Healthy diet is associated with lower risk of hepatic fibrosis

Authors: GAO, VINCENT - Emory University; LONG, MICHELLE - Boston University Medical School; SINGH, SHRIDHAR - University Of Massachusetts; YOUJIN, KIM - Tufts University; XUEHONG, ZHANG - Harvard University; ROGERS, GAIL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; LEVY, DANIEL - National Heart, Lung And Blood Institute(NHLBI, NIH); MA, JIANTAO - Tufts University

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/31/2023
Publication Date: 5/3/2023
Citation: Gao, V., Long, M.T., Singh, S.R., Youjin, K., Xuehong, Z., Rogers, G., Jacques, P.F., Levy, D., Ma, J. 2023. Healthy diet is associated with lower risk of hepatic fibrosis. Journal of Nutrition. https://doi.org/10.1016/j.tjnut.2023.03.038.
DOI: https://doi.org/10.1016/j.tjnut.2023.03.038

Interpretive Summary: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the U.S., affecting approximately 30% of the population. The rise in the prevalence of NAFLD parallels the rise in obesity, and individuals with NAFLD are at an increased risk for liver cancer and cardiometabolic diseases, and have higher overall mortality. Adopting a high-quality, healthy diet may be a good means of preventing NAFLD. Liver biopsies remain the gold standard method to diagnose NAFLD, but due to the cost, invasiveness, risk of complications, and poor subject acceptance, it is not feasible to perform liver biopsies on large numbers of research participants. We used a relatively new noninvasive procedure with good accuracy to detect the presence and severity of NAFLD based on two key features of NAFLD, the amount of liver fat and liver fibrosis (scar tissue), to examine the relationships between healthy diet patterns and NAFLD risk in two populations of American adults. We demonstrated higher diet quality was favorably related to both liver fat and fibrosis, suggesting that a healthy diet may reduce the likelihood developing NAFLD and its serious consequences.

Technical Abstract: Background. Higher diet quality is associated with a lower risk of NAFLD. Objective. We examined the relationship between diet quality and hepatic fibrosis. Design. We analyzed cross-sectional associations between three a priori diet quality scores: the Dietary Approaches to Stop Hypertension (DASH) score, the Alternative Healthy Eating Index (AHEI), and a modified Mediterranean-style diet score (MDS) and hepatic fat (controlled attenuation parameter; CAP) and fibrosis (liver stiffness measurement; LSM) measured by Vibration-controlled Transient Elastography in 2,532 Framingham Heart Study (FHS) participants and 3,295 participants of the National Health and Nutrition Examination Survey (NHANES). Results. Higher diet quality scores were associated with lower LSM in both FHS and NHANES after adjustment for demographic and lifestyle factors. Additional adjustment for CAP or BMI attenuated the observed associations. Association strengths were similar across all three diet quality scores. Fixed effect meta-analysis demonstrated that, under CAP-adjusted models, the LSM decrease associated with one SD increase of the DASH, AHEI, and MDS score was 2% (95% CI: 0.7%, 3.3%; P = 0.002), 2% (95% CI: 0.7%, 3.3%; P = 0.003), and 1.7% (95% CI: 0.7%, 2.6%; P = 0.001), respectively. Whereas, in meta-analysis of BMI-adjusted models, LSM reduction associated with one SD increase of the DASH, AHEI, and MDS scores was 2.2% (95% CI: -0.1%, 2.2%; P=0.07), 1.5% (95% CI: 0.3%, 2.7%; P=0.02), and 0.9 (95% CI: -0.1%, 1.9%; P=0.07), respectively. Conclusions. We demonstrated associations of higher diet quality with favorable hepatic fat and fibrosis measures. Our data suggest that a healthy diet may reduce the likelihood of obesity and hepatic steatosis as well as the progression of steatosis to fibrosis.