The Associations Between Dietary Patterns And Non-alcoholic Fatty Liver Disease

Objective1.Deriving dietary patterns among the participants living in Tianjin based on the Tianjin chronic inflammation and health(TCLSIHealth)cohort study.Exploring the associations between dietary patterns and non-alcoholic fatty liver disease(NAFLD)and the roles of obesity and inflammation in these associations.Providing evidence for constructing the dietary guidelines for preventing NAFLD.2.Deriving obesity and inflammatory dietary pattern which is associated with obesity and inflammation.Exploring the associations between obesity and inflammatory dietary pattern and NAFLD and the roles of obesity and inflammation in these associations.3.Combining the dietary patterns in Tianjin and the obesity and inflammatory dietary pattern to construct a simplified healthy dietary pattern score for preventing and measuring the risk of NAFLD.Methods1.Dietary intake was assessed using a valid self-administered food frequency questionnaire.Cases and controls were matched using the propensity score matching method.2.Dietary patterns in Tianjin were derived using exploratory factor analysis(EFA).The associations between dietary patterns and NAFLD were assessed using conditional logistic regression analysis.3.The obesity and inflammatory dietary pattern was derived using reduced rank regression(RRR).We selected body mass index(BMI)and leukocyte count(LC)as responses variables in order that the final derived dietary pattern could explain the obesity and inflammation status.The associations between the obesity and inflammatory dietary pattern and NAFLD were assessed using conditional logistic regression analysis.4.The simplified healthy dietary pattern score was calculated by summing the weighted standardized intake of the food items with high factor loadings on the dietary patterns in Tianjin and the obesity and inflammatory dietary pattern.The associations between the simplified healthy dietary pattern score and NAFLD were assessed using conditional logistic regression analysis.Results1.The main dietary patterns in Tianjin and NAFLD1.1.Propensity score matching2400 cases and 2400 controls were generated using the propensity score matching method from 13468 participants?1.2.Main dietary patterns in TianjinAfter varimax rotation,EFA revealed three dietary patterns in Tianjin.The three dietary patterns accounted for 22.8%of the variance in total food intake.According to the contribution to the total variation,the three dietary patterns were:sweets and fruits pattern;healthy pattern;animal foods pattern.1.3.The associations between the sweets and fruits pattern and NAFLDThe sweets and fruits pattern was positively associated with the prevalence of NAFLD before adjustment of BMI and LC.Compared with the participants in the lowest quartile,the odds ratios(ORs)and 95%confidence intervals(CIs)for the participants in the 2,3 and 4 quaxtiles of the sweets and fruits pattern were 1.10(0.94,1.29),1.07(0.91,1.26),and 1.28(1.09,1.51)(P for trend<0.01),respectively.The associations were non-significant after adjustment of BMI and LC.Compared with the participants in the lowest quartile,the ORs(95%CIs)for the participants in the 2,3 and4 quartiles of the sweets and fruits pattern were 1.08(0.87,1.35),1.19(0.95,1.49),1.25(0.99,1.57)(P for trend=0.05),respectively.1.4.The associations between the healthy pattern and NAFLDThe healthy pattern was negatively associated with the prevalence of NAFLD before adjustment of BMI and LC.Compared with the participants in the lowest quartile,the odds ratios(ORs)and 95%confidence intervals(CIs)for the participants in the 2,3 and 4 quartiles of the healthy pattern were 0.95(0.80,1.11),0.84(0.72,0.99),0.78(0.66,0.91)(P for trend<0.001),respectively.The associations were non-significant after adjustment of BMI and LC.Compared with the participants in the lowest quartile,the ORs(95%CIs)for the participants in the 2,3 and 4 quartiles of the healthy pattern were 0.91(0.72,1.13),0.89(0.71,1.10),0.80(0.65,1.01)(P for trend=0.06),respectively.1.5.The associations between the animal foods pattern and NAFLDThe animal foods pattern was positively associated with the prevalence of NAFLD before adjustment of BMI and LC.Compared with the participants in the lowest quartile,the odds ratios(ORs)and 95%confidence intervals(CIs)for the participants in the 2,3 and 4 quartiles of the animal foods pattern were 1.07(0.91,1.26),1.22(1.03,1.44),1.30(1.10,1.54)(P for trend<0.001),respectively.The associations were weaker after adjustment of BMI and LC.Compared with the participants in the lowest quartile,the ORs(95%CIs)for the participants in the 2,3 and 4 quartiles of the animal foods pattern were 1.12(0.90,1.40),1.14(0.90,1.43),1.27(1.01,1.59)(P for trend=0.05),respectively.2.The obesity and inflammatory dietary pattern and NAFLD2.1.The obesity and inflammatory dietary patternThe obesity and inflammatory dietary pattern was derived by RRR in 4800 participants living in Tianjin.The obesity and inflammatory dietary pattern was typified by high intake of carbonated drink,ice cream,tea and meat,low intake of coarse grain,vegetables and milk.2.2.The associations between the obesity and inflammatory dietary pattern and NAFLDThe obesity and inflammatory dietary pattern was positively associated with the prevalence of NAFLD before adjustment of BMI and LC.Compared with the participants in the lowest quartile,the odds ratios(ORs)and 95%confidence intervals(CIs)for the participants in the 2,3 and 4 quartiles of the animal foods pattern were 1.18(1.01,1.39),1.46(1.24,1.72),2.01(1.70,2.34)(P for trend<0.001),respectively.The associations were weaker after adjustment of BMI and LC.Compared with the participants in the lowest quartile,the ORs(95%CIs)for the participants in the 2,3 and 4 quartiles of the obesity and inflammatory dietary pattern were 0.94(0.76,1.17),1.12(0.90,1.39),1.39(1.09,1.74)(P for trend<0.01),respectively.3.The simplified healthy dietary pattern score and NAFLD3.1.The simplified healthy dietary pattern scoreThe simplified healthy dietary pattern score was calculated by summing the weighted standardized intake of the 26 healthy food items(each weighted 1)and 11 unhealthy food items(each weighted-1)with high factor loadings on the dietary patterns in Tianjin and the obesity and inflammatory dietary pattern.The simplified healthy dietary pattern score was positively associated with the healthy dietary pattern while negatively associated with the obesity and inflammatory dietary pattern.3.2.The associations between the simplified healthy dietary pattern score and NAFLDThe simplified healthy dietary pattern score was negatively associated with the prevalence of NAFLD before adjustment of BMI and LC.Compared with the participants in the lowest quartile,the odds ratios(ORs)and 95%confidence intervals(CIs)for the participants in the 2,3 and 4 quartiles of the simplified healthy dietary pattern score were 0.83(0.71,0.98),0.79(0.67,0.93),0.68(0.58,0.80)(P for trend<0.001),respectively.The associations were weaker after adjustment of BMI and LC.Compared with the participants in the lowest quartile,the ORs(95%CIs)for the participants in the 2,3 and 4 quartiles of the simplified healthy dietary pattern score were 0.79(0.64,0.99),0.81(0.65,0.99),0.77(0.62,0.95)(P for trend=0.03),respectively.Conclusion1.The healthy pattern was negatively associated with the prevalence of NAFLD while the sweets and fruits pattern and the animal foods pattern were positively associated the prevalence of NAFLD.The associations between dietary patterns and the prevalence of NAFLD were mediated by obesity and inflammation.2.RRR revealed the obesity and inflammatory dietary pattern which was typified by high intake of carbonated drink,ice cream,tea and meat,low intake of coarse grain,vegetables and milk.The obesity and inflammatory dietary pattern was positively associated the prevalence of NAFLD.The associations between the obesity and inflammatory dietary pattern and the prevalence of NAFLD were mediated by obesity and inflammation.3.The simplified healthy dietary pattern score was constructed by combining the characteristics of the healthy pattern and the obesity and inflammatory dietary pattern.The simplified healthy dietary pattern score was negatively associated with the prevalence of NAFLD.The simplified healthy dietary pattern score could be considered as a tool for preventing and measuring the risk of NAFLD.