Flow chart for study population selection from NHANES 2007–2018.

Flow chart for study population selection from NHANES 2007–2018.</p

Effects estimates and 95% confidence intervals (95% CI) between MAFLD and PAEs in different age.

Adjusted by age, sex, race/ ethnicity, educational level, smoking status, alcohol consumption, physical activity, PIR, creatinine, and cycle. (DOCX)</p

Associations between PAE concentration and MAFLD in restricted cubic spline model for the overall population.

The solid line and dashed lines represent the estimated ORs and the 95%CI. (TIF)</p

The WQS index weights of each of the eleven PAEs associated with MAFLD.

The WQS index weights of each of the eleven PAEs associated with MAFLD.</p

Effects estimates and 95% confidence intervals (95% CI) between MAFLD and PAEs in different sexes.

Adjusted by age, sex, race/ ethnicity, educational level, smoking status, alcohol consumption, physical activity, PIR, creatinine, and cycle. (DOCX)</p

Estimation of the mixture effect of PAEs on the risk of MAFLD using WQS.

Estimation of the mixture effect of PAEs on the risk of MAFLD using WQS.</p

Physical examination and biochemical measures in the general characteristics of the participants.

WC: waist circumference; WHtR: waist-height ratio; HOMA-IR, homeostasis model assessment for insulin resistance; HDL, high-density lipoprotein; TG, triacylglycerol. (DOCX)</p

General characteristics of the participants.

As a new definition for the evidence of hepatic steatosis and metabolic dysfunctions, the relationship between phthalates (PAEs) and metabolic dysfunction-associated fatty liver disease (MAFLD) remains virtually unexplored. This study included 3,137 adults from the National Health and Nutrition Examination Survey spanning 2007–2018. The diagnosis of MAFLD depended on the US Fatty Liver Index (US FLI) and evidence of metabolic dysregulation. Eleven metabolites of PAEs were included in the study. Poisson regression, restricted cubic spline (RCS), and weighted quantile sum (WQS) regression were used to assess the associations between phthalate metabolites and MAFLD. After adjusting for potential confounders, Poisson regression analysis showed that mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-n-butyl phthalate, mono-(3-carboxypropyl) phthalate, mono-ethyl phthalate (MEP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono-(2-ethyl-5-oxohexyl) phthalate were generally significant positively associated with MAFLD (P</div

The concentration distribution [Median (IQR)] of urinary PAEs (ng/mL) in different ages, sexes.

The concentration distribution [Median (IQR)] of urinary PAEs (ng/mL) in different ages, sexes.</p

Relationship between phthalates and MAFLD.

As a new definition for the evidence of hepatic steatosis and metabolic dysfunctions, the relationship between phthalates (PAEs) and metabolic dysfunction-associated fatty liver disease (MAFLD) remains virtually unexplored. This study included 3,137 adults from the National Health and Nutrition Examination Survey spanning 2007–2018. The diagnosis of MAFLD depended on the US Fatty Liver Index (US FLI) and evidence of metabolic dysregulation. Eleven metabolites of PAEs were included in the study. Poisson regression, restricted cubic spline (RCS), and weighted quantile sum (WQS) regression were used to assess the associations between phthalate metabolites and MAFLD. After adjusting for potential confounders, Poisson regression analysis showed that mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-n-butyl phthalate, mono-(3-carboxypropyl) phthalate, mono-ethyl phthalate (MEP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono-(2-ethyl-5-oxohexyl) phthalate were generally significant positively associated with MAFLD (P</div