Abstract
BackgroundLittle is known about the associations between healthy dietary patterns and metabolic dysfunction-associated fatty liver disease (MAFLD) in less-developed ethnic minority regions (LEMRs), where the prevalence of MAFLD is increasing rapidly and dietary habits are quite different from those in developed countries. Moreover, a significant subset of MAFLD individuals in LEMRs are nonobese, but the efficacy of dietary patterns on MAFLD individuals with different obese statuses is also unclear. We aimed to test the associations of two wildly recommended a priori dietary patterns—Alternate Mediterranean diet (AMED) and Dietary Approaches to Stop Hypertension (DASH)—with the risk of MAFLD in the total population, and further in nonobese and obese individuals.MethodsWe recruited 99,556 participants in the China Multi-Ethnic Cohort Study, an ongoing cohort study in less-developed southwest China. Using validated food frequency questionnaire, each participant was assigned an AMED score and a DASH score. MAFLD was ascertained as hepatic steatosis on ultrasound together with diabetes, overweight/obesity, or two other metabolic risk factors. We performed logistic regression with inverse probability of exposure weighting (IPEW) to examine associations between two dietary patterns and MAFLD, adjusting for potential confounders under the guidance of directed acyclic graphs. Further, analyses were stratified by body mass index.ResultsWe included 66,526 participants (age 49.5±11.0; 62.6% women), and the prevalence of MAFLD was 16.1%. Participants in the highest quintile of DASH score showed strong inverse associations with risks of MAFLD (OR = 0.85; 95% CI, 0.80-0.91; Ptrend < 0.001) compared with participants in the lowest quintile. The association between DASH and nonobese MAFLD (OR = 0.69; 95% CI, 0.61-0.78; Ptrend < 0.001) was stronger (I2 = 78.5 % ; Pheterogeneity = 0.001) than that with obese MAFLD (OR = 0.90; 95% CI, 0.83-0.98; Ptrend = 0.002). There was a null association between AMED and MAFLD risk.ConclusionsIn LEMRs, a DASH diet but not AMED was associated with MAFLD. The relationship appeared to be more pronounced in nonobese MAFLD individuals than in obese MAFLD individuals.
Highlights
Little is known about the associations between healthy dietary patterns and metabolic dysfunctionassociated fatty liver disease (MAFLD) in less-developed ethnic minority regions (LEMRs), where the prevalence of MAFLD is increasing rapidly and dietary habits are quite different from those in developed countries
In LEMRs, a Dietary Approaches to Stop Hypertension (DASH) diet but not Alternate Mediterranean diet (AMED) was associated with MAFLD
The relationship appeared to be more pronounced in nonobese MAFLD individuals than in obese MAFLD individuals
Summary
Little is known about the associations between healthy dietary patterns and metabolic dysfunctionassociated fatty liver disease (MAFLD) in less-developed ethnic minority regions (LEMRs), where the prevalence of MAFLD is increasing rapidly and dietary habits are quite different from those in developed countries. The prevalence of NAFLD has dramatically increased in less-developed countries [1, 5], especially in populations of low socioeconomic status (SES) and racial/ethnic minorities [6, 7], with the rate increasing more than twice as fast in some regions as in developed countries [8]. Some healthy dietary patterns, such as the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet, have been recommended for the management of NAFLD [13, 14] These dietary patterns were proposed based on dietary habits from developed countries, and whether they can be generalized to other populations, racial/ethnic minority groups in less-developed regions, is still doubtful. Large population-based evidence on the efficacy of western dietary guidance in MAFLD management from less-developed ethnic minority regions (LEMRs) is scarce
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