Association Between The Frequency Of Carbonated Drink Intakeand Nonalcoholic Fatty Liver Disease:A Cross-sectional Study

Objective The aim of this study is to assess the relationship between the frequency of carbonated drink intake and nonalcoholic fatty liver disease(NAFLD)in a large-scale adult population in Tianjin.We investigated the effect of frequency of carbonated drink intake to the prevalence of NAFLDin different gender,BMI levels and so on.So as to provide dietary advice for people who are on high NAFLD risk.Methods We analyzed the baseline data from The Tianjin Chronic Low-grade Systemic Inflammation and Health(TCLSIHealth)Cohort Study.A cross-sectional analysis was conducted with 12,976 general adults who underwent the annual health check in Health Management Center of Tianjin Medical University General Hospital.Investigators collected the questionnaires and physical examination data.Dietary intake was assessed using a valid self-administered food frequency questionnaire.NAFLD and NAFLD with elevated ALT levels were diagnosed by liver ultrasonography and alanine aminotransferase(ALT)levels.The frequency of carbonated drink was divided into three categories for analysis: almost not drink,<1 cup/week and ?1 cup/week.Logistic regression and analysis of variance was used to describe the characteristics of NAFLD and non-NAFLD,as well as different carbonated drink categories.NAFLD was used as dependent variables,and frequency of carbonated categories were used as independent variables.Multiple logistic regression analysis was used to examine the relationship between carbonated categories and NAFLD or NAFLD with elevated ALT levels.During the analysis,study population was stratified into different groups according to gender,age,body mass index(BMI)and the amount of physical activity.Study population was divided into young(age <40)and older group(age ?40).The degree of obesity was classified into four groups according to the level of BMI: underweight group(BMI<18.5kg/m2),normal weight group(18.5kg/m2?BMI<24kg/m2),overweight group(24kg/m2?BMI<28kg/m2)and obese group(BMI?28kg/m2).Study population was divided into high(?23METs * hour / week)and low activity group(< 23 METs * hour / week).Results In the study population,the prevalence of overall NAFLD and NAFLD with elevated ALT levels were 27.5%,and 6.25%,respectively.In males,they were 38.72%and 9.69%,in females,they were 15.66% and 2.57%.Males have higher prevalence than femalesin both diseases(P<0.05).The prevalence of NAFLD and NAFLD with elevated ALT levels in different frequency of carbonated drinks were 27.96%,27.16%,26.87% and 5.27%,6.47%,8.59%,respectively.In the general population,there were significant differences between non-NAFLD group and NAFLD group in age,gender,education level,smoking,drinking,the amount of physical activity,family history,physical examination and biochemical results(P<0.05).And among subjects with different carbonated drinking frequency,there were significant differences in age,gender,education level,employment status,lifestyle-related variables and the physical and biochemical indicators(P<0.05).In multivariate logistic regression analysis,after adjusted for all potential confounders,the ORs for NAFLD and NAFLD with elevated ALT levels across categories of carbonated drink consumption were 1.00,1.18(1.02,1.38),1.30(1.13,1.50)(P for trend <0.0001)and 1.00,1.06(0.83,1.35),1.42(1.15,1.75)(P for trend <0.01).Gender,age and low physical activity amounts did not modify the observed associations for carbonated beverage.Normal and overweight groups were observed that carbonated drinking frequency was positively correlated with the prevalence of NAFLD.There were no significant results in obese group,the odds ratio were 1.00,0.88(0.61,1.24)and 1.26(0.93,1.69)(P for trend = 0.16).In high physical activity groups,less carbonated beverages(<1 cup / week)was not associated with the prevalence of NAFLD,but the large one(?1 cup / week)was positive associated with NAFLD.Conclusions The study showed that higher carbonated drink was associated with higher prevalence of NAFLD.People in all gender,age and BMI levels should reduce the amount of carbonated beverages to reduce the risk of NAFLD.People with high physical activity may have a small amount of carbonated drink during exercise.More studies are need to demonstrate the results.