Adherence to the Dietary Approaches to Stop Hypertension Diet and Non-alcoholic Fatty Liver Disease

Yuanyuan Sun; Shuohua Chen; Xinyu Zhao; Yanhong Wang; Yanqi Lan; Xiaozhong Jiang; Xiang Gao; Shouling Wu; Li Wang

Disclosures

Liver International. 2022;42(4):809-819. 

In This Article

Results

Population Characteristics

We finally included 11 888 participants with a mean age of 51.1 ± 14.6 years and 68.8% men. In total, 2529 (21.3%) participants were incident NAFLD. DASH score ranged from 14 to 43, with a mean score of 27.5 ± 3.8 points. The characteristics of participants according to the quintiles of DASH score were shown in Table 1. Individuals with higher adherence to the DASH diet were more likely to be older men, who had higher energy intake, current smokers and low level of physical activity.

Adherence to DASH and NAFLD

We found an inverse relationship between higher DASH scores and lower odds of having NAFLD (P trend <0.001) (Table 2). Adjusted OR for the highest vs lowest DASH quintiles was 0.82 (95% CI: 0.70–0.96).

The association of each component score of the DASH diet with odds of NAFLD was explored. As showed in Figure 2, higher intake of vegetables (OR = 0.67, 95% CI: 0.59–0.77), fruits (OR = 0.65, 95% CI: 0.57–0.75), dairy (OR = 0.85, 95% CI: 0.75–0.96), beans (OR = 0.56, 95% CI: 0.49–0.64) and whole grains (OR = 0.85, 95% CI: 0.75–0.97) were associated with a lower risk of having NAFLD. Lower intake of meats (OR = 0.85, 95% CI: 0.74–0.98), sodium (OR = 0.79, 95% CI: 0.69–0.91) and beverage (OR = 0.80, 95% CI: 0.65–0.99) was associated with a lower risk of NAFLD after adjusting for potential covariates. No significant association was observed between dairy, beverage, meats intake and the development of NAFLD.

Figure 2.

Adherence to each DASH components and the risk of NAFLD (quintile 5 vs quintile1-4)

Stratification Analysis

Table 3 showed the stratification analysis by sex, BMI, FBG, LDL-c, HDL-c, CPR and ALT. Results showed that sex, BMI, FBG, LDL-c, HDL-c, CRP and ALT might modify the associations between adherence to DASH and NAFLD. The association between DASH and NAFLD was different for men and women. The protective effects existed in the quintile 4 (OR = 0.65, 95% CI: 0.47–0.91)and quintile 5 (OR = 0.67, 95% CI: 0.48–0.94) groups in women but not in men. The protective effect of higher adherence of DASH on NAFLD was only observed in the participants with overweight (OR = 0.79, 95% CI: 0.66–0.94), FBG < 6.1 mmol/L (OR = 0.80, 95% CI: 0.67–0.96), LDL-c ≥ 3.4 mmol/L (OR = 0.71, 95% CI: 0.53–0.96), HDL-c ≥ 1.0 mmol/L (OR = 0.81, 95% CI: 0.69–0.96), CRP ≥ 2.0 mg/L (OR = 0.56, 95% CI: 0.40–0.78) and ALT < 40 U/L (OR = 0.79, 95% CI: 0.67–0.93).

Sensitivity Analysis

We reanalyzed the DASH adherence and NAFLD by calculating the total intake of the dry weight of foods for each of the DASH components. Multivariate analysis showed that the quintile 5 group had a lower NAFLD risk (OR = 0.81, 95% CI: 0.69–0.94) (Table 4).

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