Soft drink consumption and risk of nonalcoholic fatty liver disease: results from the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) cohort study

Abstract

Background Epidemiological evidence for the association of soft drink consumption with nonalcoholic fatty liver disease (NAFLD) is inconsistent, and such association has not been prospectively examined in the general adult population. Objectives We aimed to investigate the prospective association between soft drink consumption and the risk of NAFLD in a Chinese adult population. Methods This prospective cohort study investigated 14,845 participants [mean age: 39.3 y; 6203 (41.8%) men] who were free of liver disease, cardiovascular disease, and cancer at baseline. Soft drink consumption (mainly sugar-containing carbonated beverages) was measured at baseline using a validated FFQ. NAFLD was diagnosed based on abdominal ultrasound without significant alcohol consumption and other causes of liver disease. Hepatic steatosis index (HSI) was calculated based on sex, BMI, and blood transaminase levels. Cox proportional hazards regression models were used to examine the association of soft drink consumption with incident NAFLD. Results A total of 2888 first-incident cases of NAFLD occurred during 42,048 person-years of follow-up (median follow-up: 4.2 y). After adjusting for demographic characteristics, lifestyle factors, dietary intake, and inflammatory markers, the multivariable HRs (95% CIs) for incident NAFLD were 1.00 (reference) for <1 serving/wk, 1.18 (1.03, 1.34) for 1 serving/wk, 1.23 (1.08, 1.40) for 2–3 servings/wk, and 1.47 (1.25, 1.73) for ≥4 servings/wk, respectively (P for trend < 0.0001). Further sensitivity analysis showed that the corresponding multivariable HRs (95% CIs) for incident HSI-defined NAFLD were 1.00 (reference), 0.96 (0.70, 1.31), 1.16 (0.83, 1.62), and 1.59 (1.07, 2.37), respectively (P for trend < 0.0001). Conclusions The results from our prospective study indicate that soft drink consumption is associated with an increased risk of NAFLD in Chinese adults. This study was registered at UMIN Clinical Trials Registry as UMIN000027174.

Relationship Between Dietary Patterns and Carotid Atherosclerosis Among People Aged 50 Years or Older: A Population-Based Study in China

“…In addition, some infrequently consumed foods might have been overlooked due to the limited food items on the FFQ. Although these may influence the accuracy of food intake, it indicated that dietary data were relatively stable over time according to our published studies ( 22 , 50 ). Third, there may be some residual confounding factors we could not fully capture; variables that are intrinsically related to the dietary patterns may influence the relationship between dietary patterns and CA.…”

“…The FFQ contained seven frequencies ranging from “almost never” to “twice or more per day” for foods, and eight frequencies ranging from “almost never” to “four or more times per day” for beverages. The reproducibility and validity of the FFQ have been tested in a random sample of 150 participants living in Tianjin by comparing the data from the repeat measure ~3 months apart and 4-day weighed dietary records (WDRs) ( 22 ). Spearman's rank correlation coefficient for energy intake between two FFQs was 0.68, for food items (fruits, vegetables, meat, beverages, etc.)…”

One size does not fit all; practical, personal tailoring of the diet to NAFLD patients

“…114 Prospective cohort study supports these findings, by showing a dose-response association between soft drink consumption (mainly sugar-containing carbonated beverages) and NAFLD diagnosed by US; a consumption of 4 or more servings per week was related with 45% increased risk to develop NAFLD. 115 Importantly, high sugar consumption is also related to the risk for liver cancer. 116 This is emphasized explicitly for sugar-sweetened beverages consumption, which is strongly related to the risk of hepatocellular carcinoma (HCC).…”

Organ meat consumption and risk of non-alcoholic fatty liver disease: the Tianjin Chronic Low-grade Systemic Inflammation and Health cohort study

“…Daily energy and nutrient intakes were extracted from the questionnaires using the China Food Composition database that includes information on nutrient content per gram or serving per product (14) . The reproducibility and validity of the FFQ in measuring food intake have been described in detail previously (24) . The Spearman correlation coefficients between the FFQ and dietary records were 0.49 for energy and 0.68 for organ meats.…”