Dietary patterns are associated with prevalence of fatty liver disease in adults

The association between raw garlic consumption and the risk of depressive symptoms: the TCLSIH cohort study

Background: Garlic has antioxidant, anti-inflammatory, cardiovascular improvement and other beneficial effects on human health. However, few studies have evaluated the association of garlic intake with the risk of depressive symptoms. The aim of this prospective cohort was to examine the association between the frequency of raw garlic consumption and depressive symptoms in the general adult population. Methods: A total of 7427 participants (mean ± standard deviation: 39.7 ± 10.5 years) without baseline depressive symptoms were included in the cohort study. Garlic consumption was assessed using a validated food frequency questionnaire, and depressive symptoms were assessed by a Chinese version of the Self-rating Depression Scale score (SDS score ≥ 45). Multivariable Cox proportional hazards models were used to determine the association between garlic consumption and the risk of depressive symptoms. Results: This study identified 1070 cases of depressive symptoms during a median follow-up of 2.0 years, with a depression prevalence of 73.4 cases per 1000 person-years. After multivariate adjustment, the hazard ratios (95% confidence intervals) for depressive symptoms in males were 1.00 (reference) for almost never, 1.05 (0.84, 1.32) for ≤1 time per week, 1.16 (0.90, 1.49) for 2-3 times per week, and 1.31 (0.97, 1.78) for ≥4 times per week, and in females, they were 1.00 (reference) for almost never, 0.85 (0.69, 1.06) for ≤1 time per week, 0.72 (0.54, 0.97) for 2-3 times per week, and 0.78 (0.53, 1.13) for ≥4 times per week. Conclusion: In a large general population, we demonstrate for the first time that moderate raw garlic consumption is associated with a reduced risk of depressive symptoms in females, but not in males. Additional prospective studies with long-term follow-up and randomized controlled trials are necessary to confirm the preliminary results of the current study.

Genetic risk accentuates dietary effects on hepatic steatosis, inflammation and fibrosis in a population-based cohort

BACKGROUND & AIMS

Steatotic liver disease (SLD), characterized by elevated liver fat content (LFC), is influenced by genetics and diet. However, whether diet has differential effect based on genetic risk is not well-characterized. We aimed to determine how genetic factors interact with diet to affect SLD in a large national biobank.

METHODS

We included UK Biobank participants with dietary intake measured by 24-hour recall and genotyping. The primary predictors were dietary pattern, PNPLA3-rs738409-G, TM6SF2-rs58542926-T, a 16-variant hepatic steatosis polygenic risk score (PRS), and gene-environment interactions. The primary outcome was LFC, and secondary outcomes were iron-controlled T1 time (cT1, a measure of liver inflammation and fibrosis) and liver-related events/mortality.

RESULTS

21,619 participants met inclusion criteria. In non-interaction models, Mediterranean diet and intake of fruit/vegetables/legumes and fish associated with lower LFC, while higher red/processed meat intake and all genetic predictors associated with higher LFC. In interaction models, all genetic predictors interacted with Mediterranean diet and fruit/vegetable/legume intake; the steatosis PRS interacted with fish intake; and TM6SF2 genotype interacted with red/processed meat intake, to affect LFC. Dietary effects on LFC were up to 3.8 times as high in PNPLA3-rs738409-GG vs. -CC individuals, and 1.4-3.0 times as high in the top vs. bottom quartile of the steatosis PRS. Gene-diet interactions were stronger in participants with vs. without overweight. The steatosis PRS interacted with Mediterranean diet and fruit/vegetable/legume intake to affect cT1 and most dietary and genetic predictors associated with risk of liver-related events or mortality by age 70.

CONCLUSIONS

Effects of diet on LFC and cT1 were markedly accentuated in patients at increased genetic risk for SLD, implying dietary interventions may be more impactful in these populations.

Effects of carnosine supplementation on markers for the pathophysiological development of metabolic dysfunction-associated steatotic liver disease in a diet-induced model

Consumption of diets high in sugar and fat is related to the development of Metabolic dysfunction-associated steatotic liver disease (MASLD). Carnosine (CAR) is a dipeptide with antioxidant and anti-inflammatory action and has been studied for treating diseases. This work aimed to evaluate the effects of CAR on diet-induced MASLD in rats. Male Wistar rats were distributed into 2 groups (17 weeks): normocaloric (Co, n = 12), and hypercaloric diet rich in lipids and simple carbohydrates (MASLD, n = 12). After, the animals were redistributed to begin the treatment with CAR (4 weeks): Co (n = 6), Co + CAR (n = 6), MASLD (n = 6), and MASLD + CAR (n = 6), administered intraperitoneally (250 mg/kg). Evaluations included nutritional, hormonal and metabolic parameters; hepatic steatosis, inflammatory and oxidative markers. MASLD group had a higher adiposity index, systolic blood pressure, glucose, plasma and liver triglycerides and cholesterol, insulin, hepatic steatosis, oxidative markers, and lower PPAR-α (Peroxisome Proliferator-activated receptor α), compared to the Co. CAR attenuated plasma and hepatic triglyceride and cholesterol levels, hepatic steatosis, CD68+ macrophages, and hepatic oxidative markers, in addition to increasing HDL cholesterol levels and PPAR-α, compared to the untreated MASLD group. CAR acts in importants pathophysiological processes of MASLD and may be a therapeutic compound to control the disease.

Differential Gut Microbiota, Dietary Intakes in Constipation Patients with or without Hypertension

SCOPE

Diet and gut microbiota are involved in blood pressure regulations, but few studies have focused on the constipation patients. The study seeks to identify differences in gut microbiota between hypertensive and normotensive subjects in constipation patients, analyzes the relationship between dietary patterns and blood pressure, and explores mediation effects of gut microbiota.

METHODS AND RESULTS

Gut microbial genera and dietary information of 186 functional constipation participants are characterized by 16S rRNA sequencing and a food frequency questionnaire. The hypertensive subjects shows lower α-diversity and β-diversity of gut microbiota than normotensive (p < 0.05) and 17 differential microbial genera. The dried-beans intake frequency inversely correlated with systolic and diastolic blood pressure after multivariate adjustment (r = -0.273, p-FDR < 0.01; r = -0.251, p-FDR = 0.026, respectively). Logistic regression indicates that the individuals often consumed dried-beans have a lower hypertension risk than those never consumed [OR = 0.137, 95% CI: (0.022, 0.689), p = 0.022]. A marginal mediating effect of the genus Monoglobus is observed for the association between high-fiber dietary pattern and hypertension.

CONCLUSION

In patients with functional constipation, hypertension-related gut microbial differences are identified. Dried-beans intake is inversely associated with blood pressure, and a genus may potentially mediate the association between high-fiber dietary pattern and hypertension.

Dietary intake of pregnant women with non-alcoholic fatty liver disease: A case-control study

BACKGROUND AND AIMS

Findings on the role of diet in non-alcoholic fatty liver disease (NAFLD) pathogenesis are inconsistent. There are few studies on the dietary habits of pregnant women with NAFLD. Our primary aim was to compare the dietary intakes of pregnant women with and without NAFLD.

METHODS

This case-control study recruited 60 women (26-34 weeks' gestation) with recently diagnosed gestational diabetes (GDM) before any treatment was implemented. At recruitment, all participants underwent B-mode hepatic ultrasound. We included 30 women with sonographic NAFLD (cases) and 30 women without NAFLD (controls) matched for age, skin color, and pre-pregnancy body mass index. We assessed participants' dietary intakes in the last six months using a validated food frequency questionnaire. Mann-Whitney´s test was used to compare differences in median macro and micronutrient intakes between cases and controls.

RESULTS

Total median daily energy (1965.1 × 1949.2 calories) and lipid (25.1% × 28.3%) intakes were similar in women with and without NAFLD and fell within recommended ranges. Participants with NAFLD reported significantly higher median daily intakes of carbohydrates (59.4% × 53.1% p = 0.003), and significantly lower protein (15.6% × 17.0% p = 0.005), fiber (10.7 × 13.3 g/day p = 0.010), and vitamin C (151.8 × 192.6 mg/day p = 0.008) intakes than those without NAFLD.

CONCLUSIONS

Pregnant women with NAFLD ingest more carbohydrates and less protein, fiber, and vitamin C than those without NAFLD. Our findings contribute to understanding the role of diet in the development of NAFLD in pregnant women.

Individualized intervention for patients with metabolic fatty liver disease based on Dietary Guidelines for Chinese Residents

BACKGROUND

Metabolic associated fatty liver disease (MAFLD) is widely prevalent. Poor dietary and living habits are closely related to the development of MAFLD. Diet and exercise intervention is one of the important measures for the prevention and treatment of MAFLD, but the intervention strategies are still inconclusive, and further research is still required.

AIM

To explore the effect of individualized intervention through limited energy balanced diet and exercise on MAFLD.

METHODS

MAFLD patients were divided into either an intervention group or a control group according to whether they received individualized diet and exercise intervention or not. At the time of enrollment (T0), the anthropometric information and laboratory indicators of the patients were collected, and the general information, family history, dietary and living habits, and food frequency of the patients were collected by questionnaire survey. Individualized diet and exercise intervention was executed in the intervention group, while routine health education without individualized intervention was executed in the control group. We collected the above parameters after 6 mo (T1) for the second time, and then compared their differences between T0 and T1.

RESULTS

Among 127 MAFLD patients included, those with daily travelling by car accounted for 62.99%, and those preferring sedentary lifestyle (>8 h/d), heavy flavor food, and extra meal accounted for 48.82%, > 50%, and 37.01%, respectively. Five main factors were extracted after factor analysis, including "fungus and vegetable", "grain and milk", "meat and egg", "aquatic", and "snack". The upper quintile (Q5) of the "meat and egg" factor could increase the risk of high triglyceride (odds ratio [OR] = 5.60, 95% confidence interval [CI]: 1.41-22.24) and high cholesterol (OR = 6.45, 95%CI: 1.51-27.63) compared with the lower quintile (Q1); the middle quintile (Q3) of the "aquatic" factor could also increase the risk of high cholesterol (OR = 4.54, 95%CI: 1.10-18.78). The differences in anthropometric information and laboratory test indicators (except glycosylated hemoglobin in the control group) between T0 and T1 were statistically significant (P < 0.05) both in the intervention group and in the control group.

CONCLUSION

Individualized dietary and exercise intervention based on the Dietary Guidelines for Chinese Residents can help MAFLD patients reduce body weight, body mass index, waist circumference, visceral fat area, body fat ratio, etc. and improve their glucose and lipid metabolism effectively.

TM6SF2-rs58542926 Genetic Variant Modifies the Protective Effect of a "Prudent" Dietary Pattern on Serum Triglyceride Levels

The epidemic prevalence of non-alcoholic fatty liver disease (NAFLD), despite extensive research in the field, underlines the importance of focusing on personalized therapeutic approaches. However, nutrigenetic effects on NAFLD are poorly investigated. To this end, we aimed to explore potential gene-dietary pattern interactions in a NAFLD case-control study. The disease was diagnosed with liver ultrasound and blood collection was performed after an overnight fast. Adherence to four a posteriori, data-driven, dietary patterns was used to investigate interactions with PNPLA3-rs738409, TM6SF2-rs58542926, MBOAT7-rs641738, and GCKR-rs738409 in disease and related traits. IBM SPSS Statistics/v21.0 and Plink/v1.07 were used for statistical analyses. The sample consisted of 351 Caucasian individuals. PNPLA3-rs738409 was positively associated with disease odds (OR = 1.575, p = 0.012) and GCKR-rs738409 with lnC-reactive protein (CRP) (beta = 0.098, p = 0.003) and Fatty Liver Index (FLI) levels (beta = 5.011, p = 0.007). The protective effect of a "Prudent" dietary pattern on serum triglyceride (TG) levels in this sample was significantly modified by TM6SF2-rs58542926 (pinteraction = 0.007). TM6SF2-rs58542926 carriers may not benefit from a diet rich in unsaturated fatty acids and carbohydrates in regard to TG levels, a commonly elevated feature in NAFLD patients.

Association Between Protein Intake From Different Animal and Plant Origins and the Risk of Non-Alcoholic Fatty Liver Disease: A Case-Control Study

Previous studies have frequently reviewed how different macronutrients affect liver health. Still, no study centered around protein intake and the non-alcoholic fatty liver disease (NAFLD) risk relationship. This study aimed to examine the association between the consumption of total and different sources of protein and NAFLD risk. We allocated 243 eligible subjects to the case and control groups, including 121 incidence cases of NAFLD, and 122 healthy controls. Two groups were matched in age, body mass index, and sex. We evaluated the usual food intake of participants using FFQ. Binary logistic regression was conducted to estimate the risk of NAFLD in relation to different sources of protein intake. The age of participants was 42.7 years on average, and 53.1% were male. We found Higher intake of protein in total (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.11-0.52) was significantly associated with a lower risk of NAFLD, despite adjusting for multiple confounders. in detail, higher tendency to the vegetables (OR, 0.28; 95% CI, 0.13-0.59), grains (OR, 0.24; 95% CI, 0.11-0.52), and nuts (OR, 0.25; 95% CI, 0.12-0.52) as the main sources of protein, were remarkably correlated with lower NAFLD risk. In contrary, increased intake of meat protein (OR, 3.15; 95% CI, 1.46-6.81) was positively associated with a higher risk. Totally, more calorie intake from proteins was inversely associated with lower NAFLD risk. This was more likely when the protein sources were selected less from meats and more from plants. Accordingly, increasing the consumption of proteins, particularly from plants, may be a good recommendation to manage and prevent NAFLD.

The Application of Clustering on Principal Components for Nutritional Epidemiology: A Workflow to Derive Dietary Patterns

In the last decades, different multivariate techniques have been applied to multidimensional dietary datasets to identify meaningful patterns reflecting the dietary habits of populations. Among them, principal component analysis (PCA) and cluster analysis represent the two most used techniques, either applied separately or in parallel. Here, we propose a workflow to combine PCA, hierarchical clustering, and a K-means algorithm in a novel approach for dietary pattern derivation. Since the workflow presents certain subjective decisions that might affect the final clustering solution, we also provide some alternatives in relation to different dietary data used. For example, we used the dietary data of 855 women from Catania, Italy. Our approach-defined as clustering on principal components-could be useful to leverage the strengths of each method and to obtain a better cluster solution. In fact, it seemed to disentangle dietary data better than simple clustering algorithms. However, before choosing between the alternatives proposed, it is suggested to consider the nature of dietary data and the main questions raised by the research.

Triglyceride Level- and MTHFR- Specific Mediation Effect of Handgrip Strength on the Association of Dietary Protein Intake and Cognitive Function in the Chinese Elderly

BACKGROUND

Recent findings suggest that both dietary protein intake and hand grip strength (HGS) were associated with cognitive function, however, few studies have been devoted specifically to the mediation effect of HGS on the association of dietary protein with cognitive function.

OBJECTIVES

To confirm the hypothesis that HGS mediated the association of dietary protein intake with cognitive function in the elderly, which was modified by triglyceride level and methylenetetrahydrofolate reductase (MTHFR) gene status.

METHODS

This cross-sectional study included 3,268 participants. Dietary protein intake, HGS, and cognitive function were collected by food frequency questionnaires (FFQ), grip measurements and mini mental state examination (MMSE), respectively. In this mediation analysis, dietary protein intake was entered as independent variable, HGS was entered as mediator, and cognitive function was entered as dependent variable.

RESULTS

HGS significantly mediated the associations of dietary protein (β = 0.0013, 95% CI: 0.0007, 0.0022), animal protein (β = 0.0024, 95% CI: 0.0012, 0.0037), and plant protein intake (β = 0.0011, 95% CI: 0.0001, 0.0023) with cognitive function in total participants, with the mediated proportion of 16.19%, 12.45% and 20.57%, respectively. Furthermore, significant mediation effects of HGS on the associations of dietary protein, animal protein, and plant protein intake with MMSE score were found in the elderly without hypertriglyceridemia or in MTHFR C677T CC/CT carriers.

CONCLUSION

This study suggested that HGS mediated the association of dietary protein intake with cognitive function, and this mediation effect was modified by triglyceride level and MTHFR C677T gene status.

Dietary patterns and sarcopenia in elderly adults: the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) study

Sarcopenia is a core contributor to several health consequences, including falls, fractures, physical limitations and disability. The pathophysiological processes of sarcopenia may be counteracted with the proper diet, delaying sarcopenia onset. Dietary pattern analysis is a whole diet approach used to investigate the relationship between diet and sarcopenia. Here, we aimed to investigate this relationship in an elderly Chinese population. A cross-sectional study with 2423 participants aged more than 60 years was performed. Sarcopenia was defined based on the guidelines of the Asian Working Group for Sarcopenia, composed of low muscle mass plus low grip strength and/or low gait speed. Dietary data were collected using a FFQ that included questions on 100 food items along with their specified serving sizes. Three dietary patterns were derived by factor analysis: sweet pattern, vegetable pattern and animal food pattern. The prevalence of sarcopenia was 16·1 %. The higher vegetable pattern score and animal food pattern score were related to lower prevalence of sarcopenia (P_trend = 0·006 and < 0·001, respectively); the multivariate-adjusted OR of the prevalence of sarcopenia in the highest v. lowest quartiles were 0·54 (95 % CI 0·34, 0·86) and 0·50 (95 % CI 0·33, 0·74), separately. The sweet pattern score was not significantly related to the prevalence of sarcopenia. The present study showed that vegetable pattern and animal food pattern were related to a lower prevalence of sarcopenia in Chinese older adults. Further studies are required to clarify these findings.

Green tea consumption and risk of depressive symptoms: Results from the TCLSIH Cohort Study

BACKGROUND

The prospective studies on the effect of particular type of tea consumption, especially green tea, on depressive symptoms are limited.

OBJECTIVE

The aim of this study is to investigate the prospective association between green tea consumption and depressive symptoms in a large general adult population.

METHODS

This prospective cohort study investigated 7524 participants aged 25 to 90 years from May 2013 to December 2018 and they were free of cardiovascular disease, cancer, and depressive symptoms at baseline. Green tea consumption was obtained through a validated food frequency questionnaire. Depressive symptoms were assessed by using the Self-Rating Depressive Scale (SDS). The association between green tea consumption and depressive symptoms was analyzed by Cox proportional hazards regression models.

RESULTS

A total of 1064 first incident cases of depressive symptoms (SDS ≥45) occurred during 14,661 person-years of follow-up (median follow-up of 2.0 years). In the crude model, the hazard ratios (95% confidence intervals) were 1.00 (reference), 0.95 (0.81, 1.12), 0.97 (0.83, 1.14) and 0.95 (0.79, 1.14), respectively. After adjusting for demographic characteristics, lifestyle factors, and dietary intake, the multivariable adjusted hazard ratios (95% confidence intervals) were 1.00 (reference), 0.88 (0.74, 1.05), 0.84 (0.69, 1.02) and 0.78 (0.63, 0.97), respectively.

CONCLUSIONS

The prospective study suggests that frequent green tea consumption is associated with a decreased risk of depressive symptoms in the general Chinese population.

Crosstalk between dietary patterns, obesity and nonalcoholic fatty liver disease

The prevalence of nonalcoholic fatty liver disease (NAFLD) is rising worldwide, paralleling the epidemic of obesity. The liver is a key organ for the metabolism of proteins, fats and carbohydrates. Various types of fats and carbohydrates in isocaloric diets differently influence fat accumulation in the liver parenchyma. Therefore, nutrition can manage hepatic and cardiometabolic complications of NAFLD. Even moderately reduced caloric intake, which leads to a weight loss of 5%-10% of initial body weight, is effective in improving liver steatosis and surrogate markers of liver disease status. Among dietary patterns, the Mediterranean diet mostly prevents the onset of NAFLD. Furthermore, this diet is also the most recommended for the treatment of NAFLD patients. However, clinical trials based on the dietary interventions in NAFLD patients are sparse. Since there are only a few studies examining dietary interventions in clinically advanced stages of NAFLD, such as active and fibrotic steatohepatitis, the optimal diet for patients in these stages of the disease must still be determined. In this narrative review, we aimed to critically summarize the associations between different dietary patterns, obesity and prevention/risk for NAFLD, to describe specific dietary interventions’ impacts on liver steatosis in adults with NAFLD and to provide an updated overview of dietary recommendations that clinicians potentially need to apply in their daily practice.

The association between major dietary patterns with the risk of non-alcoholic fatty liver disease, oxidative stress and metabolic parameters: A case-control study

Purpose

Non-alcoholic fatty liver disease (NAFLD) is caused by the increase of fat in the liver. The present study aimed to study the association between different dietary patterns and NAFLD in adults.

Methods

This study included 121 adult patients with NAFLD and 119 non-NAFLD. Dietary intake was calculated by a 168-item food frequency questionnaire. Biochemical markers were measured. Dietary patterns were determined by factor analysis. The association between dietary patterns and NAFLD was evaluated using multiple logistic regression analysis.

Results

Two dietary patterns (healthy, western) were recognized in participants. Western dietary pattern was related with 72 percent increase in the odds of NAFLD (OR: 1.72; 95% CI: 1.32,2.14), after adjustment for covariates. Healthy dietary pattern was associated with 38 percent lower odds of NAFLD (OR: 0.38; 95% CI: 0.11, 0.65). Adherence to the western diet was related to 0.486 greater amounts of ALT, 3.248 mg/dl higher levels of FBS, and 3.989 mg/dl greater amounts of TG and 2.354 mg/dl greater amounts of MDA after adjusting for confounding factors (p > 0.001, p = 0.042, p > 0.001, p = 0.036 respectively). The healthy dietary pattern score was negatively associated with FBS and Cholesterol and TG levels (p = 0.035, p = 0.048, and p = 0.025), respectively. Moreover, it was associated with 3.211 mg/dl higher levels of TAC (p = 0.049).

Conclusions

There is a significant relationship between dietary patterns and non-alcoholic fatty liver disease. Adherence to a western dietary pattern is related to an increase in non-alcoholic fatty liver disease.

Relationship between Dietary Behaviors and Physical Activity and the Components of Metabolic Syndrome: A Case-Control Study

Poor diet and low physical activity play an important role in the etiopathogenesis of metabolic syndrome. The aim of this study was to analyze the association between nutrient intake, groups of food products and physical exercise undertaken and the components of metabolic syndrome (MS). The study included 330 patients with MS, and the control group comprised of 270 subjects without MS. The food intake was assessed using 24-h dietary recall, and a 13-item Food Frequency Questionnaire. To assess nutrition knowledge, a Beliefs and Eating Habits Questionnaire was used. The level of physical activity was assessed using the International Physical Activity Questionnaire. Three patterns of behavior were identified: Prudent-Active, Western-Sedentary, and NotPrudent-notWestern-lowActive. In the Prudent-Active group, as compared to the NotPrudent-notWestern-lowActive subjects, the risk of central obesity, hypertension, hypertriglyceridemia, low HDL cholesterol and hyperglycemia occurrence was lower. There was also a lower proportion of patients with MS. As compared to the NotPrudent-notWestern-lowActive subjects, in the Prudent-Active group there was more than a two times higher chance of subjects with a high level of nutrition knowledge. Western diets have been proven to exert a detrimental effect on the components of MS. When designing intervention programs, education of patients with MS on dietary habits and physical activity should be considered.

Empirically-Derived Dietary Patterns in Relation to Non-Alcoholic Fatty Liver Diseases Among Adult Participants in Amol, Northern Iran: A Structural Equation Modeling Approach

Dietary modifications remain the mainstay in managing nonalcoholic fatty liver disease (NAFLD). Published data on the effect of overall dietary patterns on NAFLD is scarce. The present study aims to extract the dietary patterns and investigate their association to NAFLD by gender, using structural equation modeling, among adult participants in Amol, northern Iran. In this cross-sectional study, data from 3,149 participants in the Amol cohort study (55.3% men, n = 1,741) were analyzed. Usual dietary intake was assessed by a validated 168-items semiquantitative food frequency questionnaire. We classified major dietary patterns by explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). NAFLD diagnosis was based on ultrasound scanning, including increased hepatic echogenicity, abnormal appearance of hepatic arteries, and diaphragm in the absence of excessive alcohol consumption. Multivariable logistic regression and structural equation modeling (SEM) were used to explore the relationship between dietary patterns and NAFLD. Three distinct dietary patterns, including western, healthy, and traditional/mixed dietary patterns, were identified. Adult male who adhere to the western dietary pattern were more affected with NAFLD risk [Q1, Q2, Q3, Q4, odds ratio (OR) = 1, 1.16, 1.34, 1.39; 95% confidence interval (CI) = 0.83–1.61, 0.96–1.85, 0.98–1.96, p_trend = 0.04, respectively]. A full mediating effect of healthy dietary pattern, western dietary pattern, and traditional dietary pattern via dietary acid load (DAL) proxy (of dietary patterns to DAL: βstd = −0.35, p < 0.006, βstd = 0.15, p = 0.009, and βstd = 0.08, p = 0.001, respectively), on NAFLD was found through mediation analysis using SEM. A western dietary pattern comprising frequent intake of salty and sweet snacks, soft drinks, refined grains, processed meats, cooked and fried potatoes, eggs, and coffee was associated with a higher odds of NAFLD in an Iranian male population. Additionally, our findings might provide a mechanistic explanation for the association between dietary patterns and NAFLD via DAL proxy. However, further prospective studies, including assessing acid-base biomarkers, are needed.

Empirically derived dietary pattern and odds of non-alcoholic fatty liver diseases in overweight and obese adults: a case-control study

Background

The prevalence of non-alcoholic fatty liver disease (NAFLD) is rising at an exponential rate throughout the world. Given the confirmed association between nutritional status and NAFLD, this study aimed to investigate the relationship of dietary patterns with NAFLD in overweight and obese adults.

Methods

In this age- and gender-matched case–control study, 115 newly diagnosed cases and 102 control individuals participated. A validated 178-item semi-quantitative food frequency questionnaire was administered to assess the participants' dietary data. Dietary patterns were extracted from 24 predefined food groups by factor analysis. Multivariate logistic regression was run to evaluate the relationship between dietary patterns and NAFLD.

Results

Factor analysis resulted in: “western”, “traditional”, and “snack and sweets” dietary patterns. The NAFLD odds were greater in participants at the highest quintile of the “western” dietary pattern than the lowest quintile (OR: 3.52; 95% CI: 1.64, 8.61). A significant increasing trend was observed in NAFLD odds across increasing quintiles of the “western” dietary pattern (P-trend = 0.01). After adjusting for the potential confounders, this relationship remained significant (OR: 3.30; 95% CI: 1.06–10.27). After full adjustments, NAFLD had no association with “traditional” or “snack and sweets” dietary patterns.

Conclusion

The “western” dietary pattern containing fast food, refined grains, liquid oil, pickles, high-fat dairy, sweet desserts, red meat, tea, and coffee was associated with increased odds of NAFLD. However, further prospective studies are required to establish these results.

Preliminary Study on Risk Factors for Morbidity of Nonalcoholic Fatty Liver Disease in High-Income Male Population

OBJECTIVES

Believed to be a result of metabolic syndrome and unhealthy lifestyle, the incidence of nonalcoholic fatty liver disease (NAFLD) has become a serious public health problem. Among the high-income male population, metabolic syndrome and unhealthy lifestyle are particularly prominent. Therefore, we conducted a survey on 375 high-income male subjects, expecting to understand the risk factors and related factors for morbidity of NAFLD among the high-income male population being physically examined in Shanghai.

METHODS

A cross-sectional study was applied to 375 high-income male subjects (including 190 patients with NAFLD and 185 non-NAFLD subjects) who were examined in the special needs clinic at Huadong Hospital affiliated to Fudan University. In combination with medical history, physical examination, and laboratory test results and by use of a self-made NAFLD health questionnaire, the basic data of the research objects were collected and the obtained data were subject to a correlation analysis.

RESULTS

This study investigated 375 high-income males, and the morbidity rate of NAFLD was 50.67%. The NAFLD group was higher than the non-NAFLD group in terms of body weight, BMI, systolic blood pressure, and diastolic blood pressure (P < 0.05). Hypertension (OR = 2.944), diabetes (OR = 7.278), and hyperuricemia (OR = 1.922) are the risk factors for NAFLD; compared with no metabolic diseases, one (OR = 1.848), two (OR = 2.417), and three metabolic diseases (OR = 14.788) are risk factors for the development of NAFLD. Compared with the non-NAFLD group, the NAFLD group had a higher level of WBC, RBC, Hb, PLT, FPG, HbA1c, ALT, AST, GGT, ALP, TP, and UA (P < 0.05). There was a statistically significant difference in the intake of supper and staple foods between the NAFLD group and the non-NAFLD group, and the highly greasy diet was a risk factor for NAFLD (OR = 2.173) as opposed to the nongreasy diet.

CONCLUSION

High-income male population is a high-risk group of NAFLD. Most of the patients with NAFLD have abnormal biochemical indicators as opposed to the healthy population and are more likely to be complicated with other chronic diseases or abnormal health status. And the occurrence of hypertension, diabetes, and hyperuricemia is the risk factor for the development of NAFLD. At the same time, the number of metabolic diseases complicated is also a risk factor for NAFLD as compared with the absence of complications with such metabolic diseases. Compared with a diet that is not greasy, the fact that high-income male NAFLD patients have a very greasy diet increases the risk of NAFLD.

Dietary Patterns and Prevalent NAFLD at Year 25 from the Coronary Artery Risk Development in Young Adults (CARDIA) Study

The prevalence of nonalcoholic fatty liver disease is rapidly rising. We aimed to investigate associations of diet quality and dietary patterns with nonalcoholic fatty liver disease (NAFLD) in Black and White adults. We included 1726 participants who attended the Year 20 Exam of the Coronary Artery Risk Development in Young Adults (CARDIA) study and had their liver attenuation (LA) measured using computed tomography at Year 25 (2010–2011). NAFLD was defined as an LA of ≤51 Hounsfield units after the exclusion of other causes of liver fat. The a priori diet-quality score (APDQS) was used to assess diet quality, and dietary patterns were derived from principal components analysis. Univariate and multivariable logistic regression models were used to evaluate the association between the APDQS, dietary patterns, and NAFLD, and were adjusted for Year 20 covariates. NAFLD prevalence at Year 25 was 23.6%. In a model adjusted for age, race, sex, education, alcohol use, physical activity, smoking, and center at Year 25, the APDQS was inversely associated (p = 0.004) and meat dietary pattern was positively associated (p < 0.0001) with NAFLD, while the fruit-vegetable dietary pattern was not significantly associated (p = 0.40). These associations remained significant when additionally adjusting for comorbidities (type 2 diabetes mellitus, dyslipidemia, hypertension), however, significant associations were diminished after additionally adjusting for body mass index (BMI). Overall, this study finds that the APDQS and meat dietary patterns are associated with prevalent NAFLD in mid-life. The associations appear to be partially mediated through higher BMI.

Association of Dietary Patterns with MRI Markers of Hepatic Inflammation and Fibrosis in the MAST4HEALTH Study

Whereas the etiology of non-alcoholic fatty liver disease (NAFLD) is complex, the role of nutrition as a causing and preventive factor is not fully explored. The aim of this study is to associate dietary patterns with magnetic resonance imaging (MRI) parameters in a European population (Greece, Italy, and Serbia) affected by NAFLD. For the first time, iron-corrected T1 (cT1), proton density fat fraction (PDFF), and the liver inflammation fibrosis score (LIF) were examined in relation to diet. A total of 97 obese patients with NAFLD from the MAST4HEALTH study were included in the analysis. A validated semi-quantitative food frequency questionnaire (FFQ) was used to assess the quality of diet and food combinations. Other variables investigated include anthropometric measurements, total type 2 diabetes risk, physical activity level (PAL), and smoking status. Principal component analysis (PCA) was performed to identify dietary patterns. Six dietary patterns were identified, namely “High-Sugar”, “Prudent”, “Western”, “High-Fat and Salt”, “Plant-Based”, and “Low-Fat Dairy and Poultry”. The “Western” pattern was positively associated with cT1 in the unadjusted model (beta: 0.020, p-value: 0.025) and even after adjusting for age, sex, body mass index (BMI), PAL, smoking, the center of the study, and the other five dietary patterns (beta: 0.024, p-value: 0.020). On the contrary, compared with low-intake patients, those with medium intake of the “Low-Fat Dairy and Poultry” pattern were associated with lower values of cT1, PDFF, and LIF. However, patients with a “Low-Fat Dairy and Poultry” dietary pattern were negatively associated with MRI parameters (cT1: beta: −0.052, p-value: 0.046, PDFF: beta: −0.448, p-value: 0.030, LIF: beta: −0.408, p-value: 0.025). Our findings indicate several associations between MRI parameters and dietary patterns in NAFLD patients, highlighting the importance of diet in NAFLD.

Ultra-processed food consumption and risk of subclinical thyroid dysfunction：A prospective cohort study

Background: Prospective cohort studies linking Ultra-processed foods (UPF) and subclinical thyroid dysfunction (SCTD) are limited, especially in Chinese adults. Objective: We designed a large-scale cohort study to examine whether UPF...

Longitudinal Associations Between Hand Grip Strength and Non-Alcoholic Fatty Liver Disease in Adults: A Prospective Cohort Study

Purpose: This study aimed to determine the longitudinal association between hand grip strength (HGS) and the development of non-alcoholic fatty liver disease (NAFLD) in adults. Design: A cohort study. Methods: This study was conducted in a general Chinese population (n = 14,154) from 2013-2018. NAFLD was diagnosed by liver ultrasonography during evaluating alcohol consumption. The associations between the HGS and NAFLD were assessed using a multivariable Cox proportional hazards regression model. Results: During the study period with a mean follow-up duration of 3.20 years, 2,452 participants developed NAFLD. The risk of NAFLD decreased progressively with increasing HGS in both men and women (P for trend <0.0001). The multivariate-adjusted hazard ratios (95% CI) for NAFLD incidence across the quartiles of HGS were 1 (reference), 0.90 (0.79, 1.02), 0.69 (0.60, 0.79), and 0.44 (0.37, 0.52) for men and 1 (reference), 0.82 (0.69, 0.96), 0.54 (0.45, 0.66), and 0.41 (0.33, 0.52) for women, respectively. The interaction terms for body mass index (BMI)-HGS and waist-HGS were significant in men and women (all P < 0.0001). The participants with normal BMIs and waist circumferences had the lowest hazard ratios on the subgroup analyses. The sensitivity analysis that defined NAFLD using the hepatic steatosis and fatty liver indices revealed results that were similar to the main analyses. Conclusion: The present study indicates that the HGS is inversely associated with the incidence of NAFLD.

Dietary carbohydrates and fats in nonalcoholic fatty liver disease

The global prevalence of nonalcoholic fatty liver disease (NAFLD) has dramatically increased in parallel with the epidemic of obesity. Controversy has emerged around dietary guidelines recommending low-fat-high-carbohydrate diets and the roles of dietary macronutrients in the pathogenesis of metabolic disease. In this Review, the topical questions of whether and how dietary fats and carbohydrates, including free sugars, differentially influence the accumulation of liver fat (specifically, intrahepatic triglyceride (IHTG) content) are addressed. Focusing on evidence from humans, we examine data from stable isotope studies elucidating how macronutrients regulate IHTG synthesis and disposal, alter pools of bioactive lipids and influence insulin sensitivity. In addition, we review cross-sectional studies on dietary habits of patients with NAFLD and randomized controlled trials on the effects of altering dietary macronutrients on IHTG. Perhaps surprisingly, evidence to date shows no differential effects between free sugars, with both glucose and fructose increasing IHTG in the context of excess energy. Moreover, saturated fat raises IHTG more than polyunsaturated or monounsaturated fats, with adverse effects on insulin sensitivity, which are probably mediated in part by increased ceramide synthesis. Taken together, the data support the use of diets that have a reduced content of free sugars, refined carbohydrates and saturated fat in the treatment of NAFLD.

Diet and Liver Adiposity in Older Adults: The Multiethnic Cohort Adiposity Phenotype Study

BACKGROUND

Diet plays a key role in the pathogenesis of nonalcoholic fatty liver disease. Limited data exist regarding specific nutrients and food groups and liver fat continuously, particularly among different ethnicities.

OBJECTIVES

We aimed to determine the relationship between usual dietary intake and accurately measured liver fat content in a multiethnic population.

METHODS

Participants from the Multiethnic Cohort were recruited into the cross-sectional Adiposity Phenotype Study including women and men aged 60-77 y and 5 race/ethnic groups (African American, Japanese American, Latino, Native Hawaiian, and white). They filled out a detailed FFQ and underwent abdominal MRI for liver fat quantification and whole-body DXA for total adiposity. Intake of a priori-selected dietary factors (total and macronutrient energy, specific micronutrients, and food groups) was analyzed in relation to liver fat by estimating the mean percentage liver fat for quartiles of each dietary factor in a general linear model that adjusted for age, sex, race/ethnicity, percentage body fat, and daily energy intake (kcal/d).

RESULTS

In total, 1682 participants (mean age: 69.2 y; 51% female) were included. Mean ± SD liver fat percentage was 5.7 ± 4.6. A significant positive association with liver fat was found across quartiles of percentage energy from fat, saturated fat, cholesterol, total red meat, red meat excluding processed red meat, and coffee (Bonferroni-adjusted P-trend < 0.05). A significant inverse association was observed for dietary fiber, vitamin C, and vitamin E (Bonferroni-adjusted P-trend < 0.05).

CONCLUSIONS

This study of ethnically diverse older adults shows that certain dietary factors, in particular red meat and saturated fat from red meat, were strongly associated with liver fat, whereas dietary fiber was inversely associated with liver fat, replicating some of the previous studies conducted mostly in whites.

Dietary patterns and risk of non-alcoholic fatty liver disease in adults: A prospective cohort study

BACKGROUND AND AIMS

Prospective cohort studies linking dietary patterns and non-alcoholic fatty liver disease (NAFLD) are limited, especially in Asian populations. This study aimed to prospectively investigate the association between dietary patterns and risk of NAFLD in a general Chinese adult population.

METHODS

This study included a total of 17,360 participants free from NAFLD at baseline. Dietary patterns at baseline were identified with factor analysis based on responses to a validated 100-item food frequency questionnaire. NAFLD was diagnosed by abdominal ultrasound after excluding other causes related to chronic liver disease. Cox proportional regression models were used to assess the association between dietary patterns and risk of NAFLD.

RESULTS

During a median follow-up of 4.2 years, 4034 NAFLD cases were documented. Three main dietary patterns were extracted: sugar rich dietary pattern, vegetable rich dietary pattern, and animal food dietary pattern. After adjusting for age, sex, body mass index, smoking, alcohol, education, occupation, income, physical activity, total energy intake, personal and family history of disease, depressive symptoms, dietary supplement use, inflammation markers, and each other dietary pattern score, comparing the highest with the lowest quartiles of dietary pattern scores, the multivariable hazard ratios (95% confidence interval) of NAFLD were 1.11 (1.01, 1.23) for sugar rich dietary pattern, 0.96 (0.86, 1.07) for vegetable rich dietary pattern, and 1.22 (1.10, 1.36) for animal food dietary pattern. Further adjustment for waist circumference instead of body mass index provided similar results.

CONCLUSION

Dietary patterns rich in animal foods or sugar were associated with a higher risk of NAFLD among Chinese adults, whereas a vegetable rich dietary pattern was not associated.

Associations between different types and sources of dietary fibre intake and depressive symptoms in a general population of adults: a cross-sectional study

This cross-sectional study aimed to examine the associations between dietary fibre (DF) intake and depressive symptoms in a general adult population in Tianjin, China. A total of 24 306 participants (mean age 41 years; range 18-91 years) were enrolled. DF intake was assessed using a validated self-administered FFQ. Depressive symptoms were assessed using the Self-Rating Depression Scale. Associations between DF intake and depressive symptoms were estimated using logistic regression analysis. Socio-demographic, behavioural, health status and dietary factors were adjusted. In men, compared with participants in the lowest quartiles for total, soluble, vegetable and soya DF, OR for depressive symptoms in the highest were 0·83 (95 % CI 0·69, 0·99), 0·74 (95 % CI 0·63, 0·87), 0·79 (95 % CI 0·65, 0·96) and 0·69 (95 % CI 0·60, 0·81), respectively. In women, compared with participants in the lowest quartiles for vegetable and soya DF, the OR for depressive symptoms in the highest were 0·77 (95 % CI 0·64, 0·93) and 0·82 (95 % CI 0·70, 0·95), respectively. No association was found between total or soluble DF intake and depressive symptoms in women. No association was found between insoluble, cereal, fruit or tuber DF intake and depressive symptoms in men and women. Linear associations between DF intake and depressive symptoms were only detected for soya DF (men, β = -0·148, P < 0·0001; women, β = -0·069, P = 0·04). Results suggest that intake of soluble, vegetable and soya DF was inversely associated with depressive symptoms. These results should be confirmed through prospective and interventional studies.

Relationship between dietary patterns and non-alcoholic fatty liver disease: A systematic review and meta-analysis

BACKGROUND AND AIM

Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. Previous studies have investigated the association between dietary patterns and NAFLD, but their results are contradictory. Therefore, we carried out this meta-analysis to examine the association between dietary patterns and NAFLD.

METHODS

We searched PubMed, Web of Science, Scopus, and Google Scholar databases until November 14, 2019, to identify the observational studies on the association between dietary patterns and NAFLD. We selected three dietary patterns of Western, Prudent, and Mediterranean. A random-effect model was used to compute the summary risk estimates. Odds ratios (ORs) that were reported for fully adjusted models and their confidence intervals (CIs) were extracted for meta-analysis. Heterogeneity between studies was assessed using Cochran's Q- and I² tests. Eighteen articles (n = 24 867 participants) were entered our systematic review and meta-analysis.

RESULTS

We determined that Western dietary patterns (n = 8787 participants) containing high levels of processed food, red meat, high-fat dairy, and refined grains could significantly increase NAFLD (OR = 1.56, CI = 1.27 to 1.92; P ≤ 0.001). However, the Prudent (n = 13 023 participants) (OR = 0.78, CI = 0.71 to 0.85; P ≤ 0.001) and Mediterranean dietary patterns (n = 3057 participants) (OR = 0.77, CI = 0.60 to 0.98; P = 0.41), defined by high intake of fruits, vegetables, whole grains, fish, and olive oil decreased the risk of this disease.

CONCLUSIONS

We found that Western dietary patterns increased the risk of NAFLD by 56%, although the Prudent and Mediterranean dietary patterns reduced the risk of this disease by 22% and 23%, respectively.

Soft drink consumption and risk of nonalcoholic fatty liver disease: results from the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) cohort study

BACKGROUND

Epidemiological evidence for the association of soft drink consumption with nonalcoholic fatty liver disease (NAFLD) is inconsistent, and such association has not been prospectively examined in the general adult population.

OBJECTIVES

We aimed to investigate the prospective association between soft drink consumption and the risk of NAFLD in a Chinese adult population.

METHODS

This prospective cohort study investigated 14,845 participants [mean age: 39.3 y; 6203 (41.8%) men] who were free of liver disease, cardiovascular disease, and cancer at baseline. Soft drink consumption (mainly sugar-containing carbonated beverages) was measured at baseline using a validated FFQ. NAFLD was diagnosed based on abdominal ultrasound without significant alcohol consumption and other causes of liver disease. Hepatic steatosis index (HSI) was calculated based on sex, BMI, and blood transaminase levels. Cox proportional hazards regression models were used to examine the association of soft drink consumption with incident NAFLD.

RESULTS

A total of 2888 first-incident cases of NAFLD occurred during 42,048 person-years of follow-up (median follow-up: 4.2 y). After adjusting for demographic characteristics, lifestyle factors, dietary intake, and inflammatory markers, the multivariable HRs (95% CIs) for incident NAFLD were 1.00 (reference) for <1 serving/wk, 1.18 (1.03, 1.34) for 1 serving/wk, 1.23 (1.08, 1.40) for 2-3 servings/wk, and 1.47 (1.25, 1.73) for ≥4 servings/wk, respectively (P for trend < 0.0001). Further sensitivity analysis showed that the corresponding multivariable HRs (95% CIs) for incident HSI-defined NAFLD were 1.00 (reference), 0.96 (0.70, 1.31), 1.16 (0.83, 1.62), and 1.59 (1.07, 2.37), respectively (P for trend < 0.0001).

CONCLUSIONS

The results from our prospective study indicate that soft drink consumption is associated with an increased risk of NAFLD in Chinese adults. This study was registered at UMIN Clinical Trials Registry as UMIN000027174.

Saltwater fish but not freshwater fish consumption is positively related to handgrip strength: The TCLSIH Cohort Study

Fish contain many important nutrients and are primarily known for high n-3 polyunsaturated fatty acids (n-3 PUFA) content. Studies have shown that supplementation of fish oil-derived n-3 PUFA improves muscle mass and strength. Here, we hypothesized that fish consumption might improve muscle strength. To test this hypothesis, we performed this cross-sectional study (n = 29,084) in Tianjin, China. The frequency of fish consumption was assessed using a valid self-administered food frequency questionnaire. Handgrip strength (HGS) was used as the indicator of muscle strength, and was measured using a handheld digital dynamometer. Analysis of covariance was used to examine the relationship between fish consumption and HGS. In men, after adjusted potential confounding factors, the least square means (95% confidence intervals) of HGS across saltwater fish consumption categories were 41.5 (41.1, 43.7) kg for <1 time/week, 44.6 (43.2, 45.8) kg for 1 time/week, and 44.7 (43.3, 46.1) kg for ≥2 to 3 times/week (P for trend <0.001). In men, the least square means (95% confidence intervals) of HGS across the ascending quartiles of dietary n-3 PUFA intake were 43.6 (43.2, 44.4) kg, 43.7 (43.2, 44.6) kg, 44.4 (43.0, 45.8) kg, and 44.6 (43.1, 46.0) kg (P for trend <0.01). The results showed that saltwater fish consumption was positively related to HGS in men, but not in women, suggesting that saltwater fish contain nutrients that may be used to improve HGS.

Nutrients, Genetic Factors, and Their Interaction in Non-Alcoholic Fatty Liver Disease and Cardiovascular Disease

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Western countries and expose patients to increased risk of hepatic and cardiovascular (CV) morbidity and mortality. Both environmental factors and genetic predisposition contribute to the risk. An inappropriate diet, rich in refined carbohydrates, especially fructose, and saturated fats, and poor in fibers, polyunsaturated fats, and vitamins is one of the main key factors, as well as the polymorphism of patatin-like phospholipase domain containing 3 (PNPLA3 gene) for NAFLD and the apolipoproteins and the peroxisome proliferator-activated receptor (PPAR) family for the cardiovascular damage. Beyond genetic influence, also epigenetics modifications are responsible for various clinical manifestations of both hepatic and CV disease. Interestingly, data are accumulating on the interplay between diet and genetic and epigenetic modifications, modulating pathogenetic pathways in NAFLD and CV disease. We report the main evidence from literature on the influence of both macro and micronutrients in NAFLD and CV damage and the role of genetics either alone or combined with diet in increasing the risk of developing both diseases. Understanding the interaction between metabolic alterations, genetics and diet are essential to treat the diseases and tailoring nutritional therapy to control NAFLD and CV risk.

The relationship between dietary patterns and grip strength in the general population: the TCLSIH cohort study

PURPOSE

Previous studies have shown that many nutrients play an essential role in maintaining skeletal muscle strength. Hand grip strength (HGS) is frequently used as an objective and reliable method to evaluate overall body muscle strength and physical function. Some studies have demonstrated that some specific single nutrients such as PUFA, fiber, vitamin C, fruits and vegetables are associated with muscle strength. However, few studies have explored the relationship between dietary patterns and HGS in the adult population. The aim of this study was to investigate how dietary patterns are related to HGS in a large-scale Chinese population.

METHODS

A cross-sectional study (n = 35,175) was performed in Tianjin, China. Adherence to dietary patterns was measured by a valid self-administered food frequency questionnaire with 81 food items. Principal-components analysis was used to derive three major dietary patterns: "sweet", "healthy" and "animal food". HGS was measured using a handheld digital dynamometer. Analysis of covariance and multiple logistic regression were employed to explore the relationship between dietary patterns and HGS.

RESULTS

After adjustment for potential confounders, the means (95% confidence interval) of HGS for increasing quartile of dietary patterns were as follows: "sweet", 0.50 (0.49-0.51), 0.50 (0.49-0.51), 0.50 (0.49-0.51), 0.50 (0.48-0.51) (P value = 0.07); "healthy" 0.50 (0.49-0.51), 0.50 (0.49-0.51), 0.50 (0.49-0.51), 0.50 (0.49-0.51) (P value < 0.0001); "animal food" 0.51(0.50-0.52), 0.50 (0.49-0.51), 0.50 (0.49-0.51), 0.49 (0.48-0.51) (P value < 0.0001), respectively.

CONCLUSIONS

The present study demonstrated a slight improvement between healthy dietary pattern and HGS across the quartiles. On the contrary, this study also showed higher adherence to the animal food dietary pattern (i.e., higher quartile) had lower grip strength. A long-term prospective study or randomized trials are required to clarify this association.

Complex Dietary Topologies in Non-alcoholic Fatty Liver Disease: A Network Science Analysis

Background and Aims: Previous studies have explored the associations between nutrition (food groups, nutrients, and dietary patterns) and the prevalence of non-alcoholic fatty liver disease. However, it remains unclear whether how foods are consumed together is associated with non-alcoholic fatty liver disease. The present study aims to construct dietary networks from network science and to explore the associations between complex dietary networks and non-alcoholic fatty liver disease. Methods: The present case-control study generated 2,043 multivariate matched controls for 2,043 newly diagnosed non-alcoholic fatty liver disease cases. Mutual information, which represents both linear and non-linear dependencies among food groups, was used to construct the network topologies. Results: The dietary topologies in the studied case and control groups were different despite the fact that only few food groups show differences in absolute intake. The dietary structure of the case group focused on two major components with more cohesion among food groups, while contrarily the control group had one major component with higher diversity of food groups. The dietary topology of the case group showed equality in connections among beneficial and detrimental food groups, whereas the control group focused more on healthier food choices. Conclusions: This study suggests how foods are consumed, besides the absolute intake, could be an important determinant of the occurrence of non-alcoholic fatty liver disease. A diverse diet that focuses on whole grain, tubers, and vegetables could yield beneficial effects regarding non-alcoholic fatty liver disease. Network science could offer a complementary tool in nutritional epidemiology.

Serum Soluble Receptor for AGE (sRAGE) Levels Are Associated With Unhealthy Lifestyle and Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) has been demonstrated to be positively associated with serum advanced glycation end products (AGEs) and negatively with soluble receptor for AGE (sRAGE) in a few small studies. We aimed to test the association between lifestyle and sRAGE levels and the association between sRAGE levels or AGEs intake and NAFLD, insulin resistance (IR), and elevated alanine aminotransferase (ALT).

Associations between honey consumption and prehypertension in adults aged 40 years and older

Background: Honey has been shown to have multiple positive effects on human health. However, data on the associations of honey consumption with prehypertension are scarce. The aim of this study was to investigate whether honey consumption is associated with prehypertension in a Chinese population. Method: A cross-sectional study was conducted in 4,561 individuals aged ≥40 years. A validated 100-item semi-quantitative food frequency questionnaire was used to assess honey consumption. Blood pressure was measured at least twice by trained nurses. Multiple logistic regression models were used to explore the associations between honey consumption and prehypertension. Results: After adjustment for potential confounders, the odds ratios and 95% confidence intervals of prehypertension across increasing frequency of honey consumption were 1.00 (reference) for almost never, 1.17 (0.96, 1.41) for ≤6 times/week, and 1.25 (0.86, 1.84) for ≥7 times/week in men (P _{for trend} = 0.09); 1.00 (reference) for almost never, 0.76 (0.62, 0.92) for ≤6 times/week, and 0.84 (0.63, 1.12) for ≥7 times/week in women (P _{for trend} = 0.055), respectively. Conclusion: Our results showed that light-to-moderate intake of honey was associated with lower prevalence of prehypertension in women, but not men. Future studies are required to confirm these associations.

Association of the dietary patterns with the risk of non-alcoholic fatty liver disease among Iranian population: a case-control study

BACKGROUND

Diet-based recommendations can be developed for preventing and treating non-alcoholic fatty liver disease (NAFLD) after investigating the effects of whole diets on NAFLD. The aim of this study was to identify major dietary patterns and their association with the risk of NAFLD.

METHODS

A total of 244 individuals (122 NAFLD patients and 122 controls) participated in this case-control study. The patients with NAFLD were diagnosed by a gastroenterologist. The participants' dietary intake data were collected using a 147-item semi-quantitive food frequency questionnaire and major dietary patterns were identified by principal component analysis. Adherence to dietary patterns was divided into tertiles and its association with odds of NAFLD was investigated by multivariate logistic regression.

RESULTS

The results showed four major dietary patterns, among which adherence to the "ordinary pattern" was positively associated with NAFLD risk. After adjusting for all confounding factors, individuals in the highest tertile of "ordinary pattern" exhibited a significantly elevated risk of NAFLD compared to the lowest tertile (OR = 3.74, 95%CI = 1.23-11.42, P trend< 0.001). As well as, Individuals in the second and third tertiles of the "traditional pattern" were associated with the risk of NAFLD compared to the lowest tertile (medium vs. lowest tertile OR = 2.37, 95%CI = 1.02-5.53; highest vs. lowest tertile OR = 3.58, 95% CI = 1.48-8.68, P trend< 0.001). The highest tertile of "vegetable and dairy pattern" compared to the lowest tertile was inversely associated with NAFLD risk (OR = 0.23, 95%CI = 0.09-0.58, P trend = 0.02). No significant association was found between "fast food type pattern" and the risk of NAFLD.

CONCLUSION

A significant association was observed between different dietary patterns and the risk of NAFLD. These results can potentially serve as a dietary strategy for preventing NAFLD in individuals who are at a high risk for progression of NAFLD.

Association of dietary patterns with the newly diagnosed diabetes mellitus and central obesity: a community based cross-sectional study

Aim

The purpose of this study was to investigate the association of dietary patterns with the risk of insulin resistance (IR), diabetes mellitus (DM), and central obesity in China.

Methods

We performed a cross-sectional study on 1432 participants, aged 40–65 years in Hangzhou, Zhejiang province, China. Dietary intake was assessed using a semi-quantitative food frequency questionnaire.

Results

Factor analysis extracted four major dietary patterns: vegetable-fruits, rice–meat, seafood–eggs, and sweet–fast. The vegetable-fruits pattern was inversely associated with HOMA-IR (p < 0.001 in both genders), while sweet–fast food pattern was significantly associated with higher HOMA-IR (p = 0.002 in male, and p < 0.001 in female). The vegetables–fruits pattern was inversely correlated with visceral fat area (VFA) (p = 0.029 in males, and p = 0.017 in females), while sweet–fast food pattern presented a significant direct association (p < 0.001 in male) with VFA in males. There was no association observed between the rice–meat pattern or the seafood–eggs pattern and HOMA-IR or VFA. After adjustment for potential confounding factors, participants in the highest tertile of vegetable-fruits pattern showed a significantly lower risk of DM in both males and females (OR: 0.30, 95% CI: 0.13–0.70 in male, and OR: 0.28, 95% CI: 0.11–0.72 in female), and lower risk of central obesity was observed in males (OR: 0.50, 95% CI: 0.29–0.86 in male). Conversely, participants in the highest tertile of sweet–fast food pattern had higher risk of DM (OR: 2.58, 95% CI: 1.23–5.88 in male), and central obesity (OR: 2.85, 95% CI: 1.67–4.86 in male) only in male. While neither the rice–meat pattern nor the seafood–eggs pattern showed significant association with DM or central obesity in both genders.

Conclusions

Our findings indicated low risk of IR, DM, and central obesity with vegetable-fruits pattern while inverse relation with sweet–fast food pattern.

Food groups and the likelihood of non-alcoholic fatty liver disease: a systematic review and meta-analysis

Dietary habits have been implicated in the development and severity of non-alcoholic fatty liver disease (NAFLD). Several epidemiological studies attempted to assess the relationship between food groups and the likelihood of NAFLD, but these results were conflicting. The present meta-analysis was conducted to assess the association between food groups and the likelihood of NAFLD. Published literature was retrieved and screened from MEDLINE, Embase and Web of Science. Out of 7892 retrieved articles, twenty-four observational studies (fifteen cross-sectional studies and nine case–control studies) met our eligibility criteria and were finally included in this systematic review and meta-analysis. Consumption of both red meat and soft drinks contributed to a positive association with NAFLD. Inversely, nut consumption was negatively associated with NAFLD. There were no significant influences on the likelihood of NAFLD about consuming whole grains, refined grains, fish, fruits, vegetables, eggs, dairy products and legumes. This meta-analysis suggests that individuals who consumed more red meat and soft drinks may have a significantly increased likelihood of NAFLD, whereas higher nut intake may be negatively associated with NAFLD. Further prospective studies are required to assess the association between food patterns and NAFLD.

Association between soft drink consumption and handgrip strength in middle aged and older adults: the TCLSIH cohort study

A cross-sectional study was conducted to explore the association between soft drink consumption and handgrip strength (HGS) in subjects aged 40 years and older (n = 14,925). After multivariable-adjustment (including demographics, lifestyles, family history of diseases, dietary intake, and other beverages consumption), the least square means (95% confidence interval) of HGS across soft drink consumption categories were 43.1(42.7, 43.5) kg for almost never drink, 42.9(42.4, 43.4) kg for <1 cup/week, 42.8(42.1, 43.5) kg for 1-6 cups/week and 41.2(40.1, 42.6) kg for ≥1 cup/day (p for trend < 0.001) in men, and 26.6(25.9, 27.8) kg for almost never drink, 26.5(25.8, 27.1) kg for <1 cup/week, 26.3(25.7, 27.2) kg for 1-6 cups/week and 25.2(24.9, 27.0) kg for ≥1 cup/day (p for trend < 0.001) in women, respectively. Our findings suggest that higher consumption of soft drinks was significantly associated with lower HGS in middle-aged and older adults. Additional prospective or interventional studies are needed to confirm this issue.

Association between dietary patterns during the third trimester and the risk of postpartum depression in China

BACKGROUND

Postpartum depression, which has affected one in six women after giving birth, can exert detrimental effects on maternal, children and family well-being. This study investigated the association between dietary patterns and postpartum depression among Chinese women.

METHODS

A total of 1659 participants were recruited and collected between July 2015 and June 2017 in Tianjin, China. The Chinese version of the Self-Rating Depression Scale was used to assess depressive symptoms at 6-12 weeks postpartum. Information about diet was obtained using an 81-item food frequency questionnaire. Logistic regression models were used to assess relationships between dietary patterns and the risk of postpartum depression.

RESULTS

Six dietary patterns were identified by principal component analysis, including beverage, vegetable, cereal-meat, nut-fruit, egg and seafood patterns. The highest tertile (T3) of the nut-fruit pattern was significantly associated with a decreased risk of postpartum depression (OR: 0.740, 95% CI: 0.573-0.955, p = =0.020). Moreover, T3 of the seafood pattern was associated with a lower risk of postpartum depression than the lowest tertile (T1) of this pattern (OR: 0.753, 95% CI: 0.580-0.978, p = =0.033). No other associations were found.

LIMITATIONS

A retrospective study.

CONCLUSIONS

The nut-fruit pattern and seafood pattern were associated with a decreased risk of postpartum depression in Chinese women. The present findings reinforce the importance of an adequate diet of fruit, nuts, and seafood for postpartum women.

The association between banana consumption and the depressive symptoms in Chinese general adult population: A cross-sectional study

BACKGROUND

Banana contains many kinds of substances that are beneficial to depressive symptoms. However, there are no epidemiological researches directly to explore the association between banana consumption and depressive symptoms. This study aimed to investigate whether the banana consumption is related to depressive symptoms in a general adult population.

METHODS

A cross-sectional study was performed in 24,673 adults in Tianjin. Banana consumption was evaluated via a validated food frequency questionnaire. Depressive symptoms were assessed by using Self-Rating Depression Scale (SDS). The association between banana consumption and depressive symptoms was analyzed by multiple logistic regression analysis.

RESULTS

The prevalence of depressive symptoms was 16.1% in males and 18.4% in females (SDS ≥ 45), respectively. In males, comparing to the reference group (almost never), the multivariable adjusted odds ratios (ORs) (95% confidence intervals) of depressive symptoms across banana consumption were 0.86 (0.74, 0.99) for <1 time/week, 0.76 (0.66, 0.88) for 1-3 times/week and 0.97 (0.82, 1.16) for ≥4 times/week. By contrast, the multivariable adjusted ORs (95% confidence intervals) were 1.11 (0.94, 1.32) for <1 time/week, 0.99 (0.85, 1.16) for 1-3 times/week and 1.22 (1.02, 1.46) for ≥4 times/week in females. Similar association was observed when other cut-offs (SDS ≥ 48 and 50) were used to define depressive symptoms.

LIMITATION

This is a cross-sectional study, causality remains unknown.

CONCLUSION

Findings from this study suggested a negative association between moderate banana consumption and depressive symptoms in males. In females, high banana consumption is positively related to depressive symptoms.

Insoluble dietary fibre intake is associated with lower prevalence of newly-diagnosed non-alcoholic fatty liver disease in Chinese men: a large population-based cross-sectional study

BACKGROUND

The health benefits of dietary fibre (DF) intake on non-alcoholic fatty liver disease (NAFLD) are controversial. Thus, this large cross-sectional study aimed to determine the associations between DF intake and the prevalence of newly-diagnosed NAFLD in a large general population.

METHODS

A total of 23,529 participants were enrolled in the analyses. Newly-diagnosed NAFLD was diagnosed according to liver ultrasonography and history of alcohol intake. DF intake was assessed using a validated self-administered food frequency questionnaire. Logistic regression analysis was applied to estimate the associations between DF intake and NAFLD.

RESULTS

In total, 18.81% (n = 4426) of the participants were newly diagnosed with NAFLD. Compared with the participants in the lowest quartile of DF intake, the ORs (95% CI) for the participants in the highest quartile were 0.81 (0.67, 0.97), 0.78 (0.62, 0.99), and 0.85 (0.62, 1.17) for all participants, men, and women, respectively. Compared with the participants in the lowest quartile of insoluble DF intake, the ORs (95% CI) for the participants in the highest quartile were 0.70 (0.58, 0.85), 0.60 (0.47, 0.76), and 0.95 (0.68, 1.32) in all participants, men, and women, respectively. No association was observed between soluble DF intake and NAFLD. DF from whole grain, soy foods, vegetables, and nuts but not fruits were negatively associated with NAFLD.

CONCLUSIONS

A higher intake of insoluble DF is associated with lower prevalence of newly-diagnosed NAFLD in men. Moreover, intake DF from whole grain, soy foods, vegetables, and nuts, but not fruits have favorable effect on the prevalence of newly diagnosed NAFLD. Further cohort studies and randomized controlled trials are needed to validate this finding.

Intestinal Fructose and Glucose Metabolism in Health and Disease

The worldwide epidemics of obesity and diabetes have been linked to increased sugar consumption in humans. Here, we review fructose and glucose metabolism, as well as potential molecular mechanisms by which excessive sugar consumption is associated to metabolic diseases and insulin resistance in humans. To this end, we focus on understanding molecular and cellular mechanisms of fructose and glucose transport and sensing in the intestine, the intracellular signaling effects of dietary sugar metabolism, and its impact on glucose homeostasis in health and disease. Finally, the peripheral and central effects of dietary sugars on the gut–brain axis will be reviewed.

The relationship between Helicobacter pylori infection and depressive symptoms in the general population in China: The TCLSIH cohort study

BACKGROUND

Depressive symptoms are a common, debilitating, and costly public health issue. Helicobacter pylori (H pylori) infection cause changes in the normal physiological state of the gastrointestinal (GI) flora. Although the physiological state of the GI tract is closely related to mental disorders, few population studies have examined the relationship between H pylori infection and depressive symptoms in the general population. The aim of this study was to examine whether H pylori infection is related to depressive symptoms among the general adult population.

MATERIALS AND METHODS

This cross-sectional study included 5558 inhabitants of Tianjin, China. H pylori infection was diagnosed with the carbon 13 breath test. Depressive symptoms were assessed using the Chinese version of 20-item Self-rating Depression Scale (SDS) with three cutoffs (45, 48, and 50) to indicate elevated depressive symptoms. Multiple logistic regression analysis were conducted to assess the association between H pylori infection and depressive symptoms.

RESULTS

The prevalence of depressive symptoms (SDS ≥ 45) was 12.7% in men and 17.4% in women. In multivariable models, the odds ratios and 95% confidence interval of having depressive symptoms by H pylori infection were 1.25 (1.01-1.56), 1.46 (1.11-1.91), and 1.46 (1.05-2.06) for three cutoffs: 45, 48, and 50 in women. However, no significant difference was found between H pylori infection and depressive symptoms in men.

CONCLUSIONS

This study firstly suggested that H pylori infection was related to depressive symptoms in women in the general adult population. Further prospective studies or randomized trials are required to clarify the causality.

Prevalence and Severity of Nonalcoholic Fatty Liver Disease Among Caregivers of Patients With Nonalcoholic Fatty Liver Disease Cirrhosis

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, affecting nearly 1 in 3 Americans.¹ Nonalcoholic steatohepatitis (NASH), the clinically aggressive variant of NAFLD, has a propensity of fibrosis progression and increased risk of cirrhosis and hepatocellular carcinoma. NASH-related cirrhosis is now the most rapidly growing indication for liver transplantation (LT).² Disease recurrence and progression to advanced fibrosis after LT are high³; however, the key contributors of these are unknown. We hypothesized that patients with NASH cirrhosis reside in a microenvironment conducive to not only development of NASH but also fibrosis progression, which likely persist after LT and contribute to disease recurrence. The hypothesis was tested by performing vibration-controlled transient elastography (VCTE) in primary caregivers and cohabitants of patients with decompensated cirrhosis awaiting LT.

Association between nut consumption and non-alcoholic fatty liver disease in adults

BACKGROUND & AIMS

Increased nut consumption has been associated with reduced inflammation, insulin resistance, and oxidative stress. Although these factors are closely involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD), few studies have focused on the association between nut consumption and NAFLD in the general population. We aimed to investigate the association of nut consumption and NAFLD in an adult population.

METHODS

A total of 23 915 participants from Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) Cohort Study were included in this study. Information on dietary intake was collected using a validated food frequency questionnaire. Abdominal ultrasonography was done to diagnose NAFLD. Multivariable logistic regression was used to assess the association of nut consumption with NAFLD.

RESULTS

After adjusting for sociodemographic, medical, dietary, and lifestyle variables, the odds ratios (95% confidence interval) for NAFLD across categories of nut consumption were 1.00 (reference) for <1 time/week, 0.91 (0.82, 1.02) for 1 time/week, 0.88 (0.76, 1.02) for 2-3 times/week, and 0.80 (0.69, 0.92) for ≥4 times/week (P for trend < 0.01). These associations were attenuated but remained significant after further adjustment for blood lipids, glucose, and inflammation markers.

CONCLUSIONS

Higher nut consumption was significantly associated with lower prevalence of NAFLD. Further prospective studies and randomized trials are required to ascertain the causal association between nut consumption and NAFLD.

Intermediary effect of inflammation on the association between dietary patterns and non-alcoholic fatty liver disease

OBJECTIVE

Previous studies have demonstrated that nutritional status is associated with non-alcoholic fatty liver disease (NAFLD). Meanwhile, subclinical inflammation is associated with the prevalence of NAFLD. To our knowledge, however, no study has investigated the intermediary effect of inflammation on the association between dietary pattern and NAFLD. Thus, the aim of this case-control study was to explore the intermediary effect of inflammation on the association between dietary patterns and NAFLD.

METHODS

Using the propensity score matching method, we generated 2043 cases and 2043 controls. Dietary intake was assessed using a valid self-administered food frequency questionnaire. Major dietary patterns in the population were derived by factor analysis. Reduced rank regression with leukocyte count as a response variable was used to derive an inflammatory pattern. NAFLD was diagnosed by liver ultrasonography and drinking history. The association between dietary patterns and NAFLD was tested using multiple conditional logistic regression analysis.

RESULTS

Three major dietary patterns were derived by factor analysis: sweet pattern, animal foods pattern, and traditional pattern. Compared with participants in the lowest quartile of the animal foods pattern, the odds ratio (OR; 95% confidence interval [CI]) of NAFLD in the highest quartile was 1.30 (95% CI, 1.09-1.55). After adjustment of inflammation status, the OR was weaker (OR, 1.23; 95% CI, 1.03-1.48), albeit significant. Compared with the participants in the lowest quartile of inflammatory pattern, the OR of NAFLD in the highest quartile was 1.52 (95% CI, 1.28-1.81).

CONCLUSION

The present data suggested that inflammation may mediate the association between dietary patterns and NAFLD.

Association Between Dietary Selenium Intake and the Prevalence of Nonalcoholic Fatty Liver Disease: A Cross-Sectional Study

Objective: The aim was to examine the association between dietary selenium intake and nonalcoholic fatty liver disease (NAFLD) in a large group of middle-aged and elderly Chinese persons.Method: The data included in this analysis were from a population-based study, the Xiangya Hospital Health Management Center Study. NAFLD was diagnosed by (1) imaging or histological evidence of hepatic steatosis; (2) absence of specific etiologies of NAFLD; and (3) no heavy consumption of alcohol. Dietary selenium intake was assessed using a validated semi-quantitative food frequency questionnaire. The association between dietary selenium intake and the prevalence of NAFLD was evaluated using logistic and spline regression in a cross-sectional study of 5436 subjects.Results: The prevalence of NAFLD was 36.8%. Compared with the lowest quintile, the energy-adjusted odds ratios for NAFLD were 1.27 (95% confidence interval [CI], 1.07-1.52), 1.30 (95% CI, 1.09-1.55), and 1.58 (95% CI, 1.33-1.89) for the third, fourth, and fifth quintiles of selenium intake, respectively, and there was a positive dose-response relationship (r = 0.88, p for trend = 0.008). Similar results were observed for men and women separately. The findings were not materially altered by adjustment for potential confounders (i.e., age, gender, body mass index, smoking status, diabetes, hypertension, activity level, nutritional supplements, energy intake, fat intake, fiber intake, cholesterol and saturated fatty acid intake).Conclusions: In this middle-aged and elderly population, subjects with higher dietary selenium intake, even below the recommended nutrient intake in China, had higher prevalence of NAFLD in a dose-response relationship manner.

Dietary patterns and non-alcoholic fatty liver disease in a Greek case-control study

OBJECTIVE

The aim of this study was to test the hypothesis that posteriori-derived dietary patterns of a Greek sample are associated with the odds for non-alcoholic fatty liver disease (NAFLD) and common NAFLD-related biomarkers.

METHODS

We recruited 351 individuals (134 NAFLD patients, 217 controls). NAFLD was diagnosed with abdominal ultrasound. Dietary intake data were collected through a semi-quantitative food frequency questionnaire of 172 items and dietary patterns were derived by factor analysis. Consumption of dietary patterns was divided into quartiles. Multivariate logistic and linear regression models were applied to investigate associations of dietary patterns with NAFLD odds and common NAFLD-associated biomarkers.

RESULTS

Four dietary patterns were identified. Adherence to the fast food-type dietary pattern was independently associated with higher odds for NAFLD. However, results were statistically significant only for the highest versus the lowest consumption (odds ratio, 3.9; P = 0.003). On the contrary, individuals in the second quartile of the unsaturated fatty acid dietary pattern had 55.7% reduced odds of developing NAFLD than those in the first quartile after adjusting for age, sex, energy intake, physical activity level, pack-years smoked, education years, and presence of metabolic syndrome (P = 0.039). The fast food-type pattern was further associated with higher levels of C-reactive protein and uric acid and the unsaturated fatty acid pattern with reduced levels of insulin and homeostatic model assessment of insulin resistance (P < 0.05). The prudent dietary pattern was associated with decreased triacylglycerol and uric acid levels (β = -5.960; P = 0.037 and β = -0.153; P = 0.035, respectively).

CONCLUSION

This is the first study to indicate associations of dietary patterns with NAFLD in a European population.