331.00 (268.54, 423.66)	-1.35	0.177
VAT/cm²	122.72 (95.00, 169.00)	85.34 (51.69, 148.15)	132.00 (109.60, 170.00)	-2.66	0.008
Erythritol/(μmol·L^-1)	10.34 (6.15, 18.30)	7.26 (5.11, 11.92)	11.47 (6.76, 23.21)	-2.62	0.009
Maltitol/(μmol·L^-1)	0.52 (0.50, 0.58)	0.52 (0.50, 0.55)	0.52 (0.50, 0.59)	-0.97	0.331
Xylitol/(μmol·L^-1)	9.09 (6.26, 11.95)	9.04 (5.80, 10.87)	9.09 (6.63, 12.20)	-1.02	0.307
Sorbitol/(μmol·L^-1)	2.14 (1.79, 3.04)	2.16 (1.83, 2.63)	2.14 (1.77, 3.04)	-0.06	0.950

Index	Total (n=91)	Non-MASLD (n=24)	MASLD (n=67)	Z/χ²	P value
Age/year	34.00 (29.00, 42.00)	32.50 (28.00, 45.50)	35.00 (29.50, 42.00)	-0.57	0.567
Male/n(%)	44 (48.35)	7 (29.17)	37 (55.22)	4.80	0.028
BMI/(kg·m^-2)	33.04 (29.60, 36.46)	34.28 (28.14, 37.11)	32.77 (29.74, 36.26)	-0.26	0.791
Systolic blood pressure/mmHg	130.00 (121.25, 140.00)	124.00 (116.00, 135.50)	131.50 (123.00, 140.00)	-1.43	0.152
Diastolic blood pressure/mmHg	81.50 (77.00, 89.00)	79.50 (76.00, 89.25)	82.00 (77.00, 88.75)	-0.26	0.795
ALT/(U·L^-1)	29.00 (18.00, 54.50)	16.00 (13.75, 17.25)	44.00 (25.00, 69.00)	-5.88	<0.001
AST/(U·L^-1)	22.00 (16.00, 35.00)	16.00 (13.75, 18.25)	24.00 (20.00, 37.00)	-5.05	<0.001
GGT/(U·L^-1)	33.00 (19.50, 46.50)	19.50 (17.00, 26.00)	39.00 (27.00, 53.00)	-4.56	<0.001
Creatinine/(μmol·L^-1)	68.00 (60.00, 79.00)	66.50 (58.00, 74.75)	68.50 (62.00, 79.75)	-1.00	0.316
Uric acid/(μmol·L^-1)	397.00 (347.25, 475.25)	348.50 (305.00, 393.25)	416.00 (363.00, 524.50)	-3.28	0.001
eGFR/[mL·(min·1.73 m²)^-1]	109.50 (97.25, 116.00)	110.00 (96.25, 114.25)	109.50 (98.00, 118.25)	-0.36	0.718
TG/(mmol·L^-1)	1.76 (1.25, 2.35)	1.50 (0.98, 2.03)	1.86 (1.27, 2.47)	-2.22	0.027
TC/(mmol·L^-1)	5.26 (4.47, 5.80)	5.00 (4.34, 5.42)	5.30 (4.52, 5.87)	-1.29	0.198
HDL-C/(mmol·L^-1)	1.03 (0.89, 1.23)	1.08 (0.92, 1.26)	1.02 (0.89, 1.21)	-0.84	0.401
LDL-C/(mmol·L^-1)	3.19 (2.60, 3.62)	3.11 (2.48, 3.44)	3.24 (2.71, 3.80)	-1.34	0.181
FPG/(mmol·L^-1)	5.03 (4.68, 5.39)	4.80 (4.62, 5.17)	5.13 (4.73, 5.39)	-1.43	0.153
2 h PG/(mmol·L^-1)	7.13 (6.31, 8.27)	6.57 (6.00, 7.70)	7.42 (6.42, 8.47)	-1.90	0.057
FINS/(μIU·mL^-1)	14.21 (10.26, 20.57)	12.30 (9.06, 15.36)	15.61 (10.53, 21.88)	-2.47	0.013
HOMA-IR	3.27 (2.17, 4.49)	2.71 (1.97, 3.40)	3.51 (2.24, 5.18)	-2.45	0.014
HbA1c/%	5.40 (5.10, 5.70)	5.20 (5.00, 5.53)	5.40 (5.30, 5.70)	-1.96	0.049
PFC/%	5.32 (4.22, 9.39)	4.50 (2.45, 5.88)	5.95 (4.47, 10.39)	-2.48	0.013
LFC/%	12.58 (5.86, 22.07)	4.26 (2.87, 5.24)	16.79 (11.11, 25.10)	-7.24	<0.001
SAT/cm²	323.22 (264.22, 435.25)	302.27 (223.59, 446.75)	331.00 (268.54, 423.66)	-1.35	0.177
VAT/cm²	122.72 (95.00, 169.00)	85.34 (51.69, 148.15)	132.00 (109.60, 170.00)	-2.66	0.008
Erythritol/(μmol·L^-1)	10.34 (6.15, 18.30)	7.26 (5.11, 11.92)	11.47 (6.76, 23.21)	-2.62	0.009
Maltitol/(μmol·L^-1)	0.52 (0.50, 0.58)	0.52 (0.50, 0.55)	0.52 (0.50, 0.59)	-0.97	0.331
Xylitol/(μmol·L^-1)	9.09 (6.26, 11.95)	9.04 (5.80, 10.87)	9.09 (6.63, 12.20)	-1.02	0.307
Sorbitol/(μmol·L^-1)	2.14 (1.79, 3.04)	2.16 (1.83, 2.63)	2.14 (1.77, 3.04)	-0.06	0.950

Variable	LFC
Variable	r	P value
Erythritol	0.209	0.046
Maltitol	0.026	0.809
Xylitol	-0.055	0.607
Sorbitol	-0.052	0.623

Variable	LFC
Variable	r	P value
Erythritol	0.209	0.046
Maltitol	0.026	0.809
Xylitol	-0.055	0.607
Sorbitol	-0.052	0.623

Variable	Univariate Logistic regression					Multivariate Logistic regression
Variable	β	SE	Z	OR (95%CI)	P value	β	SE	Z	OR (95%CI)	P value
Age	0.01	0.02	0.24	1.01 (0.96‒1.05)	0.808
Gender (female vs male)	-1.10	0.51	-2.14	0.33 (0.12‒0.91)	0.032	-0.10	0.76	-0.14	0.90 (0.20‒4.00)	0.891
BMI	0.03	0.05	0.69	1.03 (0.94‒1.13)	0.493
Uric acid	0.01	<0.01	2.82	1.01 (1.01‒1.02)	0.005	0.01	<0.01	2.06	1.01 (1.01‒1.02)	0.039
eGFR	0.01	0.02	0.46	1.01 (0.98‒1.04)	0.648
HOMA-IR	0.46	0.18	2.60	1.59 (1.12‒2.25)	0.009	0.43	0.24	1.81	1.53 (0.96‒2.44)	0.071
TG	0.64	0.32	2.02	1.90 (1.02‒3.55)	0.044	0.39	0.41	0.96	1.48 (0.67‒3.27)	0.336
Erythritol	0.92	0.39	2.34	2.50 (1.16‒5.39)	0.019	0.85	0.40	2.15	3.02 (1.15‒7.94)	0.025