Abstract
Background: Greater adiposity is an important risk factor for nonalcoholic fatty liver disease (NAFLD). Thus, it is likely that dietary intake is involved in the development of the disease. Prospective studies assessing the relation between childhood dietary intake and risk of NAFLD are lacking.Objective: This study was designed to explore associations between energy, carbohydrate, sugar, starch, protein, monounsaturated fat, polyunsaturated fat, saturated fat, and total fat intake by youth at ages 3, 7, and 13 y and subsequent (mean age: 17.8 y) ultrasound scan (USS)–measured liver fat and stiffness and serum alanine aminotransferase, aspartate aminotransferase, and γ-glutamyltransferase. We assessed whether observed associations were mediated through fat mass at the time of outcome assessment.Methods: Participants were from the Avon Longitudinal Study of Parents and Children. Trajectories of energy and macronutrient intake from ages 3–13 y were obtained with linear-spline multilevel models. Linear and logistic regression models examined whether energy intake and absolute and energy-adjusted macronutrient intake at ages 3, 7, and 13 y were associated with liver outcomes.Results: Energy intake at all ages was positively associated with liver outcomes; for example, the odds of having a USS-measured liver fat per 100 kcal increase in energy intake at age 3 y were 1.79 (95% CI: 1.14, 2.79). Associations between absolute macronutrient intake and liver outcomes were inconsistent and attenuated to the null after adjustment for total energy intake. The majority of associations attenuated to the null after adjustment for fat mass at the time liver outcomes were assessed.Conclusion: Higher childhood and early adolescent energy intake is associated with greater NAFLD risk, and the macronutrients from which energy intake is derived are less important. These associations appear to be mediated, at least in part, by fat mass at the time of outcome assessment.
Highlights
Nonalcoholic fatty liver disease (NAFLD)9 is a common cause of chronic liver disease in children and adolescents [1], and is associated with fibrosis, insulin resistance, and dyslipidemia, inde
In this study we assessed associations between energy intakes and absolute and energy-adjusted total fat, mono- and polyunsaturated fat, saturated fat, total carbohydrate, sugar, starch, Dietary intake through childhood and risk of nonalcoholic fatty liver disease (NAFLD) 985
After adjusting for energy intake, the majority of the observed positive associations between absolute macronutrient intake and ALT attenuated to the null. These results suggest that higher energy intake in childhood and early adolescence is associated with greater NAFLD risk, and that the relative proportions of macronutrients from which energy intake is derived are less important
Summary
Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease in children and adolescents [1], and is associated with fibrosis, insulin resistance, and dyslipidemia, inde-pendently of total body fat [2]. Because greater adiposity is a key risk factor for NAFLD [3], it is likely that dietary intake is involved in its development. Linear and logistic regression models examined whether energy intake and absolute and energy-adjusted macronutrient intake at ages 3, 7, and 13 y were associated with liver outcomes. Associations between absolute macronutrient intake and liver outcomes were inconsistent and attenuated to the null after adjustment for total energy intake. Conclusion: Higher childhood and early adolescent energy intake is associated with greater NAFLD risk, and the macronutrients from which energy intake is derived are less important. These associations appear to be mediated, at least in part, by fat mass at the time of outcome assessment.
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