Diet-Quality Scores and Prevalence of Nonalcoholic Fatty Liver Disease: A Population Study Using Proton-Magnetic Resonance Spectroscopy

Ruth Chan, Vincent Wai-Sun Wong, Winnie Chiu-Wing Chu, Grace Lai-Hung Wong, Liz Sin Li, Jason Leung, Angel Mei-Ling Chim, David Ka-Wai Yeung, Mandy Man-Mei Sea, Jean Woo, Francis Ka-Leung Chan, Henry Lik-Yuen Chan, Ruth Chan, Vincent Wai-Sun Wong, Winnie Chiu-Wing Chu, Grace Lai-Hung Wong, Liz Sin Li, Jason Leung, Angel Mei-Ling Chim, David Ka-Wai Yeung, Mandy Man-Mei Sea, Jean Woo, Francis Ka-Leung Chan, Henry Lik-Yuen Chan

Abstract

Dietary pattern analysis is an alternative approach to examine the association between diet and nonalcoholic fatty liver disease (NAFLD). This study examined the association of two diet-quality scores, namely Diet Quality Index-International (DQI-I) and Mediterranean Diet Score (MDS) with NAFLD prevalence. Apparently healthy Chinese adults (332 male, 465 female) aged 18 years or above were recruited through a population screening between 2008 and 2010 in a cross-sectional population-based study in Hong Kong. DQI-I and MDS, as well as major food group and nutrient intakes were calculated based on dietary data from a food frequency questionnaire. NAFLD was defined as intrahepatic triglyceride content at ≥5% by proton-magnetic resonance spectroscopy. Multivariate logistic regression models were used to examine the association between each diet-quality score or dietary component and prevalent NAFLD with adjustment for potential lifestyle, metabolic and genetic factors. A total of 220 subjects (27.6%) were diagnosed with NAFLD. DQI-I but not MDS was associated with the prevalence of NAFLD. A 10-unit decrease in DQI-I was associated with 24% increase in the likelihood of having NAFLD in the age and sex adjusted model (95% CI: 1.06-1.45, p = 0.009), and the association remained significant when the model was further adjusted for other lifestyle factors, metabolic and genetic factors [OR: 1.26 (95% CI: 1.03-1.54), p = 0.027]. Multivariate regression analyses showed an inverse association of the intake of vegetables and legumes, fruits and dried fruits, as well as vitamin C with the NAFLD prevalence (p<0.05). In conclusion, a better diet quality as characterized by a higher DQI-I and a higher consumption of vegetables, legumes and fruits was associated with a reduced likelihood of having NAFLD in Hong Kong Chinese.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL. How common is non-alcoholic fatty liver disease in the Asia-Pacific region and are there local differences? J Gastroenterol Hepatol. 2007;22:788–793.
    1. Chitturi S, Wong VW, Farrell G. Nonalcoholic fatty liver in Asia: Firmly entrenched and rapidly gaining ground. J Gastroenterol Hepatol. 2011;26:S163–S172.
    1. Masarone M, Federico A, Abenavoli L, Loguercio C, Persico M. Non alcoholic fatty liver: epidemiology and natural history. Rev Recent Clin Trials. 2014;9:126–133.
    1. Caldwell SH, Oelsner DH, Iezzoni JC, Hespenheide EE, Battle EH, Driscoll CJ. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology 1999;29:664–669.
    1. Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology 2006;43:S99–S112.
    1. Hamaguchi M, Kojima T, Takeda N, Nagata C, Takeda J, Sarui H, et al. Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease. World J Gastroenterol. 2007;13:1579–1584.
    1. Wong VW, Wong GL, Yip GW, Lo AO, Limquiaco J, Chu WC, et al. Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut 2011;60:1721–1727. 10.1136/gut.2011.242016
    1. Wong VW, Chan RS, Wong GL, Cheung BH, Chu WC, Yeung DK, et al. Community-based lifestyle modification programme for non-alcoholic fatty liver disease: A randomized controlled trial. J Hepatol. 2013;59:536–542. 10.1016/j.jhep.2013.04.013
    1. Musso G, Gambino R, De Michieli F, Cassader M, Rizzetto M, Durazzo M, et al. Dietary habits and their relations to insulin resistance and postprandial lipemia in nonalcoholic steatohepatitis. Hepatology 2003;37:909–916.
    1. Sathiaraj E, Chutke M, Reddy M, Pratap N, Rao P, Reddy D, et al. A case-control study on nutritional risk factors in non-alcoholic fatty liver disease in Indian population. Eur J Clin Nutr. 2011;65:533–537. 10.1038/ejcn.2011.3
    1. Solga S, Alkhuraishe A, Clark J, Torbenson M, Greenwald A, Diehl A, et al. Dietary Composition and Nonalcoholic Fatty Liver Disease. Dig Dis Sci. 2004;49:1578–1583.
    1. Allard JP, Aghdassi E, Mohammed S, Raman M, Avand G, Arendt BM, et al. Nutritional assessment and hepatic fatty acid composition in non-alcoholic fatty liver disease (NAFLD): A cross-sectional study. J Hepatol. 2008;48:300–307.
    1. Kim C, Kallman J, Bai C, Pawloski L, Gewa C, Arsalla A, et al. Nutritional Assessments of Patients with Non-alcoholic Fatty Liver Disease. Obes Surg. 2010;20:154–160. 10.1007/s11695-008-9549-0
    1. Ricci G, Canducci E, Pasini V, Rossi A, Bersani G, Ricci E, et al. Nutrient intake in Italian obese patients: Relationships with insulin resistance and markers of non-alcoholic fatty liver disease. Nutrition 2011;27:672–676. 10.1016/j.nut.2010.07.014
    1. Cortez-Pinto H, Jesus L, Barros H, Lopes C, Moura MC, Camilo ME. How different is the dietary pattern in non-alcoholic steatohepatitis patients? Clin Nutr. 2006;25:816–823.
    1. Zelber-Sagi S, Nitzan-Kaluski D, Goldsmith R, Webb M, Blendis L, Halpern Z, et al. Long term nutritional intake and the risk for non-alcoholic fatty liver disease (NAFLD): A population based study. J Hepatol. 2007;47:711–717.
    1. Oya J, Nakagami T, Sasaki S, Jimba S, Murakami K, Kasahara T, et al. Intake of n-3 polyunsaturated fatty acids and non-alcoholic fatty liver disease: a cross-sectional study in Japanese men and women. Eur J Clin Nutr. 2010;64:1179–1185. 10.1038/ejcn.2010.139
    1. Abdelmalek MF, Suzuki A, Guy C, Unalp-Arida A, Colvin R, Johnson RJ, et al. Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. Hepatology 2010;51:1961–1971. 10.1002/hep.23535
    1. Guerrerio AL, Colvin RM, Schwartz AK, Molleston JP, Murray KF, Diehl A, et al. Choline intake in a large cohort of patients with nonalcoholic fatty liver disease. Am J Clin Nutr. 2012;95:892–900. 10.3945/ajcn.111.020156
    1. Chan R, Wong VWS, Chu WCW, Wong GLH, Li LS, et al. Higher estimated net endogenous acid production may be associated with increased prevalence of nonalcoholic fatty liver disease in Chinese adults in Hong Kong. PLoS ONE 2015;10:e0122406 10.1371/journal.pone.0122406
    1. Krupp D, Johner SA, Kalhoff H, Buyken AE, Remer T. Long-term dietary potential renal acid load during adolescence is prospectively associated with indices of nonalcoholic fatty liver disease in young women. J Nutr 2012;142:313–319. 10.3945/jn.111.150540
    1. Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13:3–9.
    1. Slattery ML. Defining dietary consumption: is the sum greater than its parts? Am J Clin Nutr. 2008;88:14–15.
    1. Hashemi kani A, Moayed Alavian S, Esmaillzadeh A, Adibi P, Azadbakht L. Dietary Quality Indices and Biochemical Parameters Among Patients With Non Alcoholic Fatty Liver Disease (NAFLD). Hepat Mon. 2013;13:e10943 10.5812/hepatmon.10943
    1. Kontogianni MD, Tileli N, Margariti A, Georgoulis M, Deutsch M, Tiniakos D, et al. Adherence to the Mediterranean diet is associated with the severity of non-alcoholic fatty liver disease. Clin Nutr. 2014;33:678–683. 10.1016/j.clnu.2013.08.014
    1. Ferolla SM, Ferrari TC, Lima ML, Reis TO, Tavares WC Jr, et al. Dietary patterns in Brazilian patients with non-alcoholic fatty liver disease: a cross-sectional study. Clinics 2013;68:11–17.
    1. Chang JH, Lee HS, Kang EH. A study on dietary habits, nutrient intakes and dietary quality in adults of a health screening and promotion center according to non-alcoholic fatty liver disease. J Nutr Health. 2014;47:330–341.
    1. Jia Q, Xia Y, Zhang Q, Wu H, Du H, et al. Dietary patterns are associated with prevalence of fatty liver disease in adults. Eur J Clin Nutr. 10.1038/ejcn.2014.297
    1. Koch M, Borggrefe J, Barbaresko J, Groth G, Jacobs G, Siegert S, et al. Dietary patterns associated with magnetic resonance imaging-determined liver fat content in a general population study. Am J Clin Nutr. 2014;99:369–377. 10.3945/ajcn.113.070219
    1. Oddy WH, Herbison CE, Jacoby P, Ambrosini GL, O'Sullivan TA, Ayonrinde OT, et al. The Western dietary pattern is prospectively associated with nonalcoholic fatty liver disease in adolescence. Am J Gastroenterol. 2013;108:778–785. 10.1038/ajg.2013.95
    1. Abenavoli L, Milic N, Peta V, Alfieri F, De Lorenzo A, Bellentani S. Alimentary regimen in non-alcoholic fatty liver disease: Mediterranean diet. World J Gastroenterol. 2014;20:16831–16840. 10.3748/wjg.v20.i45.16831
    1. Sofi F, Casini A. Mediterranean diet and non-alcoholic fatty liver disease: new therapeutic option around the corner? World J Gastroenterol. 2014;20:7339–7346. 10.3748/wjg.v20.i23.7339
    1. Woo J, Woo KS, Leung SS, Chook P, Liu B, Ip R, et al. The Mediterranean score of dietary habits in Chinese populations in four different geographical areas. Eur J Clin Nutr. 2001;55:215–220.
    1. Kim S, Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J Nutr. 2003;133:3476–3484.
    1. Yu R, Woo J, Chan R, Sham A, Ho S, Tso A, et al. Relationship between dietary intake and the development of type 2 diabetes in a Chinese population: the Hong Kong Dietary Survey. Public Health Nutr. 2011;14:1133–1141. 10.1017/S136898001100053X
    1. Wong VWS, Chu WCW, Wong GLH, Chan RSM, Chim AML, Ong A, et al. Prevalence of non-alcoholic fatty liver disease and advanced fibrosis in Hong Kong Chinese: a population study using proton-magnetic resonance spectroscopy and transient elastography. Gut 2012;61:409–415. 10.1136/gutjnl-2011-300342
    1. Wong VW, Wong GL, Chu WC, Chim AM, Ong A, Yeung DK, et al. Hepatitis B virus infection and fatty liver in the general population. J Hepatol. 2012;56:533–540. 10.1016/j.jhep.2011.09.013
    1. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640–1645. 10.1161/CIRCULATIONAHA.109.192644
    1. Wong VW, Wong GL, Tsang SW, Fan T, Chu WC, Woo J, et al. High prevalence of colorectal neoplasm in patients with non-alcoholic steatohepatitis. Gut 2011;60:829–36. 10.1136/gut.2011.237974
    1. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004;40:1387–1395.
    1. Shen J, Wong GL, Chan HL, Chan HY, Yeung DK, et al. PNPLA3 gene polymorphism accounts for fatty liver in community subjects without metabolic syndrome. Aliment Pharmacol Ther. 2014;39:532–539. 10.1111/apt.12609
    1. Woo J, Leung SSF, Ho SC, Lam TH, Janus ED. A food frequency questionnaire for use in the Chinese population in Hong Kong: Description and examination of validity. Nutr Res. 1997;17:1633–1641.
    1. Leung SSF, Woo J, Ho S, Lam TH, Janus ED. Hong Kong Adult Dietary Survey, 1995. Aust J Nutr Diet. 1998;55:S11–S13.
    1. Yang Y, Wang G, Pan X. China Food Composition 2002. University Medical Press: Peking, 2002.
    1. Yang Y, Wang G, Pan X. China Food Composition 2004. University Medical Press: Peking, 2004.
    1. Centre for Food Safety. Nutrient Information Inquiry. Centre for Food Safety: Hong Kong SAR, 2006.
    1. Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr. 1997;65:1220S–1228S.
    1. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599–2608.
    1. Woo J, Cheung B, Ho S, Sham A, Lam TH. Influence of dietary pattern on the development of overweight in a Chinese population. Eur J Clin Nutr. 2008;62:480–487.
    1. Alkerwi A, Vernier C, Crichton GE, Sauvageot N, Shivappa N, Hebert JR. Cross-comparison of diet quality indices for predicting chronic disease risk: findings from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study. Br J Nutr. 2014;5:1–11.
    1. George SM, Ballard-Barbash R, Manson JE, Reedy J, Shikany JM, Subar AF, et al. Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the Women's Health Initiative Observational Study: evidence to inform national dietary guidance. Am J Epidemiol. 2014;180:616–625. 10.1093/aje/kwu173
    1. World Health Organization. WHO Technical Report Series, No. 916. Diet, nutrition and the prevention of chronic diseases. Report of the joint WHO/FAO expert consultation. World Health Organization: Geneva, 2003.
    1. Waijers PM, Feskens EJ, Ocke MC. A critical review of predefined diet quality scores. Br J Nutr. 2007;97:219–231.
    1. Santoro N, Savoye M, Kim G, Marotto K, Shaw MM, Pierpont B, et al. Hepatic fat accumulation is modulated by the interaction between the rs738409 variant in the PNPLA3 gene and the dietary omega6/omega3 PUFA intake. PLoS ONE 2012;7:e37827 10.1371/journal.pone.0037827
    1. Davis JN, Le KA, Walker RW, Vikman S, Spruijt-Metz D, Weigensberg MJ, et al. Increased hepatic fat in overweight Hispanic youth influenced by interaction between genetic variation in PNPLA3 and high dietary carbohydrate and sugar consumption. Am J Clin Nutr. 2010;92:1522–1527. 10.3945/ajcn.2010.30185
    1. Trovato GM, Catalano D, Martines GF, Pirri C, Trovato FM. Western dietary pattern and sedentary life: independent effects of diet and physical exercise intensity on NAFLD. Am J Gastroenterol. 2013;108:1932–1933. 10.1038/ajg.2013.356

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner