Development of Food Group Tree-Based Analysis and Its Association with Non-Alcoholic Fatty Liver Disease (NAFLD) and Co-Morbidities in a South Indian Population: A Large Case-Control Study

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is a global problem growing in parallel to the epidemics of obesity and diabetes, with South Asians being particularly susceptible. Nutrition and behaviour are important modifiers of the disease; however, studies to date have only described dietary patterns and nutrients associated with susceptibility to NAFLD. Methods: This cross-sectional case-control study included 993 NAFLD patients and 973 healthy controls from Trivandrum (India). Dietary data was collected using a locally validated food frequency questionnaire. A tree-based classification categorised 2165 ingredients into three levels (food groups, sub-types, and cooking methods) and intakes were associated with clinical outcomes. Results: NAFLD patients had significantly higher consumption of refined rice, animal fat, red meat, refined sugar, and fried foods, and had lower consumption of vegetables, pulses, nuts, seeds, and milk compared to controls. The consumption of red meat, animal fat, nuts, and refined rice was positively associated with NAFLD diagnosis and the presence of fibrosis, whereas consumption of leafy vegetables, fruits, and dried pulses was negatively associated. Fried food consumption was positively associated with NAFLD, whilst boiled food consumption had a negative association. Increased consumption of animal fats was associated with diabetes, hypertension, and cardiovascular outcomes among those with NAFLD, whereas consumption of wholegrain rice was negatively associated with these clinical-related outcomes. Conclusions: The tree-based approach provides the first comprehensive method of classifying food intakes to enable the identification of specific dietary factors associated with NAFLD and related clinical outcomes. This could inform culturally sensitive dietary guidelines to reduce risk of NAFLD development and/or its progression.

Race and Ethnicity in Non-Alcoholic Fatty Liver Disease (NAFLD): A Narrative Review

“…Furthermore, people from India are at higher risk for metabolic diseases like T2DM than White individuals, and they have a relatively high national NAFLD prevalence of 25.7% [ 10 , 61 ]. A recent case–control study by Vijay et al, 2022, performed on the Trivandrum NAFLD cohort attempted to investigate the association of individuals’ dietary intake and composition of the local recipes with clinical outcomes regarding NAFLD [ 62 ]. Trivandrum, the southernmost district in Kerala, India, is an area with NAFLD prevalence reports as high as 51% [ 63 ].…”

“…Trivandrum, the southernmost district in Kerala, India, is an area with NAFLD prevalence reports as high as 51% [ 63 ]. The population-based Trivandrum NAFLD cohort has been designed in the past decade to examine the interaction between lifestyle factors and genetics and the risk of NAFLD [ 62 , 63 ]. They assessed NAFLD using ultrasound, followed by the assessment of liver fibrosis in NAFLD patients using transient elastography (T.E.)…”

“…Furthermore, consuming fried and roasted foods was positively and boiled, steamed, and uncooked/unprocessed foods were negatively associated with NAFLD status (OR = 1.49 (95% CI: 1.22–1.78) vs. OR = 0.43 (95% CI: 0.20–0.48), respectively). Significant fibrosis was positively associated with higher consumption of fats, edible oils, red meat, and fried foods, while negatively associated with the consumption of leafy vegetables [ 62 ]. They linked the association of frying food with NAFLD to the possible oxidation of fats due to heat exposure, the formation of toxic compounds such as radical species, and subsequent liver cell damage [ 62 ].…”

“…Significant fibrosis was positively associated with higher consumption of fats, edible oils, red meat, and fried foods, while negatively associated with the consumption of leafy vegetables [ 62 ]. They linked the association of frying food with NAFLD to the possible oxidation of fats due to heat exposure, the formation of toxic compounds such as radical species, and subsequent liver cell damage [ 62 ].…”

Effect of Nut Consumption on Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

“…In a case–control study (134 cases and 217 controls), the results showed that nuts had a beneficial influence on NAFLD (OR = 0.95; 95% CI: 0.91–0.98) [ 22 ]. However, three studies have reported a reverse relationship between nuts and NAFLD [ 23 , 24 , 25 ]. In a study targeting individuals aged ≥25 in India, it was reported that consuming nuts poses a risk of NAFLD (OR = 1.21; 95% CI: 1.12–1.52) [ 25 ].…”