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. 2022 Oct 2;14(19):4099.
doi: 10.3390/nu14194099.

A Healthful Plant-Based Diet Is Associated with Lower Odds of Nonalcoholic Fatty Liver Disease

Xiude Li  1   2   3   4 , Zhaohong Peng  5 , Meiling Li  1 , Xueke Zeng  1 , Haowei Li  1 , Yu Zhu  1 , Hui Chen  6 , Anla Hu  1 , Qihong Zhao  1 , Zhuang Zhang  1 , Hua Wang  7 , Changzheng Yuan  6 , Wanshui Yang  1   2   3   4
Affiliations

A Healthful Plant-Based Diet Is Associated with Lower Odds of Nonalcoholic Fatty Liver Disease

Xiude Li et al. Nutrients. .

Abstract

There is little evidence for the associations of the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI) with the odds of nonalcoholic fatty liver disease (NAFLD). We present a nationwide cross-sectional study among US adults aged 18 years or older. Diet was assessed by 24-h recalls. Overall PDI, hPDI, and uPDI were constructed based on 18 food groups. NAFLD was defined based on controlled attenuation parameter derived via transient elastography (TE) in the absence of other causes of chronic liver disease. Among 3900 participants with eligible TE examination, 1686 were diagnosed with NAFLD. The overall PDI was not associated with NAFLD prevalence (comparing extreme tertiles of PDI score OR = 1.03, 95% CI 0.76, 1.38, ptrend = 0.609). However, hPDI was inversely (OR = 0.50, 95% CI 0.35, 0.72, ptrend < 0.001), while uPDI was positively associated with odds of NAFLD (OR = 1.37, 95% CI 0.93, 2.02, ptrend = 0.009) in the multivariable-adjusted models without body mass index (BMI). After further adjustment for BMI, only the association of hPDI with NAFLD remained statistically significant (OR = 0.64, 95% CI 0.46, 0.87, ptrend = 0.006). Such inverse association appeared stronger in non-Hispanic whites, but not in other racial/ethnic groups (pinteraction = 0.009). Our findings suggest that a plant-based diet rich in healthy plant foods might be associated with lower odds of NAFLD, particularly among US non-Hispanic whites. Clinical trials and cohort studies to validate our findings are needed.

Keywords: body mass index; controlled attenuation parameter; nonalcoholic fatty liver diseases; plant-based diet.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Spline analysis for the association of overall PDI (a), hPDI (b), uPDI (c), with the odds of NAFLDa. hPDI, healthful plant-based diet index; NAFLD, nonalcoholic fatty liver disease; PDI, plant-based diets index; uPDI, unhealthful plant-based diet index. a The models were adjusted for the same covariates listed for model 3 in Table 2.
Figure 2
Figure 2
Subgroup analysis for the association between hPDI scores (per 10–point increase) and odds of NAFLD a. BMI, body mass index; CI, confidence interval; hPDI, healthful plant-based diet index; METS, metabolic equivalent tasks; NAFLD, nonalcoholic fatty liver disease; OR, odds ratio. a The models were adjusted for the same covariates as those listed for model 3 in Table 2 except for the variables examined in this figure. Physical activity <8.3 METS–h/week was defined as light physical activity, and ≥8.3 METS–h/week was defined as moderate to vigorous activity. Participants with any missing values in covariates were excluded from the subgroup analysis.
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