Association between flavonoid and subclasses intake and metabolic associated fatty liver disease in U.S. adults: Results from National Health and Nutrition Examination Survey 2017-2018

Associations of the Intake of Individual and Multiple Flavonoids with Metabolic Dysfunction Associated Steatotic Liver Disease in the United States

BACKGROUND

Evidence regarding the individual and combined impact of dietary flavonoids on the risk of metabolic dysfunction associated with steatotic liver disease (MASLD) remains scarce. Our objective is to evaluate the association between individual and multiple dietary flavonoids with MASLD in adults.

METHODS

Data sets were obtained from the National Health and Nutrition Examination Survey (NHANES), 2017-2018. In total, 2581 participants aged over 18 years, with complete information on dietary flavonoid intake, MASLD, and covariates, were included. Flavonoid intake was energy-adjusted using the residual method. Logistic regression analysis was employed to examine the impact of total flavonoid intake on MASLD. Weighted quantile sum (WQS) analyses were used to evaluate the combined and individual effects of flavonoids on MASLD and to identify the predominant types with the most significant contribution to MASLD prevention.

RESULTS

The highest tertile of total flavonoid intake was associated with a 29% reduction in the risk of MASLD compared to the lowest tertile after multivariable adjustments (OR: 0.71, 95% CI: 0.51-0.97). The WQS analysis revealed that anthocyanidins, flavones, and flavanones were the most critical contributors among six subclasses (weights = 0.317, 0.279, and 0.227, respectively) and naringenin, apigenin, and delphinidin were the most critical contributors among 29 monomers. (weights = 0.240, 0.231, and 0.114, respectively). Also, a higher intake of anthocyanidins, flavones, naringenin, apigenin, and delphinidin was linked to a reduced risk of MASLD (p < 0.05).

CONCLUSIONS

Our findings suggested that a higher flavonoid intake is associated with a lower risk of MASLD, with anthocyanidins, flavones, flavanones, naringenin, apigenin, delphinidin, and myricetin contributing most to the protective effects of flavonoids.

Flavonoids and Their Role in Preventing the Development and Progression of MAFLD by Modifying the Microbiota

With the increasing prevalence and serious health consequences of metabolic-associated fatty liver disease (MAFLD), early diagnosis and intervention are key to effective treatment. Recent studies highlight the important role of dietary factors, including the use of flavonoids, in improving liver health. These compounds possess anti-inflammatory, antioxidant, and liver-protective properties. Flavonoids have been shown to affect the gut microbiota, which plays a key role in liver function and disease progression. Therefore, their role in preventing the development and progression of MAFLD through modulation of the microbiome seems to be of interest. This narrative review aims to consolidate the current evidence on the effects of selected flavonoids on MAFLD progression, their potential mechanisms of action, and the implications for the development of personalized dietary interventions for the management of liver disease.

Association between dietary intake of flavonoid and chronic kidney disease in US adults: Evidence from NHANES 2007-2008, 2009-2010, and 2017-2018

BACKGROUND

Studies investigating the relationship between flavonoid intake and chronic kidney disease (CKD) are limited. This study investigated the association between daily flavonoid intake and CKD in US adults by using data for 2007-2008, 2009-2010, and 2017-2018 from the National Health and Nutrition Examination Survey (NHANES) database.

METHODS

This study employed a cross-sectional design and used data from three cycles of the continuous NHANES: 2007-2008, 2009-2010, and 2017-2018. NHANES researchers collected data related to consumption of various food and beverages from participants by employing 24-h dietary recall questionnaires. CKD is defined as an estimated glomerular filtration rate of < 60 mL/min/1.73m2 or a urine albumin-to-creatinine ratio of ≥ 30 mg/g.

RESULTS

The odds ratios (OR) for CKD risk in the second (Q2), third (Q3), and fourth (Q4) quartiles of total flavonoid intake, compared with that in the first (Q1) quartile, were 0.780 (95% CI: 0.600, 1.015), 0.741 (95% CI: 0.573, 0.957), and 0.716 (95% CI: 0.554, 0.925), respectively (with a P value for the trend of 0.040). According to the restricted cubic spline analysis, total flavonoid intake exhibited a non-linear relationship with CKD risk (P < 0.001).

CONCLUSION

Our findings suggest that a potential J-shaped relationship was observed between total flavonoid consumption and CKD risk, with an inflection point at 69.58 mg/d. Our study indicates that a moderate intake of flavonoids may confer renal benefits which may offer novel strategies for CKD treatment.

Association between consumption of flavonol and its subclasses and chronic kidney disease in US adults: an analysis based on National Health and Nutrition Examination Survey data from 2007-2008, 2009-2010, and 2017-2018

Background

There is little research on the relationship between flavonol consumption and chronic kidney disease (CKD). This study aimed to examine the link between flavonol consumption and the risk of CKD among US adults, using data from the 2007-2008, 2009-2010 and 2017-2018 National Health and Nutrition Examination Survey (NHANES).

Methods

A cross-sectional approach was used, drawing on data from three NHANES cycles. The flavonol consumption of the participants in this study was assessed using a 48 h dietary recall interview. CKD was diagnosed based on an estimated glomerular filtration rate below 60 mL/min/1.73 m2 or a urine albumin-to-creatinine ratio of 30 mg/g or higher.

Results

Compared to the lowest quartile of flavonol intake (Q1), the odds ratios for CKD were 0.598 (95% CI: 0.349, 1.023) for the second quartile (Q2), 0.679 (95% CI: 0.404, 1.142) for the third quartile (Q3), and 0.628 (95% CI: 0.395, 0.998) for the fourth quartile (Q4), with a p value for trend significance of 0.190. In addition, there was a significant trend in CKD risk with isorhamnetin intake, with the odds ratios for CKD decreasing to 0.860 (95% CI: 0.546, 1.354) in the second quartile, 0.778 (95% CI: 0.515, 1.177) in the third quartile, and 0.637 (95% CI: 0.515, 1.177) in the fourth quartile (p for trend = 0.013).

Conclusion

Our analysis of the NHANES data spanning 2007-2008, 2009-2010, and 2017-2018 suggests that high consumption of dietary flavonol, especially isorhamnetin, might be linked to a lower risk of CKD in US adults. These findings offer new avenues for exploring strategies for managing CKD.

The association between flavonoids intake and hypertension in U.S. adults: A cross-sectional study from The National Health and Nutrition Examination Survey

Although in vitro experiments have demonstrated the potential of flavonoid compounds in regulating blood pressure, there is still a lack of evidence from large population studies. We conducted a cross-sectional study using the National Health and Nutrition Examination Survey to investigate the relationship between flavonoid intake levels (natural log transformation) and hypertension events. A total of 15 752 participants aged over 20 years were included, and a weighted multivariable logistic regression analysis was performed to explore the relationship between total flavonoids, five sub types intake, and hypertension events. Smooth curve fitting was used to explore potential nonlinear relationships. Higher total flavonoids intake was associated with a lower risk of hypertension than the lowest group. The adjusted odds ratios (95% CIs) were 0.79 (0.70-0.88) for total flavonoids intake. Elevated total flavonoids intake levels were significantly and linearly associated with a lower risk of hypertension. For each unit increase in the total flavonoids intake level, the adjusted ORs for risk of hypertension decrease by 5% (OR 0.95; 95% CI, 0.92-0.98). In addition, in restricted cubic spline regression, we found that flavan-3-ols, anthocyanidins, and flavonols intake were linearly and negatively related to prevalence of hypertension. Flavones intake showed nonlinear associations with prevalence of hypertension with inflection points of -1.90. Within a certain range, a negative correlation exists between flavonoids intake and hypertension events. This finding provides insights into dietary modifications in the prevention of hypertension.

Progress and hotspot of diet or exercise therapy in the treatment of non-alcoholic fatty liver disease

INTRODUCTION

The primary treatment for non-alcoholic fatty liver disease (NAFLD) is modifying lifestyle through dietary or exercise interventions. In recent decades, it has received increasing attention. However, the lack of bibliometric analysis has posed a challenge for researchers seeking to understand the overall trends in this field.

METHODS

As of February 3rd, 2024, 876 articles on treating NAFLD through diet or exercise therapy from 2013 to 2023 had been retrieved. Two software tools, VOSviewer and CiteSpace, were utilized to analyze the growth of publications, countries, institutions, authors, journals, citations, and keywords. Additionally, the keywords with strong citation burstiness were identified to determine the changes and future trends of research hotspots in this field.

RESULTS

China had the highest number of articles, followed by the United States and South Korea. Yonsei University and Nutrients were the institutions and journals with the most significant contributions. Professor Younossi Zobair M, from the United States, is the most prolific author in this field. Through analyzing the keywords, three research hotspots were identified: research on the pathogenesis of NAFLD, research on the treatment modalities of NAFLD, and research on the risk factors and diagnosis methods of NAFLD. In recent years, the research emphasis in this field has changed, suggesting that future research will focus on two frontier keywords: "oxidative stress" and "aerobic capacity."

CONCLUSION

In the past eleven years, the attention in this field was still rising, and the authors, journals, countries and so on had formed a considerable cooperative relationship. There were also many highly influential and productive researchers in this field. It is speculated that new research will continue around "aerobic exercise" and "oxidative stress" in the future.

Interaction between dietary flavonoid intake and trouble sleeping on non-alcoholic fatty liver disease risk: a cross-sectional study

OBJECTIVE

The possible interaction of dietary flavonoid intake and sleep on non-alcoholic fatty liver disease (NAFLD) has not been well studied. This study investigated the interaction between dietary flavonoid intake and trouble sleeping on the risk of NAFLD.

METHODS

Three discrete National Health and Nutrition Examination Survey data cycles from 2007 to 2010 and 2017 to 2018 were used. NAFLD was diagnosed by a US Fatty Liver Index ≥30. A sleep questionnaire diagnosed trouble sleeping. Univariate and multivariate logistic regression, restricted cubic spline (RCS) and subgroup analyses were used to evaluate the association between dietary flavonoids, trouble sleeping and NAFLD. We employed the relative excess risk due to interaction, attributable proportion of interaction and synergy index to evaluate additive interactions.

RESULTS

Ultimately, 5056 participants were enrolled, and higher anthocyanidins and flavanones intake was negatively correlated with NAFLD. Conversely, trouble sleeping was positively associated with NAFLD. These correlations remained stable after adjusting for confounders, and there was a sex difference in this relationship. In the RCS model, anthocyanins were negatively non-linearly related to NAFLD, while flavanones showed a negative linear relationship. Moreover, there was a synergistic interplay between low dietary anthocyanin intake and trouble sleeping on the risk of NAFLD. A similar relationship existed for flavanone intake.

CONCLUSION

Anthocyanin and flavanone intake were negatively associated, whereas trouble sleeping was positively associated with NAFLD risk. There was a synergistic effect of low anthocyanin intake and trouble sleeping. The same relationship existed for low flavanone intake.

Association of composite dietary antioxidant index and muscle mass in individuals with metabolic associated fatty liver disease

BACKGROUND

There is mounting evidence indicating the association between oxidative stress and the detrimental effect it poses on muscle mass. However, the crucial interplay between the Composite Dietary Antioxidant Index (CDAI), a key metric of antioxidant-rich diets, and the occurrence of muscle loss has remained largely unexplored. Hence, in this study, we aim to investigate the potential relationship between CDAI and muscle loss METHODS: This cross-sectional investigation harnessed data sourced from the National Health and Nutrition Examination Survey (2017 and 2018) to meticulously scrutinize the correlation between the CDAI and the occurrence of muscle loss. To unravel this intricate relationship, we engaged in multivariate weighted logistic regression analysis and employed smooth curve fitting techniques. Additionally, subgroup analyses were meticulously performed.

RESULTS

A total of 956 participants, with an average age of 42.15 years, were included in the final analysis, of which 52.19 % were males. Notably, the prevalence of low muscle mass among the study population was observed to be 15.48 %. The utilization of smooth curve fitting analysis underscored a nearly linear association between the CDAI and the presence of low muscle mass. Employing multivariate weighted logistic regression analysis, it was determined that the odds ratio (OR) between CDAI and low muscle mass was 0.88 (95 % [CI], 0.73-0.95). Through subgroup analyses, we further validated that CDAI independently mitigated the risk of muscle loss.

CONCLUSION

Higher CDAI levels were found to be associated with an reduced risk of low muscle mass in adults with metabolic associated fatty liver disease (MAFLD).

Intake of dietary flavonoids in relation to bone loss among U.S. adults: a promising strategy for improving bone health

Dietary flavonoids have been recommended for improving bone health due to their antioxidant, anti-inflammatory and osteogenic properties. However, the effectiveness of each flavonoid subclass in the prevention and treatment of osteoporosis remains controversial. The objective of the current study was to examine the association between the intake of flavonoid subclasses and bone loss in 10 480 U.S. adults in the National Health and Nutrition Examination Survey. We employed a multinomial logistic regression model to calculate the odds ratios (OR) and 95% confidence intervals (95% CI). The intake of flavones, isoflavones, and flavanones was beneficially associated with osteoporosis (ORQ5 vs. Q1 = 0.44; 95% CI: 0.30-0.64 for flavones; ORQ5 vs. Q1 = 0.53; 95% CI: 0.37-0.77 for isoflavones; ORQ5 vs. Q1 = 0.66; 95% CI: 0.45-0.97 for flavanones). A higher intake of flavones and flavanones was significantly associated with a lower risk of bone loss at the femoral neck rather than the lumbar spine. Notably, stratified analysis showed that genistein had a harmful association with osteopenia in the population with lower serum calcium levels, whereas it had a beneficial association with osteoporosis in the population with higher serum calcium levels. Multiple sensitivity analyses were performed to test the robustness of the results, including subgroup analysis, exclusion of individuals' use of anti-osteoporosis, corticosteroid, and estrogenic medications, adjusting more potential confounders and calculation of the E-value. Overall, incorporating this modifiable diet into an individual's lifestyle could provide potential possibilities to prevent and ameliorate osteoporosis.

The association between dietary intake of flavonoids and its subclasses and the risk of metabolic syndrome

Background

The healthiest way to prevent metabolic syndrome (MetS) is through behavioral and nutritional adjustments. We examined the relationship between total flavonoids intake, flavonoid subclasses, and clinically manifest MetS.

Methods

A cross-sectional analysis was conducted among 28,719 individuals from the National Health and Nutrition Examination Survey (NHANES) and Food and Nutrient Database for Dietary Studies (FNDDS) 2007-2011 and 2017-2018. Two 24-h reviews were conducted to determine flavonoids intake and subclasses. The link between flavonoids intake and MetS was investigated using a multivariate logistic regression model.

Results

Q2 and Q3 of total flavonoids intake were associated with 20 and 19% lower risk of incident MetS after adjusting age and sex. Anthocyanidins and flavanones intake in Q2 and Q3 substantially reduced the MetS risk compared to Q1. MetS risk decreased steadily as the total intake of flavonoids increased to 237.67 mg/d. Flavanones and anthocyanidins also displayed V-shaped relationship curves (34.37 and 23.13 mg/d).

Conclusion

MetS was adversely linked with total flavonoids intake, flavanones, and anthocyanidins. Moreover, the most effective doses of total flavonoids, flavanones, and anthocyanidins were 237.67, 34.37, and 23.13 mg/d, respectively, potentially preventing MetS.