Ultra-processed food consumption and the risk of non-alcoholic fatty liver disease in the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study

Abstract

Background Growing evidence supports a link between ultra-processed food consumption and human health outcomes. However, the association between ultra-processed food consumption and non-alcoholic fatty liver disease (NAFLD) is not known. We aimed to explore the association between ultra-processed food consumption and risk of NAFLD. Methods The prospective study included 16 168 participants aged 18–90 years from the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study. Information on ultra-processed food consumption was collected at baseline using a validated food frequency questionnaire. NAFLD was defined as the presence of sonographic fatty liver in the absence of significant alcohol intake (≥210 g/week for men and ≥140 g/week for women, respectively) and other liver diseases. Multivariable Cox proportional hazards models were used to examine the association between ultra-processed food consumption and risk of NAFLD. Results During 56 935 person-years of follow-up, we documented 3752 incident NAFLD cases. After adjusting for age, sex, body mass index, smoking, alcohol drinking, education, occupation, income, physical activity, total energy intake, personal and family history of disease and overall diet quality, the multivariable hazard ratios (95% confidence interval) of NAFLD across increasing quartiles of ultra-processed food consumption were 1.00 (reference), 0.99 (0.90, 1.08), 1.13 (1.03, 1.25) and 1.18 (1.07, 1.30), respectively (P for trend <0.0001). The hazard ratio (95% confidence interval) per one standard deviation increase in ultra-processed food consumption, equivalent to a 62.7 g/1000 kcal per day, was 1.06 (1.03, 1.09), P = 0.0001. Conclusions Our study indicates that higher ultra-processed food consumption is associated with a higher risk of NAFLD. This finding suggests that ultra-processed food, which is widely consumed worldwide, might be a modifiable dietary target to reduce the risk of NAFLD.

Ultra-processed food intake is associated with grip strength decline in middle-aged and older adults: a prospective analysis of the TCLSIH study

“…Our analyses focused on UPFs, which included instant noodles, bread, sausages, preserved egg, western-style pastry or cakes, cookies (biscuits), Chinese pastries or cakes, sweet snacks or candies (confectionery) or preserves (jams), ice cream, soft drinks, and fruit and vegetable drinks. The definition of UPFs in the current study is consistent with our recent publication [29]. To estimate UPF intake, we summed the intake amount (g/day) of the UPF items in the FFQ.…”

Intake of Ultra-Processed Food and Ectopic-, Visceral- and Other Fat Depots: A Cross-Sectional Study

“…Accumulation of some ectopic fat depots (e.g., liver fat) may be more responsive to changes in specific nutrients (such as SFA, fiber and total sugar) than for energy intake per se, as has previously been suggested ( 14 – 16 , 18 ) and warrants further investigation. In contrast, intake of UPF was recently demonstrated to be associated with the development of NAFLD (assessed by ultrasonography) over 4.2 years in a Chinese cohort ( 31 ). These associations remained in models adjusting for multiple potential confounders, including overall diet quality, but unfortunately not carbohydrate- or fat composition (e.g., sugars, fiber, SFA).…”

The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies

“…In the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study, the highest vs. lowest quartile of UPF intake was associated with a 17% (1.07, 1.29) higher risk of non-alcoholic fatty liver disease (NAFLD) in the age, sex and BMI adjusted model. After adjustment for other confounders including for a healthy diet score based on fruit, vegetable, red meat and fish intake, the increased risk associated with the highest vs. lowest quintile of UPF intake was 19% (1.08, 1.31) [ 125 ].…”

“…Other dietary adjustments include for fried foods, fruit and vegetables, UPF soft drinks, multivitamin use and excluding bacon, sausage and processed meats from ultra-processed food intake. These adjustments had no impact on the association between higher intakes of UPF and risk of all-cause mortality, cancer, overweight/obesity, increased total and visceral fat mass, increased BMI and FMI, NAFLD, weight and waist circumference gain, adverse blood lipid profiles, grip strength decline, incident hypertension and renal function decline [ 103 , 104 , 106 , 107 , 109 , 111 , 112 , 115 , 121 , 122 , 125 , 126 , 133 , 136 , 138 ].…”