Favorable association between Mediterranean diet (MeD) and DASH with NAFLD among Iranian adults of the Amol Cohort Study (AmolCS)

Azam Doustmohammadian,Farhad Zamani,Nima Motamed,Nazanin Asghari Hanjani,Cain C T Clark,Mansooreh Maadi,Mahsa Nikkhoo,Hossein Ajdarkosh,Mohsen Reza Mansourian,Saeed Esfandyari,Elham Sobhrakhshankhah

doi:10.1038/s41598-022-06035-8

Abstract

Nonalcoholic fatty liver disease (NAFLD) is an emerging cause of chronic liver diseases and a major health problem worldwide. Dietary patterns may play a critical role in controlling and preventing this disease, but the available evidence is scarce. The current study aims to ascertain the association of adherence to the Dietary Approach to Stop Hypertension (DASH) diet and Mediterranean diet (MeD) with nonalcoholic fatty liver disease (NAFLD) among Iranian adults of the Amol Cohort Study (AmolCS). In a cross-sectional analysis among 3220 adults (55.3% men), age ≥ 18 years (46.96 ± 14.67), we measured usual dietary intake with a validated food frequency questionnaire (FFQ) and then calculated dietary pattern scores for DASH and MeD. Sociodemographic and lifestyle factors were collected by a structured questionnaire. The presence and degree of NAFLD were also determined by abdominal sonography. Multiple regression models were used to estimate NAFLD odds across tertiles of DASH and Mediterranean dietary scores. Dietary DASH and Mediterranean components were adjusted for total energy intake, based on the residual methods. After adjusting for multiple potential confounders, we found an inverse association of DASH and MeD with NAFLD (Ptrend = 0.02, and Ptrend = 0.002, respectively). Those in the highest tertiles of adherence to the DASH and MeD had the lowest risk for NAFLD (OR = 0.80, 95%CI = 0.66–0.96, OR = 0.64, 95%CI = 0.52–0.78, respectively). The results of logistic analysis of MeD, stratified by gender and abdominal obesity, revealed the favorable association was more pronounced in women (OR = 0.42, 95%CI = 0.29–0.61, Ptrend = 0.004), and in participants with or without abdominal obesity (OR = 0.62, 95% CI = 0.47–0.81, Ptrend = 0.03, OR = 0.64, 95%CI = 0.475–0.91, Ptrend = 0.04, respectively). Similar results were obtained for the adherence to DASH diet score with the prevalence of NAFLD patients with abdominal obesity (OR = 0.75, 95% CI = 0.57–0.97, Ptrend = 0.04). The findings suggested the favorable association between DASH and MeD with NAFLD in Iranian adults, especially women and subjects with or without abdominal obesity. Further prospective investigations are needed to confirm the integrity of our findings.

Highlights

As a major health problem, Nonalcoholic fatty liver disease (NAFLD) is a well-known risk factor of cardiovascular diseases and the leading cause of liver transplantation in men and the second in women[4]
The Mediterranean diet (MeD) is defined as a plant-based diet characterized by a high intake of fruits and vegetables, legumes, whole grains, and a high ratio of monounsaturated fatty acids (MUFA), which is associated with a lower risk of many chronic diseases[2]
Owing to the distinct lack of large-scale evidence from an Iranian population, the current study investigates the association of MeD and Dietary Approaches to Stop Hypertension (DASH) patterns with NAFLD in a large-scale sample of Iranian adults who participated in the Amol Cohort Study (AmolCS)

Summary

Introduction

As a major health problem, NAFLD is a well-known risk factor of cardiovascular diseases and the leading cause of liver transplantation in men and the second in women[4]. The Dietary Approaches to Stop Hypertension (DASH) diet is a healthful low-glycemic index and low-energy-dense diet initially designed to reduce hypertension[8,9]. This dietary pattern includes a wide variety of high-quality foods rich in antioxidants, magnesium, potassium, and dietary fiber and discourages red or processed meat, sugar, and sodium intakes[10,11]. The EASL-EASD-EASO Clinical Practice Guidelines have recently recommended MeD as a dietary choice for NAFLD treatment, through a reduction in insulin resistance and lipid serum concentrations It can induce regression of steatosis, a significant reduction of cardiovascular e vents[15]. Owing to the distinct lack of large-scale evidence from an Iranian population, the current study investigates the association of MeD and DASH patterns with NAFLD in a large-scale sample of Iranian adults who participated in the Amol Cohort Study (AmolCS)

Methods

Results

Conclusion