Abstract
Dietary lifestyle intervention is key in treating non-alcoholic fatty liver disease (NAFLD). We aimed to examine the longitudinal relation between well-established dietary patterns as well as population-specific dietary patterns and NAFLD. Participants from two subsequent visits of the Rotterdam Study were included. All underwent serial abdominal ultrasonography (median follow-up: 4.4 years) and filled in a food frequency questionnaire. Secondary causes of steatosis were excluded. Dietary data from 389 items were collapsed into 28 food groups and a posteriori dietary patterns were identified using factor analysis. Additionally, we scored three a priori dietary patterns (Mediterranean Diet Score, Dutch Dietary Guidelines and WHO-score). Logistic mixed regression models were used to examine the relation between dietary patterns and NAFLD. Analyses were adjusted for demographic, lifestyle and metabolic factors. We included 963 participants of whom 343 had NAFLD. Follow-up data was available in 737 participants. Incident NAFLD was 5% and regressed NAFLD was 30%. We identified five a posteriori dietary patterns (cumulative explained variation [R2] = 20%). The patterns were characterised as: vegetable and fish, red meat and alcohol, traditional, salty snacks and sauces, high fat dairy & refined grains pattern. Adherence to the traditional pattern (i.e. high intake of vegetable oils/stanols, margarines/butters, potatoes, whole grains and sweets/desserts) was associated with regression of NAFLD per SD increase in Z-score (0.40, 95% CI 0.15–1.00). Adherence to the three a priori patterns all showed regression of NAFLD, but only the WHO-score showed a distinct association (0.73, 95% CI 0.53–1.00). Hence, in this large elderly population, adherence to a plant-based, high-fibre and low-fat diet was related to regression of NAFLD.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and characterized by fat accumulation in the liver without the presence of the well-known risk factors for liver disease such as alcohol misuse and viral hepatitis [1]
In the group without steatosis, 24 participants progressed to steatosis (5.1%), and in the group with steatosis, 68 participants regressed to no steatosis (29.8%)
There is a paramount of studies on nutrition and NAFLD, there is no study yet that assesses the longitudinal association between well-known dietary quality scores, populationspecific dietary pattern scores and NAFLD adjusted for important covariates such as BMI and metabolic confounders
Summary
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and characterized by fat accumulation in the liver without the presence of the well-known risk factors for liver disease such as alcohol misuse and viral hepatitis [1]. Apart from the liver-related sequelae, NAFLD is regarded as the hepatic manifestation of the metabolic syndrome [5]. It is strongly associated with metabolic health, but it actively contributes to the risk of cardiovascular disease incidence [6, 7]. There is a paramount of studies on the association between separate food items or groups with NAFLD, evidence on diet as a whole almost exclusively originates from either small or cross-sectional studies [12, 14–16]. Ma et al [19] showed for the first time, that high dietary quality, as assessed by the a priori hypothesized Mediterranean Diet Score (MDS) and the American Heart Eating Index, was associated with reduced odds of steatosis development in a large longitudinal cohort study
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