Relationship between dietary macronutrient composition and non-alcoholic fatty liver disease in lean and non-lean populations: a cross-sectional study

Abstract

Objective: The current study aimed to customize dietary changes for lean patients with non-alcoholic fatty liver disease (NAFLD). Design: The current study was done with a population-based cross-sectional design. The FFQ was used to analyse dietary macronutrient intake and ultrasonography results for NAFLD diagnosis. The study subjects were divided into the lean and non-lean groups based on their BMI (< 25 and ≥ 25). Multivariable logistic regression was used to evaluate the relationship between dietary macronutrients and NAFLD. Substitution analyses were also performed. Setting: Amol and its suburban areas in Iran. Participants: Adults in the age range of 18 to < 65 with full relevant data. Results: Among the total study subjects (2308), 46·7 % had fatty liver. The substitution of polysaccharides for animal protein and SFA in the lean group resulted in a significant NAFLD reduction, whereas the substitution of SFA for all types of macronutrients, except for n-6 and mono-disaccharides, led to a significant increase in NAFLD (P < 0·05). In non-lean participants, the substitution of MUFA for mono-disaccharides resulted in a significant reduction of NAFLD (P < 0·05). In this group, the substitution of SFA and mono-disaccharides for MUFA, and n-6 for all macronutrients, except vegetable protein and SFA, were significantly related to an increase in NAFLD (P < 0·05). Conclusions: Lower lean NAFLD is correlated with increasing polysaccharides in exchange for SFA and animal protein intake, whereas lower non-lean NAFLD is correlated with increasing MUFA in exchange for mono-disaccharides and reducing n-6 and SFA.

Systematic Review and Meta-analysis: The Role of Diet in the Development of Nonalcoholic Fatty Liver Disease

“…Protein intake has been investigated in 23 studies 8,[12][13][14]16,17,23,24,[26][27][28]32,35,36,39,42,[47][48][49][50][51][52][53] (4,431 NAFLD patients vs. 7,145 controls) and the percentage of protein in total caloric intake did not differ between NAFLD patients and controls (MD=0.09; 95%CI:-0.45, 0.64, p=0.73; I 2 =96%, p<0.001 Figure 2A) [10][11][12][13][14][19][20][21][24][25][26][27][28][29][30][33][34][35][36]39,41,42,54 .…”

“…There was no significant difference between NAFLD and controls in the consumption of total fat (MD=0.29, 95%CI: -0.26, 0.84, p=0.31; I 2 =95%, p<0.001) (28 studies, 12,327 NAFLD patients vs. 33,377 controls) 10-14, 19-21, 24-30, 32-42, 54, 56 (Figure 3A), saturated fat (MD=0.03; 95%CI: -0.45, 0.52, p=0.89; I 2 =92%, p<0.001) (14 studies, 5,381 NAFLD patients vs. 9,183 controls) 12,13,[19][20][21]25,29,30,32,38,39,42,54,56 Figure 3B), PUFA and MUFA (for PUFA: MD=0.21; 95%CI: -0.17, 0.58, p=0.28; I 2 =90%, p<0.0001, 12 studies, 3,654 NAFLD patients vs. 5,673 controls 12,13,17,[19][20][21]25,29,30,39,42,56 , Figure 3C and for MUFA: MD= 0.06; 95%CI: -0.47, 0.60, p=0.82; I 2 =86%, p<0.001, 12 studies, 4,852 NAFLD patients vs. 4,465 controls 12,13,17,[19][20][21]25,29,30,39,42,56 , Figure 3D) as percentage of total caloric intake. Total cholesterol intake did not differ between NAFLD and healthy c...…”

“…Twenty-six studies [10][11][12][13][14][19][20][21][24][25][26][27][28][29][30][32][33][34][35][36][39][40][41][42]54,56 investigated the association of carbohydrate intake and NAFLD. The percentage of caloric intake consumed as carbohydrates was not different in NAFLD patients compared to controls (MD=-0.09; 95%CI: -0.54, 0.37, p=0.71; I 2 =75%, p<0.001) (9,298 NAFLD patients vs. 27,466 controls, Figure 4A) [10][11][12][13][14][19][20][21][24][25][26][27][28][29][30][32][33][34][35][36][39][40]…”

“…There was no difference in carbohydrate intake between patients with NAFLD and NASH (MD=0.83; 95%CI: -3.06, 7.72, p=0.68; I 2 =83%, p<0.001) (5 studies, 148 NASH vs. 169 NAFLD patients, Figure 4B) 42,[44][45][46]55 . Absolute fibre intake 11,13,19,[25][26][27]31,32,43,45,52,55,[57][58][59][60][61] had no effect in NAFLD presence (Suppl. Figure 4).…”

Effects of oily fish and its fatty acid intake on non-alcoholic fatty liver disease development among South Korean adults

“…Moreover, NAFLD is closely associated with diabetes and metabolic syndrome, which are both related to the pathophysiology of inflammation and insulin resistance (30,31). Dietary MUFAs have been reported to improve lipid profile through their anti-inflammatory characteristics (30,32). Oily fish is protective against NAFLD owing to its omega-3 PUFA contents, which impact the lipid profile (33)(34)(35).…”