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

Abstract

Non-alcoholic fatty liver disease (NAFLD) is associated with overweight/obesity, metabolic syndrome and type 2 diabetes (T2D) due to chronic caloric excess and physical inactivity. Previous meta-analyses have confirmed associations between ultra-processed food (UPF) intake and obesity and T2D. We aim to ascertain the contribution of UPF consumption to the risk of developing NAFLD. We performed a systematic review and meta-analysis (PROSPERO (CRD42022368763)). All records registered on Ovid Medline and Web of Science were searched from inception until December 2022. Studies that assessed UPF consumption in adults, determined according to the NOVA food classification system, and that reported NAFLD determined by surrogate (steatosis) scores, imaging or liver biopsy were included. The association between UPF consumption and NAFLD was assessed using random-effects meta-analysis methods. Study quality was assessed, and evidence credibility evaluated, using the Newcastle Ottawa Scale and NutriGrade systems, respectively. A total of 5454 records were screened, and 112 records underwent full text review. From these, 9 studies (3 cross-sectional, 3 case-control and 3 cohort), analysing 60,961 individuals, were included in the current review. Both moderate (vs. low) (pooled relative risk 1.03 (1.00–1.07) (p = 0.04) (I2 = 0%)) and high (vs. low) (1.42 (1.16–1.75) (<0.01) (I2 = 89%)) intake of UPF significantly increased the risk of NAFLD. Funnel plots demonstrate low risk of publication bias. Consumption of UPF is associated with NAFLD with a dose–response effect. Public health measures to reduce overconsumption of UPF are imperative to reduce the burden of NAFLD, and the related conditions, obesity and T2D.

Ultra‐processed food and non‐communicable diseases in the United Kingdom: A narrative review and thematic synthesis of literature

“…To date, there has been a paucity of UK research assessing the association between NOVA‐based UPF consumption and NAFLD. Our own meta‐analysis demonstrates a dose–response association between UPFs and NAFLD, with high (vs. low) intake of UPFs associated with a 42% increased risk of NAFLD (RR 1.42 [95% CI 1.16–1.75]) 16 …”

“…Our own meta-analysis demonstrates a dose-response association between UPFs and NAFLD, with high (vs. low) intake of UPFs associated with a 42% increased risk of NAFLD (RR 1.42 [95% CI 1.16-1.75]). 16…”

“…Concurrently, NCD incidence and prevalence is rising in the United Kingdom, 2 widely accepted to be driven by diets characterized by poor nutritional quality and high energy density 12 . Comprehensive meta‐analyses have demonstrated associations between greater UPF consumption and increased risk of a wide range of NCDs 13 including obesity, 14 T2D, 15 cancer, 13 CVD, 13 non‐alcoholic fatty liver disease (NAFLD), 16 dementia, 17 and all‐cause mortality 18 …”

“…11 Concurrently, NCD incidence and prevalence is rising in the United Kingdom, 2 widely accepted to be driven by diets characterized by poor nutritional quality and high energy density. 12 Comprehensive meta-analyses have demonstrated associations between greater UPF consumption and increased risk of a wide range of NCDs 13 including obesity, 14 T2D, 15 cancer, 13 CVD, 13 nonalcoholic fatty liver disease (NAFLD), 16 dementia, 17 and all-cause mortality. 18 Given that poor diet quality is known to increase mortality from chronic disease, 19 it is imperative and timely to review trends in UPF consumption in the United Kingdom and how they are associated with poorer health on a biological, epidemiological, and sociological level, to inform future clinical and political decisions aiming to improve the public health of the United Kingdom.…”

A public health perspective on mitigating the global burden of chronic liver disease

“…Dietary patterns associated with detrimental health outcomes, including obesity, diabetes, cardiovascular disease, cancer, and all-cause mortality, are also associated with increased MASLD risk 21 . Specifically, higher intake of calories, 22 sugar-sweetened beverages (SSBs) (in a dose-dependent manner) and foods, 23,24 red and processed meats, 23 and ultraprocessed foods 25 are each associated with increased risk of MASLD. Dietary patterns characterized by higher plant-based foods and lower SSBs and foods, lower processed foods, and lower saturated fats are protective 14 …”