Dietary Fructose Intake, Metabolic Profile, and Liver Disease-Related Quality of Life in Adults with Obesity and MASLD: A Cross-Sectional Study

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with obesity, insulin resistance, and dietary factors. This study investigated the associations of dietary fructose intake and insulin resistance with liver disease-related quality of life (LDQOL) and factors associated with LDQOL in adults with obesity and MASLD. Methods: This cross-sectional study included 169 adults with obesity (BMI ≥ 30 kg/m2) and MASLD. Dietary intake was assessed using a single 24 h recall, while habitual fructose exposure was estimated using a fructose consumption frequency questionnaire as the primary fructose variable. Insulin resistance and quality of life were assessed using HOMA-IR and LDQOL 1.0, respectively. A parsimonious multivariable linear regression model identified factors independently associated with LDQOL. Results: Questionnaire-derived fructose intake was modestly correlated with waist circumference (ρ = 0.26, p < 0.001), but this association was no longer significant after adjustment for total energy intake (partial ρ = 0.024, p = 0.761). Fructose intake was not associated with HOMA-IR or LDQOL. Mean HOMA-IR and LDQOL scores were 4.89 ± 3.81 and 50.94 ± 12.69, respectively. The multivariable model explained 27.7% of LDQOL variance (adjusted R2 = 0.236). Male sex was associated with higher LDQOL scores, whereas lunch skipping and higher HbA1c were associated with lower scores. Conclusions: The crude association between questionnaire-derived fructose intake and waist circumference was not retained after adjustment for total energy intake, and fructose intake was not associated with HOMA-IR or LDQOL. Associations of sex, lunch skipping, and glycaemic control with LDQOL warrant prospective confirmation and should not be interpreted as evidence that modifying these factors will improve quality of life.