Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with lower presence of non-alcoholic fatty liver disease in middle-aged and elderly adults. Public Health Nutr. 2020;23:674-682. [PMID: 31566148 DOI: 10.1017/s1368980019002568]

The Associations between Healthy Eating Patterns and Risk of Metabolic Dysfunction-Associated Steatotic Liver Disease: A Case-Control Study

BACKGROUND

Although several epidemiological studies have identified an inverse association between healthy dietary patterns and metabolic dysfunction-associated steatotic liver disease (MASLD)/non-alcoholic fatty liver disease (NAFLD), little is known about the contribution of the food component to MASLD risk and the association between dietary patterns and severity of MASLD. This study aimed to investigate the association between healthy eating patterns and MASLD risk and severity of MASLD.

METHODS

A case-control study including 228 patients diagnosed with MASLD and 228 controls was conducted. The modified Alternate Healthy Eating Index (AHEI), Dietary Approaches to Stop Hypertension (DASH) score, and Alternative Mediterranean Diet (AMED) score were evaluated based on information collected via a validated food-frequency questionnaire. MASLD was confirmed if participants presented with ultrasound-diagnosed fatty liver diseases along with at least one of five cardiometabolic risk factors and no other discernible cause. The logistic regression models were applied to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of MASLD for dietary scores.

RESULTS

Compared with participants in the lowest tertile, those in the highest tertile of AHEI had a 60% reduced risk of MASLD (OR: 0.40; 95% CI: 0.25-0.66). Similar associations were also observed for DASH and AMED, with ORs comparing extreme tertiles of 0.38 (95% CI: 0.22-0.66) and 0.46 (95% CI: 0.28-0.73), respectively. Further Stratified analysis revealed that the inverse associations between AHEI and DASH with MASLD risks were stronger among women than men, and the inverse associations between AMED and MASLD risks were more pronounced among participants with normal weight (OR: 0.22; 95% CI: 0.09-0.49). For components within the dietary score, every one-point increase in vegetable score and whole grain score within the AHEI was associated with an 11% (95% CI: 5-16%) and a 6% (95% CI: 0-12%) lower MASLD risk, respectively. Similar inverse associations with those scores were observed for the DASH and AMED.

CONCLUSION

Greater adherence to healthy eating patterns was associated with reduced risk of MASLD, with vegetables and whole grains predominately contributing to these associations. These findings suggested that healthy eating patterns should be recommended for the prevention of MASLD.

A Study of Dietary Patterns Derived by Cluster Analysis and Their Association With Metabolic Dysfunction-Associated Steatotic Liver Disease Severity Among Hispanic Patients

INTRODUCTION

Diet is a modifiable metabolic dysfunction-associated steatotic liver disease (MASLD) risk factor, but few studies have been conducted among Hispanic patients, despite the fact that MASLD prevalence and severity are highest among this ethnic subgroup. We aimed to identify prevalent dietary patterns among Hispanic patients using cluster analysis and to investigate associations with MASLD severity.

METHODS

This cross-sectional analysis included 421 Harris County MASLD Cohort participants who self-reported Hispanic ethnicity and completed baseline food frequency questionnaires. All included patients had MASLD, diagnosed per standard clinical criteria. K-means analysis was used to identify clusters of patients sharing similar dietary habits. Multivariable adjusted logistic regression was used to estimate associations of dietary clusters with aminotransferases among the overall sample and with histologic steatosis, metabolic dysfunction-associated steatohepatitis, and fibrosis among a subsample of patients who underwent liver biopsy within 6 months of their baseline food frequency questionnaire (n = 186).

RESULTS

We identified 2 clusters: a plant-food/prudent and a fast-food/meat pattern. The fast-food/meat pattern was associated with 2.47-fold increased odds (95% confidence interval 1.31-4.65) of more severe steatosis than the plant-food/prudent pattern after adjusting for demographics, metabolic score, physical activity, and alcohol ( q = 0.0159). No significant association was observed between diet and aminotransferases, metabolic dysfunction-associated steatohepatitis, or fibrosis.

DISCUSSION

Given the importance of sociocultural influences on diet, it is important to understand dietary patterns prevalent among Hispanic patients with MASLD. Using cluster analysis, we identified 1 plant-based pattern vs 1 distinct fast-food/meat-based pattern associated with detrimental effects among our population. This information is an important starting point for tailoring dietary interventions for Hispanic patients with MASLD.

Dietary approaches to stop hypertension (DASH) diet improves hepatic fibrosis, steatosis and liver enzymes in patients with non-alcoholic fatty liver disease: a randomized controlled trial

PURPOSE

Recent evidence suggests that adherence to dietary approaches to stop hypertension (DASH) diet can be effective in managing non-alcoholic fatty liver disease (NAFLD). We investigated the effect of DASH diet on hepatic fibrosis, steatosis and liver enzymes in patients with NAFLD.

METHODS

This 12-week randomized controlled trial was conducted among seventy patients with NAFLD who were randomly assigned into two groups including intervention group (DASH diet containing 50-55% carbohydrate, 15-20% protein, and 30% total fat) and the control group (a healthy diet containing 50-55% carbohydrate, 15-20% protein, and 30% total fat). Both diets were calorie-restricted (500-700 kcal lower than the energy requirement). The primary outcomes included hepatic fibrosis, hepatic steatosis, alanine transaminase (ALT), aspartate transaminase (AST) and gamma-glutamyl transpeptidase (GGT).

RESULTS

At the baseline, there was no significant difference between two groups in the level of hepatic fibrosis (P = 0.63), hepatic steatosis (P = 0.53), ALT (P = 0.93), AST (P = 0.18) and GGT (P = 0.76). A significant reduction was found in the intervention group compared to the control group in hepatic fibrosis (23 grades reduction vs. 7 grades reduction; P = 0.008) and hepatic steatosis (31 grades reduction vs. 9 grades reduction; P = 0.03) after intervention. In addition, a significant change was observed in the intervention group compared to control group in ALT ( - 8.50 ± 8.98 vs.  - 2.09 ± 7.29; P = 0.002), and AST ( - 5.79 ± 6.83 vs.  - 0.51 ± 6.62; P = 0.002).

CONCLUSIONS

Adherence to DASH diet may be effective in management of NAFLD.

TRIAL REGISTRATION

The trial was registered on 06 February 2022 at Iranian Registry of Clinical Trials (IRCT20170117032026N3) with URL: https://www.irct.ir/trial/60887 .

Adherence to a Traditional Mexican Diet Is Associated with Lower Hepatic Steatosis in US-Born Hispanics of Mexican Descent with Overweight or Obesity

Hispanics of Mexican descent have disproportionate rates of non-alcoholic fatty liver disease (NAFLD). The purpose of this work is to investigate the association between the traditional Mexican diet score (tMexS) and hepatic steatosis and fibrosis, two NAFLD-related clinical endpoints, in Hispanic adults of Mexican descent. Data from 280 Hispanic adults of Mexican descent (n = 102 men, 178 women) with overweight or obesity enrolled in a cross-sectional observational study were analyzed. The tMexS was calculated from 24 h dietary recalls. Hepatic steatosis and fibrosis measurements were assessed using transient elastography (Fibroscan®). Linear regression models testing the association between tMexS and hepatic steatosis and fibrosis were run individually and through the stratification of significant modifiers. Mean tMexS were 5.9 ± 2.1, hepatic steatosis scores were 288.9 ± 48.9 dB/m, and fibrosis scores were 5.6 ± 2.2 kPa. Among the US-born group, with every point increase in the tMexS, there was a statistically significant 5.7 lower hepatic steatosis point (95% CI: -10.9, -0.6, p-value = 0.07). Higher adherence to a traditional Mexican diet was associated with lower hepatic steatosis in US-born Hispanics of Mexican descent. Findings from the current work may serve to inform future culturally relevant interventions for NAFLD prevention and management in individuals of Mexican descent.

The promising roles of medicinal plants and bioactive compounds on hepatic lipid metabolism in the treatment of non-alcoholic fatty liver disease in animal models: molecular targets

Imbalance in hepatic lipid metabolism can lead to an abnormal triglycerides deposition in the hepatocytes which can cause non-alcoholic fatty liver disease (NAFLD). Four main mechanisms responsible for regulating hepatic lipid metabolism are fatty acid uptake, de novo lipogenesis, lipolysis and fatty acid oxidation. Controlling the expression of transcription factors at molecular level plays a crucial role in NAFLD management. This paper reviews various medicinal plants and their bioactive compounds emphasising mechanisms involved in hepatic lipid metabolism, other important NAFLD pathological features, and their promising roles in managing NAFLD through regulating key transcription factors. Although there are many medicinal plants popularly investigated for NAFLD treatment, there is still little information and scientific evidence available and there has been no research on clinical trials scrutinised on this matter. This review also aims to provide molecular information of medicinal plants in NALFD treatment that might have potentials for future scientifically controlled studies.

Association of Dietary Approaches to Stop Hypertension (DASH) diet with self-reported sleep-disordered breathing (SDB): a cross-sectional study from China

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet has been associated with sleep quality. However, its relationship with sleep-disordered breathing (SDB) remains unknown. This study aimed to explore the association between the DASH diet and SDB using data from a community-based survey among adults in Suzhou, Eastern China. We conducted a cross-sectional analysis of the Suzhou Food Consumption and Health Survey in 2018-2020. Dietary intake was measured by a validated FFQ. The association between the DASH diet and SDB was estimated by multivariable logistic regression analysis. In addition, subgroup analysis and sensitivity analysis were performed to reinforce our findings. A total of 3939 participants were included in the final analysis. Participants in the upper quintile of the DASH score consumed more fruits, vegetables, nuts and legumes, whole grains, and dairy products, and less Na, red/processed meats, and sweetened beverages. The OR for the highest compared with the lowest quintile of the DASH score was 0·68 (95 % CI 0·52, 0·88; Pfor trend = 0·004) for SDB after multivariable adjustment. Of the eight DASH components, vegetables, nuts and legumes, and dairy products were inversely associated with SDB. The associations were similar in subgroups by age, sex, BMI, smoking, alcohol drinking, hypertension, diabetes and hyperlipidaemia. Adherence to the DASH diet was independently associated with decreased odds of self-reported SDB. Our novel results expand previous findings on diet and sleep and suggest the possibility of improving SDB by enhancing diet quality.

The effect of DASH diet on atherogenic indices, pro-oxidant-antioxidant balance, and liver steatosis in obese adults with non-alcoholic fatty liver disease: A double-blind controlled randomized clinical trial

Background: The present clinical trial aimed to examine whether adherence to Dietary Approaches to Stop Hypertension (DASH) diet could improve lipid profile, the Pro-oxidant-antioxidant balance (PAB) as well as liver function in obese adults with non-alcoholic fatty liver disease (NAFLD). Methods: Sixty two patients with NAFLD were equally allocated into either DASH or low-calorie diet (LCD) group for 8 weeks. The primary and secondary outcomes were determined before and after the trial. Results: Forty patients completed the trial. Significant within group differences were found in dietary saturated fat, selenium, vitamins A and E as well as body weight and body mass index (BMI) and waist circumference (WC) after the intervention (P<0.05). DASH diet showed greater significant change in systolic and diastolic blood pressure without significant differences between the groups after 8 weeks. Apart from serum high-density lipoprotein cholesterol (HDL-C) and triglyceride/HDL-C, greater reductions were found not only in serum lipids and atherogenic indices (P<0.05) but also in serum aspartate aminotransferase (AST), AST to platelet ratio index (APRI) and lipid accumulation product (LAP) in DASH group in comparison to control group (P=0.008, P=0.019 and P=0.003, respectively). Nevertheless, there was not any difference in PAB level between the groups. Furthermore, adherence to DASH diet was more effective in alleviating liver steatosis compared with usual LCD (P=0.012). Conclusion: Adherence to DASH diet appears to be more effective in improving obesity, atherogenic and liver steatosis biomarkers but not oxidative stress (OS) than usual LCD.

The effect of DASH diet on glycemic response, meta-inflammation and serum LPS in obese patients with NAFLD: a double-blind controlled randomized clinical trial

BACKGROUND

As dietary approaches to stop hypertension (DASH) dietary pattern has been shown to be effective in hypertension and obesity, the present study investigated the effects of following DASH diet on glycemic, meta-inflammation, lipopolysaccharides (LPS) and liver function in obese patients with non-alcoholic fatty liver disease (NAFLD).

METHODS

In this double-blind controlled randomized clinical trial, 40 obese patients with NAFLD were randomly allocated into either "DASH diet" (n = 20) or calorie-restricted diet as "Control" (n = 20) group for 8 weeks. Anthropometric measures, blood pressure, glycemic response, liver enzymes, toll-like reseptor-4 (TLR-4) and monocyte chemoattractant protein (MCP-1) and LPS as well as Dixon's DASH diet index were assessed at baseline and after 8 weeks.

RESULTS

After 8 weeks, although all obesity indices decreased significantly in both groups, the reduction in all anthropometric measures were significantly greater in DASH vs control group, after adjusting for baseline values and weight change. Fasting glucose level decreased in both group, however, no inter-group significant difference was found at the end of study. Nevertheless, serum levels of hemoglobin A1c (HbA1c), TLR-4, MCP-1 and LPS as well as aspartate aminotransferase (AST) decreased significantly in DASH group, after adjusting for baseline values and weight change (p < 0.001, p = 0.004, p = 0.027, p = 0.011, and p = 0.008, respectively). The estimated number needed to treats (NNTs) for one and two grade reductions in NAFLD severity following DASH diet were 2.5 and 6.67, respectively.

CONCLUSION

Adherence to DASH diet could significantly improve weight, glycemia, inflammation and liver function in obese patients with NAFLD.

Nitrate containing vegetables and dietary nitrate and nonalcoholic fatty liver disease: a case control study

BACKGROUND

Vegetables is the main sources of dietary nitrate. Studies suggested the potential link between nitrate content of vegetables and reduce the risk of chronic diseases. We aimed to assess the association between nitrate-containing vegetables (NCVs) with odds of nonalcoholic fatty liver diseases (NAFLD) in Iranian adults.

METHOD

This case-control study was performed on a total of 225 newly diagnosed NAFLD cases and 450 controls aged 20-60 years. Individuals' dietary intakes were determined using a valid and reliable food frequency questionnaire.

RESULTS

The mean ± SD age and BMI of participants were 38.1 ± 8.8 years and 26.8 ± 4.3 kg/m², respectively. In the fully adjusted model, the odds of NAFLD were decreased across tertiles of total NCVs [(adjusted OR: 0.20, 95%CI: 0.10-0.40), (P_trend <  0.001)] and low-nitrate vegetables [(adjusted OR: 0.22, 95%CI: 0.11-0.48), (P_trend <  0.001)]. Our results showed that each one SD increments in nitrate content of vegetables (adjusted OR: 0.73, 95%CI: 0.55-0.97) and nitrate content of fruits (adjusted OR: 0.59, 95%CI: 0.36-0.97) was associated with reduced odds of NAFLD (P <  0.05). However, there was a positive association between each one SD increments in nitrate content of dairy products and meats and processed meats with odds of NAFLD (adjusted OR: 1.34, 95%CI: 1.03-1.74), (P <  0.05).

CONCLUSION

Our finding suggested that a higher intake of vegetable nitrate may be related to a decrease the odds of NAFLD.

2019 Global NAFLD Prevalence: A Systematic Review and Meta-analysis

BACKGROUND & AIMS

The increasing rates of obesity and type 2 diabetes mellitus may lead to increased prevalence of nonalcoholic fatty liver disease (NAFLD). We aimed to determine the current and recent trends on the global and regional prevalence of NAFLD.

METHODS

Systematic search from inception to March 26, 2020 was performed without language restrictions. Two authors independently performed screening and data extraction. We performed meta-regression to determine trends in NAFLD prevalence.

RESULTS

We identified 17,244 articles from literature search and included 245 eligible studies involving 5,399,254 individuals. The pooled global prevalence of NAFLD was 29.8% (95% confidence interval [CI], 28.6%-31.1%); of these, 82.5% of included articles used ultrasound to diagnose NAFLD, with prevalence of 30.6% (95% CI, 29.2%-32.0%). South America (3 studies, 5716 individuals) and North America (4 studies, 18,236 individuals) had the highest NAFLD prevalence at 35.7% (95% CI, 34.0%-37.5%) and 35.3% (95% CI, 25.4%-45.9%), respectively. From 1991 to 2019, trend analysis showed NAFLD increased from 21.9% to 37.3% (yearly increase of 0.7%, P < .0001), with South America showing the most rapid change of 2.7% per year, followed by Europe at 1.1%.

CONCLUSIONS

Despite regional variation, the global prevalence of NAFLD is increasing overall. Policy makers must work toward reversing the current trends by increasing awareness of NAFLD and promoting healthy lifestyle environments.

The effect of the Dietary Approaches to Stop Hypertension (DASH) diet on body composition, complete blood count, prothrombin time, inflammation and liver function in haemophilic adolescents

There is no dietary strategy that has yet been specifically advocated for haemophilia. Therefore, we sought to assess the effect of the Dietary Approaches to Stop Hypertension (DASH) diet in adolescents with haemophilia. In this parallel trial, forty male adolescents with haemophilia were dichotomised into the DASH group or control group for 10 weeks. The serum high sensitivity C-reactive protein, IL-6, complete blood count (CBC), serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, partial thromboplastin time (PTT), waist circumference (WC), percentage of body fat, fat-free mass and liver steatosis were measured at the beginning and end of the study. Serum vitamin C was measured as a biomarker of compliance with the DASH diet. The DASH diet was designed to include high amounts of whole grains, fruits, vegetables and low-fat dairy products, as well as low amounts of saturated fats, cholesterol, refined grains, sweets and red meat. Serum vitamin C in the DASH group was significantly increased compared with the control (P = 0·001). There was a significant reduction in WC (P = 0·005), fat mass (P = 0·006), hepatic fibrosis (P = 0·02) and PTT (P = 0·008) in the DASH group, compared with the control. However, there were no significant differences regarding other selected outcomes between groups. Patients in the DASH group had significantly greater increase in the levels of erythrocyte, Hb and haematocrit, as compared with the control. Adherence to the DASH diet in children with haemophilia yielded significant beneficial effects on body composition, CBC, inflammation and liver function.

Inverse Association of Fruit and Vegetable Consumption with Nonalcoholic Fatty Liver Disease in Chinese Patients with Type 2 Diabetes Mellitus

We aimed to investigate the association of fruit and vegetable consumption with nonalcoholic fatty liver disease (NAFLD) in Chinese patients with type 2 diabetes mellitus (T2DM). This cross-sectional study included 2667 Chinese patients with T2DM aged 18 to 76 years from March 2017 to October 2021. Dietary intake was assessed using a food frequency questionnaire, and prevalent NAFLD was diagnosed with abdominal ultrasonography. High fruit−vegetable consumption was determined using ≥500 g/day consumption of both fruit and vegetable, and both fruit and vegetable consumption were divided into three categories of <200 g/day (low), 200−400 g/day (median) and >400 g (high). The primary outcome measurement was multivariate-adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for the prevalence of NAFLD in relation to the highest fruit and (or) vegetable intake compared with the lowest. Secondary analyses were conducted to assess the effects of either fruit or vegetable intake on the fatty liver index (FLI) using multivariable linear regressions. There were 1694 men and 973 women in this study, and 1445 (54.06%) participants had prevalent NAFLD. Patients with high fruit−vegetable intake had a lower prevalence of NAFLD than those with low fruit−vegetable intake (52.04% vs. 56.48%), but this difference was not statistically significant (p = 0.065). Vegetable intake had a significantly inverse association with NAFLD (OR: 0.68, 95% CI: 0.52−0.90), but this association was not pronounced with fruit intake (OR: 1.23, 95% CI: 0.89−1.69) or fruit−vegetable intake (OR: 0.90, 95% CI: 0.73−1.10). Additional analyses showed that an increase in vegetable intake was linearly associated with a significant reduction in FLI (β: −1.028, 95% CI: −1.836, −0.219). In conclusion, higher vegetable consumption was associated with lower odds of NAFLD in Chinese patients with T2DM, which suggested that increased vegetable intake might protect patients with diabetes against NAFLD.

Higher Adherence to Healthy Lifestyle Score Is Associated with Lower Odds of Non-Alcoholic Fatty Liver Disease

Growing evidence supports that individual lifestyle factors contribute to the development of non-alcoholic fatty liver disease (NAFLD) without considering the coexistence and synergistic effect of lifestyle factors. Our aim is to derive a healthy lifestyle score (HLS) and estimate its association with NAFLD. In this nationwide cross-sectional study, we derived a five-item HLS including dietary pattern, body mass index, physical activity, cigarette smoking, and sleep duration. NAFLD and clinically significant fibrosis (CSF) were assessed based on vibration-controlled transient elastography (VCTE). Liver function parameters were also tested. Multivariable logistic and linear regressions were applied to investigate the association between HLS and liver diseases. Of the 3893 participants with VCTE examination, approximately 14.1% of participants possessed zero or one healthy lifestyle, 62.5% possessed two or three healthy lifestyles, and 23.4% possessed four or five healthy lifestyles. Compared with participants with a low HLS (0−1 score), the adjusted odds ratios and 95% confidence intervals for those with a high HLS (4−5 score) were 0.25 (0.19~0.33, Ptrend < 0.001) for NAFLD and 0.30 (0.18~0.50, Ptrend < 0.001) for CSF. HLS was positively associated with albumin, total protein, and total bilirubin (all Ptrend ≤ 0.001), and was inversely associated with globulin, alanine aminotransferase, and gamma-glutamyl transaminase (all Ptrend ≤ 0.003). Higher adherence to HLS is associated with lower odds of NAFLD and CSF and may improve liver function. Strategies for the promotion of a healthy lifestyle should be considered as part of NAFLD prevention.

Lifestyle Intervention for Patients with Nonalcoholic Fatty Liver Disease: A Randomized Clinical Trial Based on the Theory of Planned Behavior

Introduction

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, accounting for about 25% and 33% of the world's adult population and Iranians, respectively. There is currently no effective therapeutic agent available for the treatment of NAFLD. However, lifestyle modifications aimed at weight loss have been introduced as a cornerstone of NAFLD management. The aim of the present study was to evaluate the effect of educational intervention on lifestyle and anthropometric indices in patients with NAFLD.

Methods

The randomized controlled clinical trial was performed on 87 overweight or obese patients with NAFLD, including intervention (n = 42) and control (n = 45) groups. The intervention received 8 training sessions based on theory of planned behavior (TPB), while the control groups received nutritional and physical activity recommendations from their internal specialist and nutritionist. Analyses were carried out based on data collected from TPB constructs and anthropometric indices (weight, body mass index (BMI), waist size, and waist-hip ratio (WHR)) at three stages (before intervention and two and 12 weeks after the intervention), as well as data obtained from liver enzymes (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)), and ultrasound-based grading of NAFLD at two stages (before and 12 weeks after the intervention).

Results

After the intervention, a significant difference was found between the intervention and control groups, resulting in the increased mean scores of TPB constructs, decreased liver enzymes, and decreased degree of NAFLD ultrasound. In addition, the intervention group experienced more activity and healthy diet as compared with the control group. Anthropometric indices showed only a significant decrease in BMI in the intervention group (p < 0.05).

Conclusions

TPB-based training, as compared with traditional training, is a more effective and cost-effective strategy for altering nutritional behavior and physical activity of patients with NAFLD.

Association between Habitual Tea Consumption and Metabolic Syndrome and Its Components among Chinese Adults Aged 18~59 Years: Based on China Nutrition and Health Surveillance 2015–2017

Background: Tea consumption is widely reported to have beneficial effects on metabolic functions. The current study is to evaluate the association between habitual tea consumption and risk for metabolic syndrome and its components among Chinese adults aged 18~59 years. Methods: 43,757 participants aged 18~59 years from China Nutrition and Health Surveillance 2015–2017 were included and divided into four groups based on the amount of daily tea consumption in the current study. Using multiple-adjustment logistic regression to explore the relationship between habitual tea consumption and metabolic syndrome-related health outcomes. Results: Compared with those who did not consume tea habitually, participants who drank over 5 cups of tea per day showed a significantly lower risk of metabolic syndrome (OR = 0.836, 95% CI = 0.771–0.905), blood pressure elevated (OR = 0.906, 95% CI = 0.845–0.972), triglyceride elevated (OR = 0.797, 95% CI = 0.741–0.857), and fasting plasma glucose elevated (OR = 0.772, 95% CI = 0.715–0.833), but higher risk for central obesity (OR = 1.354, 95% CI = 1.236–1.484). Regardless of gender, higher tea consumption was related to lower risk of triglyceride and fasting blood glucose elevated but higher risk for central obesity. While for protective effect on metabolic syndrome, blood pressure elevated, and HDL-C reduction only showed in females. Conclusions: Results from current study support that habitual tea consumption would benefit metabolic syndrome and its related components, especially among females.

Nutrient-Derived Beneficial for Blood Pressure Dietary Pattern Associated with Hypertension Prevention and Control: Based on China Nutrition and Health Surveillance 2015–2017

Background: Greater adherence of Dietary Approach to Stop Hypertension (DASH) or the Mediterranean dietary pattern were reported to be beneficial for blood pressure. However, both were established based on Western populations. Our current study aimed to explore a dietary pattern which might be suitable for hypertension prevention and control among Chinese adults nationwide. Methods: A total of 61,747 Chinese adults aged over 18 years from China Nutrition and Health Surveillance 2015–2017 was included in this study. Using reduced-rank regression (RRR) method, a dietary pattern with higher intakes of those nutrients which are inversely associated with the risk of hypertension was identified. DASH-score was also calculated for each participant for further validate the dietary pattern derived by RRR method. Multi-adjustment logistic regression was applied to examine the association between above two dietary patterns and hypertension prevention and control. Results: Dietary pattern named Beneficial for Blood Pressure (BBP) diet was characterized by higher fresh vegetables and fruits, mushrooms/edible fungi, dairy products, seaweeds, fresh eggs, nuts and seeds, legumes and related products, aquatic products, coarse cereals, and less refined grains and alcohol consumption. After multiple adjustment, protective effects showed on both hypertension prevention and control (for prevention: Q5 vs. Q1, OR = 0.842, 95% CI = 0.791–0.896; for control: Q5 vs. Q1, OR = 0.762, 95% CI = 0.629–0.924). For the DASH-diet, significant results were also observed (for prevention: Q5 vs. Q1, OR = 0.912, 95% CI = 0.854–0.973; for control: Q5 vs. Q1, OR = 0.76, 95% CI = 0.616–0.938). Conclusions: BBP-diet derived from Chinese adults has high conformity with the DASH-diet, and it might serve as an adjuvant method for both hypertension prevention and control.

Crosstalk between dietary patterns, obesity and nonalcoholic fatty liver disease

The prevalence of nonalcoholic fatty liver disease (NAFLD) is rising worldwide, paralleling the epidemic of obesity. The liver is a key organ for the metabolism of proteins, fats and carbohydrates. Various types of fats and carbohydrates in isocaloric diets differently influence fat accumulation in the liver parenchyma. Therefore, nutrition can manage hepatic and cardiometabolic complications of NAFLD. Even moderately reduced caloric intake, which leads to a weight loss of 5%-10% of initial body weight, is effective in improving liver steatosis and surrogate markers of liver disease status. Among dietary patterns, the Mediterranean diet mostly prevents the onset of NAFLD. Furthermore, this diet is also the most recommended for the treatment of NAFLD patients. However, clinical trials based on the dietary interventions in NAFLD patients are sparse. Since there are only a few studies examining dietary interventions in clinically advanced stages of NAFLD, such as active and fibrotic steatohepatitis, the optimal diet for patients in these stages of the disease must still be determined. In this narrative review, we aimed to critically summarize the associations between different dietary patterns, obesity and prevention/risk for NAFLD, to describe specific dietary interventions’ impacts on liver steatosis in adults with NAFLD and to provide an updated overview of dietary recommendations that clinicians potentially need to apply in their daily practice.

Dietary Acid Load (DAL), Glycated Hemoglobin A1c (HbA1c), and Metabolic Syndrome (MeS) Mediate the Association of the Adherence to the Dietary Approaches to Stopping Hypertension (DASH) and Mediterranean Diet (MeD) With Nonalcoholic Fatty Liver Disease

The study aimed to investigate the association of adults adhering to Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diet (MeD) with nonalcoholic fatty liver disease (NAFLD) using structural equation modeling (SEM) in Iran. In this population-based cross-sectional study, 3,220 adults (44.65% female) aged ≥18 years were selected from the Amol Cohort Study (AmolCS). The dietary intakes were assessed by a validated 168-item semi-quantitative food-frequency questionnaire (FFQ). Residual method energy adjustment of MeD and DASH scores were calculated. Demographic characteristics and anthropometric and laboratory measurements were collected. NAFLD was diagnosed by an expert radiologist via ultrasound sonography. Based on the primary hypothesis, DASH, MeD, and NAFLD were fitted into models. Metabolic syndrome (MeS) as a potential risk factor directly affected NAFLD risk in all these models. In both genders, the higher adherence to DASH negatively affected NAFLD risk indirectly through the two following paths. (1) Dietary acid load (DAL) and metabolic syndrome (2) DAL and hemoglobin A1c (HbA1c). In addition, the higher DAL positively affected NAFLD risk among male participants indirectly via increasing HbA1c level and MeS (from DAL to HbA1c: β = 0.07, P < 0.001; from HbA1c to MeS: β = 0.10, P < 0.001). Similarly, in both genders, the relationship between MeD and NAFLD was mediated through (1) DAL, HbA1c, and MeS and (2) DAL and MeS. Further, among male participants, the MeD and NAFLD risk were also associated via the mediators of HbA1c and MeS. In female participants, the higher MeD score was directly associated with a reduction of NAFLD risk (β = -0.07, P = 0.008). The present study found three important mediators, including DAL, HbA1c, and MeS, in the association of DASH and MeD scores with NAFLD risk. Preventive and therapeutic interventions should target the mediators, including DAL, HbA1c, MeS, and its components, to reduce NAFLD incidence in the general population.

Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: a Review of Shared Cardiometabolic Risk Factors

The prevalence of nonalcoholic fatty liver disease (NAFLD) is rising. NAFLD/nonalcoholic steatohepatitis (NASH) is associated not only with hepatic morbidity and mortality but also with an increased cardiovascular risk. NAFLD and cardiovascular disease (CVD) share several risk factors, such as obesity, metabolic syndrome, hypertension, dyslipidemia, type 2 diabetes, and chronic kidney disease. This review summarizes the evidence linking cardiometabolic risk factors and NAFLD in the context of risk for CVD. The cause of NAFLD/NASH is complex, involving a range of factors from genetics to lifestyle and energy balance. Genetically driven high liver fat content does not appear to be causally associated with increased CVD risk. In contrast, metabolic dysfunction not only predisposes to liver pathology but also leads to a significantly higher CVD risk. Given that NAFLD pathophysiology is influenced by multiple factors, each patient is unique as to their risk of developing CVD and liver pathology. At the same time, the rising burden of NAFLD/NASH is closely linked with the global increase in metabolic disorders, including obesity and type 2 diabetes. Therefore, both personalized therapeutic approaches that recognize individual pathophysiology, as well as public health policies that address the root causes of cardiometabolic risk factors for NAFLD may be needed to effectively address the NAFLD/NASH epidemic.

Dietary patterns in non-alcoholic fatty liver disease (NAFLD): Stay on the straight and narrow path!

Non-alcoholic fatty liver disease (NAFLD) is the most frequent hepatic disease globally. NAFLD patients are at an increased risk of both liver and cardiovascular morbidity and mortality, as well as all-cause death. NAFLD prevalence is rapidly increasing worldwide and, thus, there is an urgent need for health policies to tackle its development and complications. Currently, since there is no drug therapy officially indicated for this disease, lifestyle interventions remain the first-line therapeutic option. In the present narrative review, we discuss the effects of certain dietary patterns on NAFLD incidence and progression. The Mediterranean diet is regarded as the diet of choice for the prevention/treatment of NAFLD and its complications, based on the available evidence. Other plant-based dietary patterns (poor in saturated fat, refined carbohydrates, red and processed meats) are also beneficial [i.e., Dietary Approaches to Stop Hypertension (DASH) and vegetarian/vegan diets], whereas more data are needed to establish the role of ketogenic, intermittent fasting and paleo diets in NAFLD. Nevertheless, there is no "one-size-fits-all" dietary intervention for NAFLD management. Clinicians should discuss with their patients and define the diet that each individual prefers and is able to implement in his/her daily life.

Associations between adherence to the dietary approaches to stop hypertension (DASH) diet and six glucose homeostasis traits in the Microbiome and Insulin Longitudinal Evaluation Study (MILES)

BACKGROUND AND AIMS

The DASH diet conveys protection against type 2 diabetes mellitus (T2D) Via plant-based and non-plant-based recommendations. Research has not identified which glucose homeostasis pathways are improved. We examined associations between adherence to a DASH diet and six glucose homeostasis traits, probing whether associations could be attributed to the plant-based (DASH-P) and/or non-plant based (DASH-NP) components.

METHODS AND RESULTS

We included data from 295 adults without T2D (age 59.3 ± 9.00 years; 63.46% non-Hispanic White and 36.54% African American, self-reported race ancestry) participating in the Microbiome and Insulin Longitudinal Evaluation Study (MILES). An oral glucose tolerance test (OGTT) yielded fasting plasma glucose, insulin, C-peptide, and insulin secretion, sensitivity, and disposition index. Habitual dietary intake was assessed by food frequency questionnaire (FFQ). Associations between DASH components and glucose homeostasis traits were examined, controlling for demographics, body mass index (BMI), physical activity, and energy intake. For significant associations, the models were repeated with scores for DASH-P and DASH-NP as predictors in the same model. DASH and DASH-P scores were inversely associated with fasting plasma glucose (DASH:β = -0.036 ± 0.012,P = 0.005; DASH-P: β = -0.04 ± 0.017,P = 0.002), and positively associated with insulin sensitivity (DASH:β = 0.022 ± 0.012,P = 0.042; DASH-P: = 0.036 ± 0.015,P = 0.014). The DASH score was also associated with disposition index (β = 0.026 ± 0.013,P = 0.038), but this association did not reach significance with DASH-P (β = 0.035 ± 0.018,P = 0.051). No associations were observed with DASH-NP score (all P > 0.05).

CONCLUSIONS

DASH diet is associated with improvement in specific glucose homeostasis traits, likely arising from increased plant-based foods. Such research may help tailor future dietary advice to specific metabolic risk, and to food groups most effective at improving these.

Adherence to the dietary approaches to stop hypertension diet and non-alcoholic fatty liver disease

BACKGROUND AND AIMS

The evidence of the relationship between dietary approaches to stop hypertension (DASH) and non-alcoholic fatty liver disease (NAFLD) is limited. Thus, we conducted a cohort-based case-control study to examine whether adherence to the DASH diet was associated with lower NAFLD risk in China.

METHODS

We included 11 888 participants (2529 incident NAFLD and 9359 non-NAFLD) from the Kailuan cohort with no history of hepatitis B/C infection and alcohol drinking. DASH score was calculated based on the energy-adjusted consumption of vegetables, fruits, dairy, beans, grains, meats, fat, sodium and beverage, collected by a validated food frequency questionnaire. We used Logistic regression analysis to determine the NAFLD's risk according to the DASH score.

RESULTS

Higher DASH score was associated with lower risk of NAFLD. Compared with the lowest quintile of DASH score, the highest DASH quintile had a lower risk of occurring NAFLD, with odds ratio (OR) of 0.82 (95% confidence interval [CI]: 0.70-0.96) in the multivariate model. Stratified analysis showed that the inverse association was only observed in women (OR = 0.67, 95% CI: 0.48-0.94), and participants with overweight/obesity (OR = 0.79, 95% CI: 0.66-0.94), fasting blood glucose <6.1 mmol/L (OR = 0.80, 95%: 0.67-0.96), low density lipoprotein ≥3.4 mmol/L (OR = 0.71, 95% CI: 0.53-0.96), high density lipoprotein ≥1.0 mmol/L (OR = 0.81, 95% CI: 0.69-0.96), ALT < 40 U/L (OR = 0.79, 95% CI:0.67-0.93) and C-reactive protein ≥2.0 mg/L (OR = 0.56, 95% CI: 0.40-0.78).

CONCLUSIONS

Adherence to the DASH diet was inversely associated with a lower risk of NAFLD in the Chinese population. DASH diet should be highly recommended, especially for women and people with overweight/obesity and a high CRP level.

Favorable association between Mediterranean diet (MeD) and DASH with NAFLD among Iranian adults of the Amol Cohort Study (AmolCS)

Nonalcoholic fatty liver disease (NAFLD) is an emerging cause of chronic liver diseases and a major health problem worldwide. Dietary patterns may play a critical role in controlling and preventing this disease, but the available evidence is scarce. The current study aims to ascertain the association of adherence to the Dietary Approach to Stop Hypertension (DASH) diet and Mediterranean diet (MeD) with nonalcoholic fatty liver disease (NAFLD) among Iranian adults of the Amol Cohort Study (AmolCS). In a cross-sectional analysis among 3220 adults (55.3% men), age ≥ 18 years (46.96 ± 14.67), we measured usual dietary intake with a validated food frequency questionnaire (FFQ) and then calculated dietary pattern scores for DASH and MeD. Sociodemographic and lifestyle factors were collected by a structured questionnaire. The presence and degree of NAFLD were also determined by abdominal sonography. Multiple regression models were used to estimate NAFLD odds across tertiles of DASH and Mediterranean dietary scores. Dietary DASH and Mediterranean components were adjusted for total energy intake, based on the residual methods. After adjusting for multiple potential confounders, we found an inverse association of DASH and MeD with NAFLD (Ptrend = 0.02, and Ptrend = 0.002, respectively). Those in the highest tertiles of adherence to the DASH and MeD had the lowest risk for NAFLD (OR = 0.80, 95%CI = 0.66–0.96, OR = 0.64, 95%CI = 0.52–0.78, respectively). The results of logistic analysis of MeD, stratified by gender and abdominal obesity, revealed the favorable association was more pronounced in women (OR = 0.42, 95%CI = 0.29–0.61, Ptrend = 0.004), and in participants with or without abdominal obesity (OR = 0.62, 95% CI = 0.47–0.81, Ptrend = 0.03, OR = 0.64, 95%CI = 0.475–0.91, Ptrend = 0.04, respectively). Similar results were obtained for the adherence to DASH diet score with the prevalence of NAFLD patients with abdominal obesity (OR = 0.75, 95% CI = 0.57–0.97, Ptrend = 0.04). The findings suggested the favorable association between DASH and MeD with NAFLD in Iranian adults, especially women and subjects with or without abdominal obesity. Further prospective investigations are needed to confirm the integrity of our findings.

Healthy dietary patterns and metabolic dysfunction-associated fatty liver disease in less-developed ethnic minority regions: a large cross-sectional study

BACKGROUND

Little is known about the associations between healthy dietary patterns and metabolic dysfunction-associated fatty liver disease (MAFLD) in less-developed ethnic minority regions (LEMRs), where the prevalence of MAFLD is increasing rapidly and dietary habits are quite different from those in developed countries. Moreover, a significant subset of MAFLD individuals in LEMRs are nonobese, but the efficacy of dietary patterns on MAFLD individuals with different obese statuses is also unclear. We aimed to test the associations of two wildly recommended a priori dietary patterns-Alternate Mediterranean diet (AMED) and Dietary Approaches to Stop Hypertension (DASH)-with the risk of MAFLD in the total population, and further in nonobese and obese individuals.

METHODS

We recruited 99,556 participants in the China Multi-Ethnic Cohort Study, an ongoing cohort study in less-developed southwest China. Using validated food frequency questionnaire, each participant was assigned an AMED score and a DASH score. MAFLD was ascertained as hepatic steatosis on ultrasound together with diabetes, overweight/obesity, or two other metabolic risk factors. We performed logistic regression with inverse probability of exposure weighting (IPEW) to examine associations between two dietary patterns and MAFLD, adjusting for potential confounders under the guidance of directed acyclic graphs. Further, analyses were stratified by body mass index.

RESULTS

We included 66,526 participants (age 49.5±11.0; 62.6% women), and the prevalence of MAFLD was 16.1%. Participants in the highest quintile of DASH score showed strong inverse associations with risks of MAFLD (OR = 0.85; 95% CI, 0.80-0.91; Ptrend < 0.001) compared with participants in the lowest quintile. The association between DASH and nonobese MAFLD (OR = 0.69; 95% CI, 0.61-0.78; Ptrend < 0.001) was stronger (I2 = 78.5 % ; Pheterogeneity = 0.001) than that with obese MAFLD (OR = 0.90; 95% CI, 0.83-0.98; Ptrend = 0.002). There was a null association between AMED and MAFLD risk.

CONCLUSIONS

In LEMRs, a DASH diet but not AMED was associated with MAFLD. The relationship appeared to be more pronounced in nonobese MAFLD individuals than in obese MAFLD individuals.

Protective and Therapeutic Effects of Orlistat on Metabolic Syndrome and Oxidative Stress in High-Fat Diet-Induced Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) in Rats: Role on Nrf2 Activation

Metabolic dysfunction-associated fatty liver disease (MAFLD) is an excessive buildup of liver lipids closely associated with various kinds of undesirable metabolic effects and oxidative stress. We aimed to investigate the protective and therapeutic effects of orlistat on metabolic syndrome and oxidative stress parameters in high-fat diet (HFD) induced-MAFLD rats. Twenty-four male Sprague-Dawley rats were randomly divided into four groups (n = 6/group), i.e., Normal control (N), HFD, HFD + orlistat (HFD + O) (10 mg/kg/day administered concomitantly for 12 weeks as a protective model), and obese+orlistat (OB + O) (10 mg/kg/day administered 6 weeks after induction of obesity as a therapeutic model) groups. After 12 weeks, the HFD group had significantly increased Lee obesity index, serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total cholesterol, triglyceride, low-density lipoprotein levels, liver total cholesterol and triglyceride levels, insulin resistance and non-alcoholic steatohepatitis (NASH) together with decreased serum high-density lipoprotein level. Additionally, the HFD group also showed increased Nrf2 translocation to the nucleus with high Keap1 expression and increased liver oxidative stress parameters. Orlistat significantly improved all these alterations in HFD rats. We demonstrated that orlistat might have protective and therapeutic effects against HFD-induced MAFLD rats by its activation on Nrf2 signaling pathway, which subsequently improved metabolic syndrome and oxidative stress parameters.

Higher Healthy Lifestyle Score is associated with lower presence of non-alcoholic fatty liver disease in middle-aged and older Chinese adults: a community-based cross-sectional study

OBJECTIVE

Previous studies have reported inverse associations between certain healthy lifestyle factors and non-alcoholic fatty liver disease (NAFLD), but limited evidence showed the synergistic effect of those lifestyles. This study examined the relationship of a combination of lifestyles, expressed as Healthy Lifestyle Score (HLS), with NAFLD.

DESIGN

A community-based cross-sectional study. Questionnaires and body assessments were used to collect data on the six-item HLS (ranging from 0 to 6, where higher scores indicate better health). The HLS consists of non-smoking (no active or passive smoking), normal BMI (18·5-23·9 kg/m2), physical activity (moderate or vigorous physical activity ≥ 150 min/week), healthy diet pattern, good sleep (no insomnia or <6 months) and no anxiety (Self-rating Anxiety Scale < 50), one point each. NAFLD was diagnosed by ultrasonography.

SETTING

Guangzhou, China.

PARTICIPANTS

Two thousand nine hundred and eighty-one participants aged 40-75 years.

RESULTS

The overall prevalence of NAFLD was 50·8 %. After adjusting for potential covariates, HLS was associated with lower presence of NAFLD. The OR of NAFLD for subjects with higher HLS (3, 4, 5-6 v. 0-1 points) were 0·68 (95 % CI 0·51, 0·91), 0·58 (95 % CI 0·43, 0·78) and 0·35 (95 % CI 0·25, 0·51), respectively (P-values < 0·05). Among the six items, BMI and physical activity were the strongest contributors. Sensitivity analyses showed that the association was more significant after weighting the HLS. The beneficial association remained after excluding any one of the six components or replacing BMI with waist circumference.

CONCLUSIONS

Higher HLS was associated with lower presence of NAFLD, suggesting that a healthy lifestyle pattern might be beneficial to liver health.

The association between dietary approaches to stop hypertension diet and mediterranean diet with metabolic syndrome in a large sample of Iranian adults: YaHS and TAMYZ Studies

Dietary patterns are considered as a modifiable risk factor for metabolic syndrome (MetS). Therefore, the present study aimed to evaluate the association between the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean (MED) dietary patterns and MetS. This cross-sectional study was conducted on the data from recruitment phase of prospective studies on Iranian adults known as Yazd Health Study (YaHS) and Yazd Nutrition Study (TAMYZ). MetS was diagnosed among 2,221 adults based on the Adult Treatment Panel III criteria. The participants' dietary intake was assessed by a validated food frequency questionnaire. According to the predefined methods, DASH and MED scores were calculated. Multivariate logistic regression was used to evaluate the relationship of DASH and MED dietary patterns with MetS. The prevalence of MetS was 28.8% in the present study. Women who were in the highest quintile of DASH in comparison with those who were in the first quintile tended to decrease the odds of MetS after adjusting for the potential confounders (OR: 0.50, CI: 0.27-0.95). There was a significant decreasing trend in the odds of MetS across increasing quintiles of the DASH in women (p-trend = .006). Also, the highest adherence to DASH reduced the odds of abdominal obesity (OR: 0.34, CI: 0.15-0.77) in women. Although adherence to MED dietary pattern had no significant relationship with MetS, moderate adherence to this dietary pattern could decrease the odds of fasting blood glucose levels (OR: 0.57, CI: 0.33-0.97) and abdominal obesity (OR: 0.42, CI: 0.20-0.87) in women. We found evidence indicating a significant protective association between DASH and METs and its component in women. Hence, more prospective studies are needed to confirm our findings in other populations.

Relationship between dietary patterns and non-alcoholic fatty liver disease: A systematic review and meta-analysis

BACKGROUND AND AIM

Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. Previous studies have investigated the association between dietary patterns and NAFLD, but their results are contradictory. Therefore, we carried out this meta-analysis to examine the association between dietary patterns and NAFLD.

METHODS

We searched PubMed, Web of Science, Scopus, and Google Scholar databases until November 14, 2019, to identify the observational studies on the association between dietary patterns and NAFLD. We selected three dietary patterns of Western, Prudent, and Mediterranean. A random-effect model was used to compute the summary risk estimates. Odds ratios (ORs) that were reported for fully adjusted models and their confidence intervals (CIs) were extracted for meta-analysis. Heterogeneity between studies was assessed using Cochran's Q- and I² tests. Eighteen articles (n = 24 867 participants) were entered our systematic review and meta-analysis.

RESULTS

We determined that Western dietary patterns (n = 8787 participants) containing high levels of processed food, red meat, high-fat dairy, and refined grains could significantly increase NAFLD (OR = 1.56, CI = 1.27 to 1.92; P ≤ 0.001). However, the Prudent (n = 13 023 participants) (OR = 0.78, CI = 0.71 to 0.85; P ≤ 0.001) and Mediterranean dietary patterns (n = 3057 participants) (OR = 0.77, CI = 0.60 to 0.98; P = 0.41), defined by high intake of fruits, vegetables, whole grains, fish, and olive oil decreased the risk of this disease.

CONCLUSIONS

We found that Western dietary patterns increased the risk of NAFLD by 56%, although the Prudent and Mediterranean dietary patterns reduced the risk of this disease by 22% and 23%, respectively.

Elevated retinol binding protein 4 levels are associated with atherosclerosis in diabetic rats via JAK2/STAT3 signaling pathway

BACKGROUND

Atherosclerosis is a major cause of mortality worldwide and is driven by multiple risk factors, including diabetes, which results in an increased atherosclerotic burden, but the precise mechanisms for the occurrence and development of diabetic atherosclerosis have not been fully elucidated.

AIM

To summarize the potential role of retinol binding protein 4 (RBP4) in the pathogenesis of diabetic atherosclerosis, particularly in relation to the RBP4-Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathway.

METHODS

Male Wistar rats were randomly divided into three groups, including a control group (NC group), diabetic rat group (DM group), and diabetic atherosclerotic rat group (DA group). The contents of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), fasting insulin (FINS), fasting plasma glucose, and hemoglobin A1c (HbA1c) were measured. Moreover, the adipose and serum levels of RBP4, along with the expression levels of JAK2, phosphorylated JAK2 (p-JAK2), STAT3, phosphorylated STAT3 (p-STAT3), B-cell lymphoma-2 (Bcl-2), and Cyclin D1 in aortic tissues were also measured. Besides, homeostasis model assessment of insulin resistance (HOMA-IR) and atherogenic indexes (AI) were calculated.

RESULTS

Compared with the NC and DM groups, the levels LDL-c, TG, TC, FINS, HOMA-IR, RBP4, and AI were upregulated, whereas that of HDL-c was downregulated in the DA group (P < 0.05); the mRNA levels of JAK2, STAT3, Cyclin D1, and Bcl-2 in the DA group were significantly increased compared with the NC group and the DM group; P-JAK2, p-JAK2/JAK2 ratio, p-STAT3, p-STAT3/STAT3 ratio, Cyclin D1, and Bcl-2 at protein levels were significantly upregulated in the DA group compared with the NC group and DM group. In addition, as shown by Pearson analysis, serum RBP4 had a positive correlation with TG, TC, LDL-c, FINS, HbA1C, p-JAK2, p-STAT3, Bcl-2, Cyclin D1, AI, and HOMA-IR but a negative correlation with HDL-c. In addition, multivariable logistic regression analysis showed that serum RBP4, p-JAK2, p-STAT3, and LDL-c were predictors of the presence of diabetic atherosclerosis.

CONCLUSION

RBP4 could be involved in the initiation or progression of diabetic atherosclerosis by regulating the JAK2/STAT3 signaling pathway.

Effect of dietary carbohydrate and lipid modification on clinical and anthropometric parameters in nonalcoholic fatty liver disease: a systematic review and meta-analysis

CONTEXT

Nonalcoholic fatty liver disease (NAFLD) is estimated to affect approximately 25% of the adult population, making it one of the most common chronic liver diseases worldwide and a major public health problem. Still, there is no consensus on the most appropriate nutritional intervention for disease treatment.

OBJECTIVE

To systematize and synthesize the results of randomized controlled trials that have evaluated the effect of dietary interventions with different, quantitative, macronutrient compositions on hepatic steatosis attenuation, serum levels of alanine aminotransferase, aspartate aminotransferase, lipid profile, glucose metabolism markers, and anthropometric parameters of adults and the elderly (age ≥ 60 years) with NAFLD.

DATA SOURCES

MEDLINE databases via PubMed, Embase, Science Direct, LILACS, Web of Science, ClinicalTrials.gov, and Cochrane Library were searched. Randomized controlled trials that compared interventions as diets with values ≤ 45% or 20% of the total daily energy intake from carbohydrates or lipids, respectively, compared with dietary reference intakes, were included.

DATA EXTRACTION

Risk of bias was assessed through the Cochrane Collaboration tool. The meta-analysis was only performed to evaluate the effect of carbohydrate-modified diets on the outcome variables. The number of participants and mean values and respective standard deviations of the outcome variables were extracted and used to calculate weighted mean differences and their respective 95%CIs.

RESULTS

The search strategy resulted in 21 146 studies, of which 10 were retained for qualitative analysis and 6 were included in the meta-analysis. From the analysis of 10 studies were identified 8 articles in which low-calorie diets were evaluated and 3 interventions that used an isocaloric diet. Only 3 studies were classified as having low risk of bias.

CONCLUSION

The observed effects on hepatic steatosis, serum alanine aminotransferase and aspartate aminotransferase levels, parameters of lipid and glucose metabolism, and anthropometric variables were mostly related to a hypocaloric diet. The use of reduced macronutrient interventions had no efficacy.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42018088824.

Associations between dietary total antioxidant capacity and odds of non-alcoholic fatty liver disease (NAFLD) in adults: a case-control study

The relationships between the total antioxidant capacity (TAC) of the diet and the risk of non-alcoholic fatty liver disease (NAFLD) have not previously been assessed. The aim of this study was to assess relationships between DTAC and odds of NAFLD in a case–control study. This case–control study was carried out in 158 patients with NAFLD and 357 healthy individuals aged 18–55 years. Dietary data were collected using validated 168-item quantitative food frequency questionnaires. Triacylglycerols (TAGs), total cholesterol (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C) and fasting blood glucose (FBS) concentrations were assessed using enzymatic methods and commercial kits. The DTAC was calculated based on the oxygen radical absorbance capacity of each food reported by the U.S. Department of Agriculture. The mean ± sd (standard deviation) for age and body mass index (BMI) of the study participants were 43⋅9 years ±5⋅9 and had 30⋅5 kg/m² ±2⋅6. The NAFLD patients included higher BMI and female proportion, compared with the control group. The NAFLD patients included higher smoking rates, biochemical parameters (TG, TC, LDL-C and FBS) and DTAC scores, compared with control groups (P-value < 0⋅05). However, patients with NAFLD had lower HDL levels and physical activities, compared with the control group. The highest tertile of DTAC showed lower odds of NAFLD, compared with the lowest tertile. This association was significant after adjustment for potential confounders (OR, 0⋅19; 95 % CI, 0⋅9–0⋅34; P for trend 0⋅001). Findings suggest that the promotion of naturally increased antioxidant capacities may help prevent odds of NAFLD.

Association between serum β-carotene-to-retinol ratio and severity of hepatic steatosis in non-alcoholic fatty liver disease in Japan: A cross-sectional study

OBJECTIVES

Retinol and β-carotene have been reported to be involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). However, clinical studies are limited. The aim of this study was to investigate the relationship between serum the ratio of β-carotene to retinol (SC/SR) and hepatic steatosis in NAFLD diagnosed by ultrasonography.

METHODS

The participants were 606 Japanese adults who were enrolled in a health survey. Clinical profile, dietary nutrition intake, blood biochemistry, serum retinol, and carotenoids were analyzed. NAFLD was defined as fatty liver on ultrasonography in the absence of other causes of steatosis.

RESULTS

Women had higher daily intake of α- and β-carotene, although there were no differences in daily retinol and carotenoid intake between participants with or without NAFLD in both men and women. Women had a higher SC/SR ratio than men regardless of the presence or absence of NAFLD, and the SC/SR ratio in women decreased with exacerbation of hepatic steatosis, whereas the SC/SR ratio in men did not change despite exacerbation of hepatic steatosis. After adjusting for confounding factors, the likelihood of NAFLD among participants in the highest quartile of SC/SR ratio decreased by two-thirds compared with participants in the lowest quartile (adjusted odds ratio, 0.64; 95% confidence interval, 0.21-1.92; P = 0.041). The SC/SR ratio was positively correlated with serum high-density lipoprotein cholesterol level, and negatively correlated with serum triacylglycerol level.

CONCLUSIONS

The SC/SR ratio was lower in NAFLD with sex differences, and was associated with the severity of hepatic steatosis and lipid profile. Future studies are needed to expand on these findings.

Is the Retinol-Binding Protein 4 a Possible Risk Factor for Cardiovascular Diseases in Obesity?

Although many preventive and treatment approaches have been proposed, cardiovascular disease (CVD) remains one of the leading causes of deaths worldwide. Current epidemiological data require the specification of new causative factors, as well as the development of improved diagnostic tools to provide better cardiovascular management. Excessive accumulation of adipose tissue among patients suffering from obesity not only constitutes one of the main risk factors of CVD development but also alters adipokines. Increased attention is devoted to bioactive adipokines, which are also produced by the adipose tissue. The retinol-binding protein 4 (RBP4) has been associated with numerous CVDs and is presumably associated with an increased cardiovascular risk. With this in mind, exploring the role of RBP4, particularly among patients with obesity, could be a promising direction and could lead to better CVD prevention and management in this patient group. In our review, we summarized the current knowledge about RBP4 and its association with essential aspects of cardiovascular disease-lipid profile, intima-media thickness, atherosclerotic process, and diet. We also discussed the RBP4 gene polymorphisms essential from a cardiovascular perspective.

Dietary Patterns and Components in Nonalcoholic Fatty Liver Disease (NAFLD): What Key Messages Can Health Care Providers Offer?

Nonalcoholic fatty liver disease (NAFLD) is a rising epidemic worldwide and will be the leading cause of cirrhosis, hepatocellular carcinoma, and liver transplant within the next decade. NAFLD is considered as the hepatic manifestation of metabolic syndrome. Behaviors, such as a sedentary lifestyle and consuming a Western diet, have led to substantial challenges in managing NAFLD patients. With no curative pharmaceutical therapies, lifestyle modifications, including dietary changes and exercise, that ultimately lead to weight loss remain the only effective therapy for NAFLD. Multiple diets, including low-carbohydrate, low-fat, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean (MD) diets, have been evaluated. NAFLD patients have shown better outcomes with a modified diet, such as the MD diet, where patients are encouraged to increase the consumption of fruits and vegetables, whole grains, and olive oil. It is increasingly clear that a personalized approach to managing NAFLD patients, based on their preferences and needs, should be implemented. In our review, we cover NAFLD management, with a specific focus on dietary patterns and their components. We emphasize the successful approaches highlighted in recent studies to provide recommendations that health care providers could apply in managing their NAFLD patients.