Dietary Composition and Its Association with Newly Diagnosed Nonalcoholic Fatty Liver Disease and Insulin Resistance

Phunchai Charatcharoenwitthaya, Eakchakarj Tansakul, Kusuma Chaiyasoot, Wimolrak Bandidniyamanon, Natthinee Charatcharoenwitthaya, Phunchai Charatcharoenwitthaya, Eakchakarj Tansakul, Kusuma Chaiyasoot, Wimolrak Bandidniyamanon, Natthinee Charatcharoenwitthaya

Abstract

Dietary modification is essential for treating nonalcoholic fatty liver disease (NAFLD); however, the dietary components are less well defined. We enrolled 252 adults with no history of liver disease and excessive alcohol use to evaluate the relationship between macronutrients and NAFLD and insulin resistance. Participants took photographs of their meals and documented their food intake in a food diary for seven consecutive days. A dietitian estimated the type and portion size of food items and analyzed nutrients with INMUCAL-Nutrients software. Later, participants underwent transient elastography to diagnose NAFLD and blood tests to measure insulin resistance using the homeostasis model. Total energy intake and the proportion of carbohydrate, fat, and protein consumption did not differ between participants with NAFLD (n = 41) and those without NAFLD (n = 211). Using multiple logistic regression analysis, daily intake of protein < 1.0 g/kg (OR: 3.66, 95% CI: 1.41-9.52) and full-fat dairy product ≥ 50 g (OR: 0.42, 95% CI: 0.18-0.99) were associated with NAFLD. Insulin resistance was associated with a daily intake of protein < 1.0 g/kg (OR: 3.09, 95% CI: 1.59-6.05), full-fat dairy product ≥ 50 g (OR: 0.46, 95% CI: 0.25-0.82), and dietary fiber ≥ 8 g (OR: 0.41, 95% CI: 0.22-0.74). Our data show that a low protein intake increases the odds for NAFLD and insulin resistance. Contrarily, a high intake of full-fat dairy products and dietary fiber has been associated with a potential protective effect against NAFLD and insulin resistance.

Keywords: dietary fiber; full-fat dairy product; nonalcoholic fatty liver disease; protein; vitamin D deficiency.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Adjusted odds ratio (OD) of vitamin D deficiency for (A) nonalcoholic fatty liver disease (NAFLD) and (B) insulin resistance after controlling for age, sex, healthcare profession, and daily calorie intake.

References

    1. Younossi Z.M., Koenig A.B., Abdelatif D., Fazel Y., Henry L., Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84. doi: 10.1002/hep.28431.
    1. Ayonrinde O.T. Historical narrative from fatty liver in the nineteenth century to contemporary NAFLD-Reconciling the present with the past. JHEP Rep. 2021;3:100261. doi: 10.1016/j.jhepr.2021.100261.
    1. Angulo P., Kleiner D.E., Dam-Larsen S., Adams L.A., Bjornsson E.S., Charatcharoenwitthaya P., Mills P.R., Keach J.C., Lafferty H.D., Stahler A., et al. Liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2015;149:389–397.e10. doi: 10.1053/j.gastro.2015.04.043.
    1. Kim D., Kim W.R. Nonobese Fatty Liver Disease. Clin. Gastroenterol. Hepatol. 2017;15:474–485. doi: 10.1016/j.cgh.2016.08.028.
    1. Adams L.A., Anstee Q.M., Tilg H., Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut. 2017;66:1138–1153. doi: 10.1136/gutjnl-2017-313884.
    1. Vilar-Gomez E., Martinez-Perez Y., Calzadilla-Bertot L., Torres-Gonzalez A., Gra-Oramas B., Gonzalez-Fabian L., Friedman S.L., Diago M., Romero-Gomez M. Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis. Gastroenterology. 2015;149:367–378.e5. doi: 10.1053/j.gastro.2015.04.005.
    1. European Association for the Study of the Liver (EASL) European Association for the Study of Diabetes (EASD) European Association for the Study of Obesity (EASO) EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J. Hepatol. 2016;64:1388–1402. doi: 10.1016/j.jhep.2015.11.004.
    1. Chalasani N., Younossi Z., Lavine J.E., Charlton M., Cusi K., Rinella M., Harrison S.A., Brunt E.M., Sanyal A.J. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67:328–357. doi: 10.1002/hep.29367.
    1. Ratziu V. Non-pharmacological interventions in non-alcoholic fatty liver disease patients. Liver Int. 2017;37((Suppl. S1)):90–96. doi: 10.1111/liv.13311.
    1. Schattenberg J.M., Bergheim I. Nutritional Intake and the Risk for Non-Alcoholic Fatty Liver Disease (NAFLD) Nutrients. 2019;11:588. doi: 10.3390/nu11030588.
    1. Kalafati I.P., Borsa D., Dimitriou M., Revenas K., Kokkinos A., Dedoussis G.V. Dietary patterns and non-alcoholic fatty liver disease in a Greek case-control study. Nutrition. 2019;61:105–110. doi: 10.1016/j.nut.2018.10.032.
    1. Zelber-Sagi S., Ivancovsky-Wajcman D., Fliss Isakov N., Webb M., Orenstein D., Shibolet O., Kariv R. High red and processed meat consumption is associated with non-alcoholic fatty liver disease and insulin resistance. J. Hepatol. 2018;68:1239–1246. doi: 10.1016/j.jhep.2018.01.015.
    1. Luukkonen P.K., Sadevirta S., Zhou Y., Kayser B., Ali A., Ahonen L., Lallukka S., Pelloux V., Gaggini M., Jian C., et al. Saturated Fat Is More Metabolically Harmful for the Human Liver Than Unsaturated Fat or Simple Sugars. Diabetes Care. 2018;41:1732–1739. doi: 10.2337/dc18-0071.
    1. Cheng Y., Zhang K., Chen Y., Li Y., Li Y., Fu K., Feng R. Associations between Dietary Nutrient Intakes and Hepatic Lipid Contents in NAFLD Patients Quantified by (1)H-MRS and Dual-Echo MRI. Nutrients. 2016;8:527. doi: 10.3390/nu8090527.
    1. Kobayashi Y., Tatsumi H., Hattori M., Sugiyama H., Wada S., Kuwahata M., Tanaka S., Kanemasa K., Sumida Y., Naito Y., et al. Comparisons of dietary intake in Japanese with non-alcoholic fatty liver disease and type 2 diabetes mellitus. J. Clin. Biochem. Nutr. 2016;59:215–219. doi: 10.3164/jcbn.16-7.
    1. Wehmeyer M.H., Zyriax B.C., Jagemann B., Roth E., Windler E., Schulze Zur Wiesch J., Lohse A.W., Kluwe J. Nonalcoholic fatty liver disease is associated with excessive calorie intake rather than a distinctive dietary pattern. Medicine. 2016;95:e3887. doi: 10.1097/MD.0000000000003887.
    1. Cortez-Pinto H., Jesus L., Barros H., Lopes C., Moura M.C., Camilo M.E. How different is the dietary pattern in non-alcoholic steatohepatitis patients? Clin. Nutr. 2006;25:816–823. doi: 10.1016/j.clnu.2006.01.027.
    1. Nelson M., Atkinson M., Darbyshire S. Food photography. I: The perception of food portion size from photographs. Br. J. Nutr. 1994;72:649–663. doi: 10.1079/BJN19940069.
    1. Institute of Nutrition, Mahidol University Nutrient Calculation Computer Software INMUCAL-Nutrients V.3 Database NB.2. Nakhon Pathom 2013. [(accessed on 30 November 2018)]. Available online:
    1. Banjong O., Menefee A., Sranacharoenpong K., Chittchang U., Egkantrong P., Boonpraderm A., Tamachotipong S. Dietary assessment of refugees living in camps: A case study of Mae La Camp, Thailand. Food Nutr. Bull. 2003;24:360–367. doi: 10.1177/156482650302400406.
    1. Jeharsae R., Sangthong R., Chongsuvivatwong V. Dual dietary intake problems among under-five years old children living in an armed conflict area of southern Thailand. J. Med. Assoc. Thai. 2011;94:1104–1108.
    1. Virojanawat M., Puapatanakul P., Chuengsaman P., Boonyakrai C., Buranaosot S., Katavetin P., Praditpornsilpa K., Eiam-Ong S., Kanjanabuch T. Hypokalemia in peritoneal dialysis patients in Thailand: The pivotal role of low potassium intake. Int. Urol. Nephrol. 2021;53:1463–1471. doi: 10.1007/s11255-020-02773-8.
    1. Jeong Y., Yi K., Hansana V., Kim J.M., Kim Y. Comparison of Nutrient Intake in Lao PDR by the Korean CAN-Pro and Thailand INMUCAL Analysis Programs. Prev. Nutr. Food Sci. 2021;26:40–50. doi: 10.3746/pnf.2021.26.1.40.
    1. Caussy C., Alquiraish M.H., Nguyen P., Hernandez C., Cepin S., Fortney L.E., Ajmera V., Bettencourt R., Collier S., Hooker J., et al. Optimal threshold of controlled attenuation parameter with MRI-PDFF as the gold standard for the detection of hepatic steatosis. Hepatology. 2018;67:1348–1359. doi: 10.1002/hep.29639.
    1. Consultation W.H.O.E. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–163. doi: 10.1016/S0140-6736(03)15268-3.
    1. Alberti K.G., Eckel R.H., Grundy S.M., Zimmet P.Z., Cleeman J.I., Donato K.A., Fruchart J.C., James W.P., Loria C.M., Smith S.C., Jr., 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. doi: 10.1161/CIRCULATIONAHA.109.192644.
    1. Matthews D.R., Hosker J.P., Rudenski A.S., Naylor B.A., Treacher D.F., Turner R.C. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–419. doi: 10.1007/BF00280883.
    1. Wu G. Dietary protein intake and human health. Food Funct. 2016;7:1251–1265. doi: 10.1039/C5FO01530H.
    1. Zelber-Sagi S., Nitzan-Kaluski D., Goldsmith R., Webb M., Blendis L., Halpern Z., Oren R. Long term nutritional intake and the risk for non-alcoholic fatty liver disease (NAFLD): A population based study. J. Hepatol. 2007;47:711–717. doi: 10.1016/j.jhep.2007.06.020.
    1. Volynets V., Kuper M.A., Strahl S., Maier I.B., Spruss A., Wagnerberger S., Konigsrainer A., Bischoff S.C., Bergheim I. Nutrition, intestinal permeability, and blood ethanol levels are altered in patients with nonalcoholic fatty liver disease (NAFLD) Dig. Dis. Sci. 2012;57:1932–1941. doi: 10.1007/s10620-012-2112-9.
    1. Ampong I., Watkins A., Gutierrez-Merino J., Ikwuobe J., Griffiths H.R. Dietary protein insufficiency: An important consideration in fatty liver disease? Br. J. Nutr. 2020;123:601–609. doi: 10.1017/S0007114519003064.
    1. Watkins A.J., Sinclair K.D. Paternal low protein diet affects adult offspring cardiovascular and metabolic function in mice. Am. J. Physiol. Heart Circ. Physiol. 2014;306:H1444–H1452. doi: 10.1152/ajpheart.00981.2013.
    1. Bjorndal B., Berge C., Ramsvik M.S., Svardal A., Bohov P., Skorve J., Berge R.K. A fish protein hydrolysate alters fatty acid composition in liver and adipose tissue and increases plasma carnitine levels in a mouse model of chronic inflammation. Lipids Health Dis. 2013;12:143. doi: 10.1186/1476-511X-12-143.
    1. Martens E.A., Gatta-Cherifi B., Gonnissen H.K., Westerterp-Plantenga M.S. The potential of a high protein-low carbohydrate diet to preserve intrahepatic triglyceride content in healthy humans. PLoS ONE. 2014;9:e109617. doi: 10.1371/journal.pone.0109617.
    1. Louie J.C., Flood V.M., Hector D.J., Rangan A.M., Gill T.P. Dairy consumption and overweight and obesity: A systematic review of prospective cohort studies. Obes. Rev. 2011;12:e582–e592. doi: 10.1111/j.1467-789X.2011.00881.x.
    1. Praagman J., Franco O.H., Ikram M.A., Soedamah-Muthu S.S., Engberink M.F., van Rooij F.J., Hofman A., Geleijnse J.M. Dairy products and the risk of stroke and coronary heart disease: The Rotterdam Study. Eur. J. Nutr. 2015;54:981–990. doi: 10.1007/s00394-014-0774-0.
    1. Guo J., Astrup A., Lovegrove J.A., Gijsbers L., Givens D.I., Soedamah-Muthu S.S. Milk and dairy consumption and risk of cardiovascular diseases and all-cause mortality: Dose-response meta-analysis of prospective cohort studies. Eur. J. Epidemiol. 2017;32:269–287. doi: 10.1007/s10654-017-0243-1.
    1. Hirahatake K.M., Bruno R.S., Bolling B.W., Blesso C., Alexander L.M., Adams S.H. Dairy Foods and Dairy Fats: New Perspectives on Pathways Implicated in Cardiometabolic Health. Adv. Nutr. 2020;11:266–279. doi: 10.1093/advances/nmz105.
    1. Kratz M., Marcovina S., Nelson J.E., Yeh M.M., Kowdley K.V., Callahan H.S., Song X., Di C., Utzschneider K.M. Dairy fat intake is associated with glucose tolerance, hepatic and systemic insulin sensitivity, and liver fat but not beta-cell function in humans. Am. J. Clin. Nutr. 2014;99:1385–1396. doi: 10.3945/ajcn.113.075457.
    1. Weickert M.O., Roden M., Isken F., Hoffmann D., Nowotny P., Osterhoff M., Blaut M., Alpert C., Gogebakan O., Bumke-Vogt C., et al. Effects of supplemented isoenergetic diets differing in cereal fiber and protein content on insulin sensitivity in overweight humans. Am. J. Clin. Nutr. 2011;94:459–471. doi: 10.3945/ajcn.110.004374.
    1. Morimoto N., Kasuga C., Tanaka A., Kamachi K., Ai M., Urayama K.Y., Tanaka A. Association between dietary fibre:carbohydrate intake ratio and insulin resistance in Japanese adults without type 2 diabetes. Br. J. Nutr. 2018;119:620–628. doi: 10.1017/S0007114517003725.
    1. Castro-Quezada I., Flores-Guillen E., Nunez-Ortega P.E., Irecta-Najera C.A., Sanchez-Chino X.M., Mendez-Flores O.G., Olivo-Vidal Z.E., Garcia-Miranda R., Solis-Hernandez R., Ochoa-Diaz-Lopez H. Dietary Carbohydrates and Insulin Resistance in Adolescents from Marginalized Areas of Chiapas, Mexico. Nutrients. 2019;11:3066. doi: 10.3390/nu11123066.
    1. Reynolds A.N., Akerman A.P., Mann J. Dietary fibre and whole grains in diabetes management: Systematic review and meta-analyses. PLoS Med. 2020;17:e1003053. doi: 10.1371/journal.pmed.1003053.
    1. Makki K., Deehan E.C., Walter J., Backhed F. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host Microbe. 2018;23:705–715. doi: 10.1016/j.chom.2018.05.012.
    1. Amrein K., Scherkl M., Hoffmann M., Neuwersch-Sommeregger S., Kostenberger M., Tmava Berisha A., Martucci G., Pilz S., Malle O. Vitamin D deficiency 2.0: An update on the current status worldwide. Eur. J. Clin. Nutr. 2020;74:1498–1513. doi: 10.1038/s41430-020-0558-y.
    1. Calvo M.S., Whiting S.J., Barton C.N. Vitamin D intake: A global perspective of current status. J. Nutr. 2005;135:310–316. doi: 10.1093/jn/135.2.310.
    1. Spiro A., Buttriss J.L. Vitamin D: An overview of vitamin D status and intake in Europe. Nutr. Bull. 2014;39:322–350. doi: 10.1111/nbu.12108.
    1. Sung C.C., Liao M.T., Lu K.C., Wu C.C. Role of vitamin D in insulin resistance. J. Biomed. Biotechnol. 2012;2012:634195. doi: 10.1155/2012/634195.
    1. Williamson D.A., Allen H.R., Martin P.D., Alfonso A.J., Gerald B., Hunt A. Comparison of digital photography to weighed and visual estimation of portion sizes. J. Am. Diet. Assoc. 2003;103:1139–1145. doi: 10.1016/S0002-8223(03)00974-X.

Source: PubMed

3
S'abonner