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

Abstract

ObjectivesDietary patterns can holistically provide insights into the association of food groups and nutrients with the disease. Several studies have evaluated the association of dietary patterns with the risk of non-alcoholic fatty liver disease (NAFLD) in Western populations. However, few studies focused on this topic were conducted on Korean adults. Therefore, in this cohort study, we aimed to investigate the association between dietary patterns and the risk of NAFLD among middle-aged Koreans.DesignThe survey was performed at general hospitals and health examination centres in Korea. Dietary intake was assessed using a validated Food Frequency Questionnaire. The dietary patterns were identified using principal component analysis. The HR and 95% CI for NAFLD for each of the quartiles of the three dietary patterns were estimated using a Cox proportional hazards model.SettingSouth Korean Community.Participants44 460 healthy Koreans (aged 40–69 years) who completed a follow-up survey from 2012 to 2016 in the Health Examinees study were included.ResultsMen and women following a prudent pattern showed a 22% and 36% lower NAFLD risk, respectively (men: HR=0.78; women: HR=0.64). Men and women who highly adhered to the flour-based food and meat pattern had a 29% and 55% higher NAFLD risk, respectively (men: HR=1.29; women: HR=1.55).ConclusionThe prudent pattern induced a lower NAFLD risk, whereas the flour-based food and meat pattern induced a higher NAFLD risk. No significant difference was found between the white rice pattern and NAFLD risk.

Screening for NAFLD—Current Knowledge and Challenges

“…The development and progression of liver disease in NAFLD is now being explained with the multi-hit hypothesis, where a plethora of modifiable (dietary and environmental) and non-modifiable (genetic) factors contribute to the disease along with the worsening of insulin resistance (Figure 1). Among the modifiable factors, dietary elements, both in terms of overall calorie intake and specific dietary patterns, may contribute to the development of NAFLD [14,15]. Specifically, a high-fat diet and increased fructose and red meat intake have been associated with worsening hepatic steatosis and the induction of a pro-inflammatory status [16][17][18].…”

Association of five diet scores with severe NAFLD incidence: A prospective study from UK Biobank

“…For instance, adherence to this type of diet has been shown to be associated with reduced risk of NAFLD [odds ratio: 0.64 (0.52‐0.78)], 17 less fatty liver accumulation [odds ratio: 0.74 (95% CI: 0.61‐0.90)] 14 and lower risk of hepatic steatosis [risk ratio: 0.85 (95% CI: 0.73‐0.99)] 16 . In Korea, women and men who were in the highest quartile of flour‐based food and meat consumption (high intake of noodles and dumplings, wheat flour and bread, red meat and its products, white meat and its products, eggs, dairy products and beverages) had 55% (95% CI: 1.22‐1.97) and 29% (95% CI: 1.00‐1.67), respectively, higher NAFLD risk than their counterparts in the lowest quartile 18 . In contrast, men and women who followed a prudent pattern (high consumption of potatoes, soybean pastes, beans, tofu, soymilk, green and yellow vegetables, light‐coloured vegetables, kimchi, mushrooms, fruits, fish, shellfish and seaweed) showed a 22% and 36% lower risk 18 .…”

“…Previous prospective studies have investigated the associations between diet and NAFLD 13–19 . However, to our knowledge, no study has compared which diet score might best differentiate diets associated with high and low risk of NAFLD.…”

“…Using a cumulative combination of nutrients and foods as an overall dietary pattern may provide a more robust assessment of the association between diet and NAFLD. Previous prospective studies have investigated the association between individual diet scores, such as the Mediterranean Diet and NAFLD, separately 6,13–19 . However, to date, there have been no comparisons of the association between different scores of diet quality and severe NAFLD.…”

“…Previous prospective studies have investigated the association between individual diet scores, such as the Mediterranean Diet and NAFLD, separately. 6,[13][14][15][16][17][18][19] However, to date, there have been no comparisons of the association between different scores of diet quality and severe NAFLD.…”