The Effect of Dietary Patterns on the Development of Non-alcoholic Steatohepatitis: Findings From the National Health and Nutrition Examination Survey (NHANES): 2017 Presidential Poster Award

Abstract

Introduction: Nonalcoholic Steatohepatitis (NASH) is a major public burden in the US and the third leading indication for liver transplantation. Lifestyle and dietary alterations are the first line of treatment. However, the efficacy of these interventions is unclear. We aim to provide further insights into the relationship between the different dietary constituents, micronutrients, and NASH using a national database. Methods: This is a cross sectional study using the NHANES III database. Patients were included if they had NASH: Fatty liver on ultrasound, elevated liver enzymes, negative serology for Hepatitis B and C and alcohol consumption of < 20 gr/day for men and 10 gr/day for women. Detailed dietary information was abstracted from the 24-hour dietary recall files in NHANES III. A multivariate regression analysis model was built to measure the independent predictors of NASH. The model included known NASH risk factors (age, sex, BMI, presence of Diabetes Mellitus) in addition to percent of daily calories obtained from protein, fat and carbohydrates as well as the amount of fiber, dietary vitamins and minerals consumed daily. Results: 46,231 patients met the criteria for NASH. All adjusted Odds ratios (aOR) are presented in Table 1. There was no significant association between gender or age and NASH. Obesity was associated with a 7-fold (95% confidence interval (CI): 1.79 - 28.64, P < 0.01) increase in the odds of NASH. Each percent increase in the daily calories obtained from carbohydrates was associated with 1.24-fold (CI: 1.07 - 1.43, P < 0.01) increase in the odds of NASH. Each 10 grams (grs) increase in daily cholesterol consumption was associated with 3% higher odds (aOR: 1.03, CI: 1.01 - 1.05, P < 0.01) of NASH. Both vitamin B12 and copper had a protective effect, with an aOR per gr of 0.76 (CI: 0.60 - 0.96, P = 0.02) and 0.09 (CI: 0.01 - 0.93, P = 0.04), respectively. However, Zinc (aOR: 1.15, CI:1.02-1.30, p=0.02) and Selenium (aOR: 1.01, CI: 1.004-1.02, p < 0.01) were risk factors for NASH. Contrary to findings in other studies, there was no association between protein consumption and NASH.Table: Table. Multivariate Regression AnalysisConclusion: Our findings provide further evidence on the association between diets high in carbohydrate or cholesterol and NASH. Vitamin B12 and copper were associated with lower while Zinc and Selenium with higher odds of NASH. Further studies are required to assess the effect of incorporating the findings above as part of targeted diets for the treatment of NASH.