The Impact of Dietary Composition on Non-Alcoholic Fatty Liver Disease and Advanced Fibrosis in US Adults

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease and is associated with obesogenic behaviors. Dietary and physical activity lifestyle modifications are the first-line treatment in NAFLD. However, the effects of dietary composition component intake are controversial and dietary management recommendations are lacking. We evaluated whether dietary components are associated with NAFLD and NAFLD with advanced fibrosis. Methods: We used the 2017-2018 National Health and Nutrition Examination Survey to identify U.S. adults aged ≥20 years with at least one valid 24-hour dietary recall and reliable transient elastography data. Hepatic steatosis and advanced fibrosis were diagnosed by median controlled attenuation parameter (CAP) scores and liver stiffness measurement (LSM). Dietary components were analyzed using quartiles of daily intake. Multivariate logistic regression was performed to estimate the effect of dietary components on the risk of steatosis and advanced fibrosis adjusted by sociodemographic, lifestyle, and metabolic factors. Sampling weights were used to ensure representative population-level data. Results: NAFLD (CAP ≥248 dB/m) was present in 57.9% of patients, with 11.9% having advanced fibrosis (LSM ≥7.9 kPa). Patients with NAFLD were more likely to be men (58.5 vs. 49.4%, p=.001), older (51.2 vs. 43.8 years, p< .001), and of Hispanic ethnicity (17.7 vs. 12.4%, p=.006). No significant differences were seen in NAFLD patients with advanced fibrosis. Multivariate logistic regression demonstrated that high fiber intake (Q4 >19.2gm/day; OR 0.46; 95% CI 0.29-0.72) was associated with decreased rates of NAFLD, while high carbohydrate intake (Q3 215-281gm/day; OR 1.79; 95% CI 1.01-3.19 and Q4 >281gm/day; OR 2.85; 95% CI 1.40-5.81) was associated with higher rates of NAFLD. Moreover, low cholesterol intake (Q2 128.5-221mg/day; OR 0.53; 95% CI 0.33-0.86) was protective for NAFLD with advanced fibrosis, whereas moderate amounts of sugar (Q2 89.0-124.7; OR 2.01; 95% CI 1.00-4.03) were associated with higher rates of NAFLD with advanced fibrosis. Conclusion: Carbohydrate, sugar, fiber, and cholesterol intake are independently associated with NAFLD with and without advanced fibrosis in a nationally representative cohort. Decreasing the consumption of carbohydrates and increasing consumption of fiber may reduce the risk of NAFLD, while decreasing the consumption of sugars and cholesterol may reduce the risk of NAFLD with advanced fibrosis.Table 1.: Distribution of HCC screening modalities Pre and Post intervention