Does Consumption of Ultra-Processed Foods Matter for Liver Health? Prospective Analysis among Older Adults with Metabolic Syndrome

Abstract

Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver alterations that can result in severe disease and even death. Consumption of ultra-processed foods (UPF) has been associated with obesity and related comorbidities. However, the link between UPF and NAFLD has not been sufficiently assessed. We aimed to investigate the prospective association between UPF consumption and liver health biomarkers. Methods: We followed for 1 year 5867 older participants with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus trial. A validated 143-item semi-quantitative food frequency questionnaire was used to evaluate consumption of UPF at baseline, 6, and 12 months. The degree of processing for foods and beverages (g/day) was established according to the NOVA classification system. The non-invasive fatty liver index (FLI) and hepatic steatosis index (HSI) were used to evaluate liver health at three points in time. The associations between changes in UPF consumption (percentage of total daily dietary intake (g)) and liver biomarkers were assessed using mixed-effects linear models with repeated measurements. Results: In this cohort, UPF consumption at baseline was 8.19% (SD 6.95%) of total daily dietary intake in grams. In multivariable models, each 10% daily increment in UPF consumption in 1 year was associated with significantly greater FLI (β 1.60 points, 95% CI 1.24;1.96 points) and HSI (0.43, 0.29; 0.57) scores (all p-values < 0.001). These associations persisted statistically significant after adjusting for potential dietary confounders and NAFLD risk factors. Conclusions: A higher UPF consumption was associated with higher levels of NAFLD-related biomarkers in older adults with overweight/obesity and MetS.

Association between ultra-processed foods consumption and risk of non-alcoholic fatty liver disease: a population-based analysis of NHANES 2011–2018

“…Even in children and adolescents, metabolic parameters such as increased serum total cholesterol, triglyceride (18) and waist https://doi.org/10.1017/S0007114522003956 Published online by Cambridge University Press Accepted manuscript circumference (19) were significantly associated with the contribution of UPF. Although UPF consumption was associated with a significantly greater fatty liver index among older participants with overweight/obesity and metabolic syndrome (20), there is still a lack of evidence-based data to explain this association in NAFLD.…”

Ultra-Processed Food Intake Is Associated with Non-Alcoholic Fatty Liver Disease in Adults: A Systematic Review and Meta-Analysis

“…The main demographics and results of the studies included in this systematic review and meta-analysis are shown in Table 1 . The studies included participants from Asia [ 24 ], the USA [ 34 , 35 ] and Europe [ 25 , 26 , 27 , 36 , 37 , 38 ]. Three of the included studies were longitudinal, with follow up times ranging from 1 to 25 years [ 24 , 26 , 34 ], three were case-control [ 35 , 36 , 37 ], and three were cross-sectional in design [ 25 , 27 , 38 ].…”

“…The studies included participants from Asia [ 24 ], the USA [ 34 , 35 ] and Europe [ 25 , 26 , 27 , 36 , 37 , 38 ]. Three of the included studies were longitudinal, with follow up times ranging from 1 to 25 years [ 24 , 26 , 34 ], three were case-control [ 35 , 36 , 37 ], and three were cross-sectional in design [ 25 , 27 , 38 ]. Sample sizes ranged from 286 to 32,448 [ 35 , 36 ].…”

“…Four studies directly evaluated UPFs using the NOVA classification system [ 24 , 25 , 26 , 27 ], with the other five studies assessing foods named as ultra-processed by the NOVA classification system. Eight of the studies collected dietary information via Food Frequency Questionnaires (FFQs) [ 24 , 25 , 26 , 27 , 35 , 36 , 37 , 38 ], whilst the last study used a semi-structured interview [ 34 ]. All of the studies were published within the last four years.…”

“…In addition, experimental study has demonstrated that UPFs promote development of inflammatory diseases via promotion of systemic inflammation [ 23 ]. While observational studies have demonstrated evidence to support a link between UPF and NAFLD [ 24 , 25 , 26 , 27 ], no meta-analysis has objectively explored the association.…”