Elsevier

Nutrition

Volume 61, May 2019, Pages 105-110
Nutrition

Applied nutritional investigation
Dietary patterns and non-alcoholic fatty liver disease in a Greek case–control study

https://doi.org/10.1016/j.nut.2018.10.032Get rights and content

Highlights

  • To our knowledge, this is the first study to investigate association of dietary patterns with non-alcoholic fatty liver disease (NAFLD) in a European population.

  • Individuals with the highest adherence to a fast food–type dietary pattern had significantly higher odds for NAFLD than those with the lowest adherence after adjusting for age, sex, energy intake, physical activity level, pack-years smoked, education years, and presence of metabolic syndrome.

  • Individuals in the second quartile of an unsaturated fatty acid dietary pattern had significantly reduced odds of developing the NAFLD than those in the first quartile after adjusting for the same confounding factors.

  • Higher adherence to a fast food-type dietary pattern was independently associated with increased C-reactive protein and uric acid levels.

  • Higher adherence to a prudent dietary pattern was independently associated with reduced triacylglycerol and uric acid levels.

  • Higher adherence to the unsaturated fatty acid pattern was significantly associated with reduced insulin resistance and fasting insulin levels.

Abstract

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.

Introduction

Non-alcoholic fatty liver disease (NAFLD) is considered a potential new component of metabolic syndrome (MetS) [1]. It is characterized by excessive flux of fatty acids (FA) and triacylglycerol (TG) accumulation in the liver, primarily activated by dietary factors, obesity, and insulin resistance [2]. This results in increased inflammation and mitochondrial dysfunction in the liver—conditions that lead to fibrosis and cell apoptosis. Moreover, genetic and epigenetic factors, and gut microbiome dysfunction, further induce hepatic steatosis, inflammation, and oxidative stress. This multiple-hit model of NAFLD pathogenesis indicates the complexity of the disease and highlights the need to control liver and systemic inflammation.

As mentioned previously, diet is a major contributor to the pathogenesis of NAFLD but it also is an integral part of its treatment [3]. Overall, maintaining a normal body weight and a balanced diet has been shown to reduce inflammation and promote health. Regarding NAFLD, previous studies have demonstrated that excessive energy intake is a key determinant of disease onset and progression [4]. Increased consumption of fat, especially saturated fatty acids (SFA), and simple sugars also have been positively associated with the disease [5]. On the other hand, energy restriction, high protein, high ω-3 polyunsaturated fatty acids (PUFA), and antioxidants intake have been inversely associated with hepatic steatosis.

Many epidemiologic studies have examined the effect of single nutrients or foods on the risk for NAFLD; however, only a few have investigated the role of diet as a whole. Greater adherence to the Mediterranean diet decreases the risk for NAFLD and NAFLD-related diseases, but it also is believed to reduce the severity of the disease [6], [7]. The Mediterranean diet mainly consists of plant foods, fish, and low amounts of red meat. These food groups are rich in antioxidant vitamins and minerals, ω-3 PUFA, and dietary fibers, which are believed to be the components that give the Mediterranean diet its beneficial properties. On the other hand, dietary patterns characterized by increased consumption of red meat, fast foods, sweets, refined cereals, and sweetened soft drinks are rich in processed sugars and fat and have been associated with higher risk for NAFLD [8], [9], [10].

To our knowledge, there are no available data regarding dietary patterns of European patients with NAFLD. Against this background, the aim of this study was to assess a posteriori-derived dietary patterns of Greek patients with NAFLD and controls and to estimate the effect of these patterns on disease and its parameters.

Section snippets

Study population

Study participants were randomly and consecutively recruited from volunteers visiting the Outpatient Clinics of the First Department of Propaedeutic Medicine, Laiko General Hospital, from June 2012 to February 2015. Adults with no self-declared concomitant liver injury at the time of recruitment (viral, autoimmune, genetic, or drug-induced), and no self-declared excessive alcohol intake were screened for the disease. We excluded individuals meeting the following criteria:

  • >65 y of age,

  • Presence

Results

The present sample consisted of 134 patients with NAFLD and 217 controls. The main characteristics of the sample are presented in Table 1. Patients were older, less educated, less physically active, and smoked more than controls (P < 0.05). Moreover, the patients had a higher prevalence of obesity and MetS and had higher levels of disease-related biochemical markers than controls (P < 0.05).

The following four dietary patterns derived from the factor analysis:

  • The fast food–type pattern consisted

Discussion

In the present case-control study, four dietary patterns of 351 individuals with and without NAFLD were identified. We demonstrated associations between dietary patterns, NAFLD, and NAFLD-related biomarkers, independently of known confounding factors.

A greater adherence to a fast food–type dietary pattern was associated with higher odds for NAFLD. However, only individuals in the highest quartile compared with the lowest had a statistically significantly higher NAFLD risk, after adjusting for

Conclusion

Patients with NAFLD were more adherent to a fast food–type dietary pattern than to a prudent, high-protein, or unsaturated FA diet. It can be concluded that following a fast food–type dietary pattern significantly increases the odds of NAFLD, but also increases CRP and uric acid levels. Moreover, higher consumption of a prudent diet, characterized by vegetables, fruits, legumes, fish, and olive oil, and a diet rich in unsaturated FAsreduces several NAFLD-related biomarkers. Nevertheless, larger

References (36)

  • P Wainwright et al.

    Relationships and disconnects between NAFLD and features of the metabolic syndrome

    Int J Mol Sci

    (2016)
  • MC Hernandez-Rodas et al.

    Relevant aspects of nutritional and dietary interventions in non-alcoholic fatty liver disease

    Int J Mol Sci

    (2015)
  • MH Wehmeyer et al.

    Nonalcoholic fatty liver disease is associated with excessive calorie intake rather than a distinctive dietary pattern

    Medicine

    (2016)
  • F Sofi et al.

    Mediterranean diet and non-alcoholic fatty liver disease: new therapeutic option around the corner?

    World J Gastroenterol

    (2014)
  • Q Jia et al.

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

    Eur J Clin Nutr

    (2015)
  • WH Oddy et al.

    The Western dietary pattern is prospectively associated with nonalcoholic fatty liver disease in adolescence

    Am J Gastroenterol

    (2013)
  • CO Yang et al.

    Dietary patterns modulate the risk of non-alcoholic fatty liver disease in Chinese adults

    Nutrients

    (2015)
  • IP Kalafati et al.

    Fish intake interacts with TM6 SF2 gene variant to affect NAFLD risk: results of a case–control study [Epub ahead of print]

    Eur J Nutr

    (2018)
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    This study was funded by the project “Obesity and Metabolic Syndrome: Dietary Intervention with Greek Raisins in NAFLD/NASH. Investigation of Molecular Mechanisms” reviewed and approved by the Greek General Secretariat for Research and Technology (Cooperation 890/2009).

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