Eating Fast Is Associated with Nonalcoholic Fatty Liver Disease in Men But Not in Women with Type 2 Diabetes: A Cross-Sectional Study

Dietary characteristics associated with the risk of non-alcoholic fatty liver disease and metabolic dysfunction-associated steatotic liver disease in non-obese Japanese participants: A cross-sectional study

Background and Aim

Dietary characteristics associated with non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) in non-obese patients remain to be elucidated. This study examined the association of NAFLD and MASLD with dietary characteristics according to obesity status.

Methods

We performed a cross-sectional study of 15 135 participants (n = 7568 men and 7567 women) aged 35-74 years using data of annual health checks between 2008 and 2020. Obesity was defined as BMI ≥ 25 kg/m2. Diagnosis of fatty liver was based on abdominal ultrasonography. Fatty-liver-related dietary characteristics were assessed using a self-administered questionnaire.

Results

For non-obese participants, NAFLD was found in 31.0% of men and 19.4% of women. Non-obese MASLD was found in 27.6% of men and 18.1% of women. Multivariable-adjusted stepwise logistic regression analysis indicated that, in males, both non-obese NAFLD and non-obese MASLD were significantly and negatively associated with "often eat sesame/nuts", and positively associated with "often eat noodles/rice bowl" and "often eat evening meal" (P < 0.05). For non-obese women, both NAFLD and MASLD were significantly and positively associated with "often eat sweet buns/bread with fillings" (P < 0.05). Adjusted analyses showed that all dietary characteristics were not significantly associated with the risk of NAFLD/MASLD in obese men and women.

Conclusion

This cross-sectional study indicates the existence of sex and obesity differences in the association of NAFLD and MASLD with dietary characteristics. Our findings suggest that some dietary characteristics are associated with NAFLD and MASLD prevalence in non-obese Japanese participants.

Lifestyle factors affecting new-onset nonalcoholic fatty liver disease

Evidence for the influence of lifestyle factors on nonalcoholic fatty liver disease (NAFLD) onset is limited because the association between lifestyle factors and NAFLD has been reported mostly in cross-sectional studies. Our purpose was to elucidate which lifestyle factors are associated with NAFLD onset by performing a longitudinal study. This was a longitudinal study of 1,713 Japanese participants who underwent multiple health checkups from June 2013 to the end of March 2018 and were not diagnosed with NAFLD at the first health checkup at Watari Hospital in Fukushima, Japan. Baseline characteristics, including lifestyle factors, were compared among participants with and without NAFLD. Cox proportional hazards models were used to identify the association between lifestyle factors and NAFLD onset. Among the 1,713 participants, 420 (24.5 %) developed NAFLD during the observation period (median 47 months). There were significant differences in body mass index and hepatobiliary enzyme levels between participants with and without NAFLD. In Cox proportional hazards models, eating between meals (hazard ratio (HR): 2.08, 95 % confidence interval (CI): 1.25-3.45, p < 0.01) and eating fast (HR: 1.59, 95 % CI: 1.26-2.00, p < 0.01) were risk factors for NAFLD onset in men and women, respectively. Moreover, fast walking was a protective factor against NAFLD onset in women (HR: 0.76, 95 % CI: 0.60-0.96, p = 0.02). These findings could help to identify patients at risk and prevent future NAFLD onset.

Fast Eating Speed Could Be Associated with HbA1c and Salt Intake Even after Adjusting for Oral Health Status: A Cross-Sectional Study

This study aimed to examine the relationship between eating speed and hemoglobin A1c (HbA1c), considering the number of teeth, using cross-sectional health examination data from community-dwelling older individuals in Japan. We used data from the Center for Community-Based Healthcare Research and Education Study in 2019. We collected data on gender, age, body mass index, blood test results, Salt intake, bone mineral density, body fat percentage, muscle mass, basal metabolic rate, number of teeth, and lifestyle information. Eating speed was evaluated subjectively as fast, normal, or slow. Overall, 702 participants were enrolled in the study and 481 participants were analyzed. Multivariate logistic regression analysis revealed a significant association between fast eating speed and being a male (odds ratio [95% confidence interval]: 2.15 [1.02-4.53]), HbA1c (1.60 [1.17-2.19]), salt intake (1.11 [1.01-1.22]), muscle mass (1.05 [1.00-1.09]), and enough sleep (1.60 [1.03-2.50]). Fast eating may be associated with overall health and lifestyle. The characteristics of fast eaters, after taking oral information into consideration, tended to increase the risk of type 2 diabetes, renal dysfunction, and hypertension. Dental professionals should provide dietary and lifestyle guidance to fast eaters.

The Association of Salt Intake and Non-alcoholic Fatty Liver Disease in People With Type 2 Diabetes: A Cross-Sectional Study

Objectives

Non-alcoholic fatty liver disease (NAFLD), which has a close relationship with type 2 diabetes (T2D), is related to salt intake in the general population. In contrast, the relationship between salt intake and the presence of NAFLD in patients with T2D has not been clarified.

Methods

Salt intake (g/day) was assessed using urinary sodium excretion, and a high salt intake was defined as an intake greater than the median amount of 9.5 g/day. Hepatic steatosis index (HSI) ≥ 36 points was used to diagnosed NAFLD. Odds ratios of high salt intake to the presence of NAFLD were evaluated by logistic regression analysis.

Results

The frequency of NAFLD was 36.5% in 310 patients with T2D (66.7 ± 10.7 years old and 148 men). The patients with high salt intake had a higher body mass index (25.0 ± 4.0 vs. 23.4 ± 3.8 kg/m², p < 0.001) than those with low salt intake. HSI in patients with high salt intake was higher than that in patients with low salt intake (36.2 ± 6.2 vs. 34.3 ± 5.5 points, p = 0.005). In addition, the presence of NALFD in patients with high salt intake was higher than that in patients with low salt intake (44.5% vs. 28.4%, p = 0.005). High salt intake was associated with the prevalence of NAFLD [adjusted odds ratio, 1.76 (95% confidence interval: 1.02–3.03), p = 0.043].

Conclusion

This cross-sectional study revealed that salt intake is related to the prevalence of NAFLD in patients with T2D.

Impact of Eating Speed on Muscle Mass in Older Patients With Type 2 Diabetes: A Prospective Study of KAMOGAWA–DM Cohort

Background and Aims

Maintenance of muscle mass is important for sarcopenia prevention. However, the effect of eating speed, especially fast, normal, or slow speed, on muscle mass changes remains unclear. Therefore, the purpose of this prospective study was to investigate the effect of eating speed on muscle mass changes in patients with type 2 diabetes (T2DM).

Methods

This study included 284 patients with T2DM. Based on a self–reported questionnaire, participants were classified into three groups: fast–, normal–, and slow–speed eating. Muscle mass was assessed using a multifrequency impedance body composition analyzer, and skeletal muscle mass (SMI) decrease (kg/m²/year) was defined as [baseline SMI (kg/m²)–follow–up SMI (kg/m²)] ÷ follow–up duration (year). The rate of SMI decrease (%) was defined as [SMI decrease (kg/m²/year) ÷ baseline SMI (kg/m²)] × 100.

Results

The proportions of patients with fast–, normal–, and slow–speed eating were, respectively, 50.5%, 42.9%, and 6.6% among those aged <65 years and 40.4%, 38.3%, and 21.3% among those aged ≥65 years. In patients aged ≥65 years, the rate of SMI decrease in the normal (0.85 [95% confidence interval, CI: −0.66 to 2.35]) and slow (0.93 [95% CI −0.61 to 2.46]) speed eating groups was higher than that in the fast speed eating group (−1.08 [95% CI −2.52 to 0.36]). On the contrary, there was no difference in the rate of SMI decrease among the groups in patients aged <65 years. Compared with slow speed eating, the adjusted odds ratios of incident muscle loss [defined as rate of SMI decrease (%) ≥0.5%] due to fast– and normal–speed eating were 0.42 (95% CI 0.18 to 0.98) and 0.82 (95% CI 0.36 to 2.03), respectively.

Conclusion

Slow–speed eating is associated with a higher risk of muscle mass loss in older patients with T2DM.

Eating Speed Is Associated with the Presence of Sarcopenia in Older Patients with Type 2 Diabetes: A Cross-Sectional Study of the KAMOGAWA-DM Cohort

To determine the relationship between eating speed and the presence of sarcopenia in older patients with type 2 diabetes (T2D), in this cross-sectional study, patient eating speeds were classified as “fast-”, “normal-” and “slow-speed eating.” A multifrequency impedance analyzer was used to evaluate patient body compositions. Sarcopenia was defined as having both low muscle strength, a handgrip strength <28 kg for men and <18 kg for women, and low skeletal muscle mass as a skeletal muscle mass index <7.0 kg/m² for men and <5.7 kg/m² for women. Among 239 individuals, the frequencies of fast-, normal-, and slow-speed eating were 47.3%, 32.2%, and 20.5%, respectively; and the prevalence of sarcopenia was 15.9%. Patients with a slow eating speed had greater prevalence of low skeletal muscle mass, low muscle strength, and sarcopenia than those with a fast or normal eating speed. After adjusting for covariates, compared to slow eaters, the odds ratio of having sarcopenia among fast- and normal-speed eaters was 0.31 [95% CI: 0.12–0.80] and 0.18 [95% CI: 0.06–0.53], respectively. Having a slow eating speed is associated with a heightened risk of sarcopenia in older patients with T2D.

Clinical practice advice on lifestyle modification in the management of nonalcoholic fatty liver disease in Japan: an expert review

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver diseases worldwide, including in Japan. The Japanese Society of Gastroenterology (JSGE) and the Japanese Society of Hepatology (JSH) have established the Japanese NAFLD/NASH guidelines in 2014 and revised these guidelines in 2020. As described in these guidelines, weight reduction by diet and/or exercise therapy is important for the treatment of NAFLD patients. The I148M single nucleotide polymorphism (rs738409 C > G) of PNPLA3 (patatin-like phospholipase domain-containing 3 protein) is widely known to be associated with the occurrence and progression of NAFLD. In the Japanese, the ratio of PNPLA3 gene polymorphisms found is approximately 20%, which is higher than that found in Westerners. In addition, the ratio of lean NAFLD patients is also higher in Japan than in Western countries. Therefore, the method for lifestyle guidance for the NAFLD patients in Japan would be different from that for the people in Western countries. The problems in the treatment of NAFLD patients include alcohol consumption and sarcopenia. Therefore, guidelines that can help clinicians treat Japanese patients with NAFLD are needed. In this expert review, we summarize evidence-based interventions for lifestyle modification (diet, exercise, alcohol, and sarcopenia) for the treatment of patients with NAFLD, especially from Japan and Asian countries.

Self-Reported Eating Speed Is Associated with Indicators of Obesity in Adults: A Systematic Review and Meta-Analysis

Eating speed (ES) as a dietary behaviour has become a widely discussed factor for weight management and obesity. This study analysed the relationship between ES and anthropometric indicators of obesity, including BMI and waist circumference (WC) in adults. A search conducted of PubMed, Web of Science, Science Direct and Scopus found six longitudinal studies and fifteen cross-sectional studies published for further analysis. A quality assessment was performed with the MINORS checklist. Eight studies were included in the meta-analysis and almost all reviewed studies showed that ES was associated with BMI, and non-fast eaters had significantly lower BMI than fast eaters. Therefore, it was assumed that slowing down the ES may be an effective strategy for weight management and lowering obesity risk. There was also an association between WC and ES. Assessment of eating speed can be included in nutrition surveys to analyse obesity risk. More broadly, research is also needed to establish a validated and standardised methodology to determine eating speed. Further research needs to examine the links between eating speed, obesity, ethnicity, sex, food culture and chronic diseases.

Impact of income and eating speed on new-onset diabetes among men: a retrospective cohort study

OBJECTIVE

To examine the impact of income and eating speed on new-onset diabetes among men.

DESIGN

This was a retrospective cohort study.

SETTING

We used the administrative claims and health check-up data for fiscal years 2010-2015 obtained from the Fukuoka branch of the Japan Health Insurance Association.

PARTICIPANTS

Participants were 15 474 non-diabetic male employees, aged between 40 and 74 years. They were categorised based on their eating speeds (ie, fast, normal and non-fast).

PRIMARY AND SECONDARY OUTCOME MEASURES

To calculate the OR of the development of diabetes, we created generalised linear regression models with diabetes onset as the dependent variable and eating speed and income as covariates and calculated corresponding 95% CI values. The analyses were performed after adjusting the data for age, obesity and comorbidities.

RESULTS

Of the total participants, 620 developed diabetes during the 5-year study period. A univariate analysis using the generalised linear regression model revealed that eating fast (OR: 1.35, 95% CI 1.17 to 1.55) and having a low income wereincome (OR: 1.47, 95% CI 1.24 to 1.74) were significantly associated with the onset of diabetes. After adjusting for age, obesity and comorbidities, both eating fast (OR: 1.17, 95% CI 1.02 to 1.35) and having a low income (OR: 1.24, 95% CI 1.03 to 1.50) were recognised as independent risk factors for diabetes onset.

CONCLUSIONS

The study revealed that eating fast and having a low income were independent risk factors, leading to the development of diabetes. While it is difficult to address income differences, it may be possible to address the factors that contribute to income differences to manage diabetes appropriately and at low healthcare costs. However, eating speed can be controlled. Hence, the provision of education and coaching on dietary habits, including eating speed, may be effective in preventing diabetes onset.

Dietary Treatment for NAFLD: New Clinical and Epidemiological Evidence and Updated Recommendations

The key factor in preventing and treating nonalcoholic fatty liver disease (NAFLD) is a holistic lifestyle modification approach, encompassing diet based on healthy eating patterns of unprocessed foods, exercise, balanced drinking, and smoking habits. The Mediterranean diet and other healthy dietary patterns can reduce liver fat and may be related with lower disease progression. The type of diet should be tailored to the patient's cultural and personal preferences. Changing dietary composition without reducing caloric intake may offer an additional and sometimes more feasible alternative, so that the nutritional treatment incorporates, but is not focused on, weight reduction goals. The growing global consumption of ultra-processed foods, which is the polar opposite of the Mediterranean diet and its concept of home-based cooking, poses a great challenge in the prevention of NAFLD and probably hepatocellular carcinoma.This review will cover the most updated clinical and epidemiological evidence for lifestyle treatment in NAFLD and provide practical treatment tools.

Beyond the Paradigm of Weight Loss in Non-Alcoholic Fatty Liver Disease: From Pathophysiology to Novel Dietary Approaches

Current treatment recommendations for non-alcoholic fatty liver disease (NAFLD) rely heavily on lifestyle interventions. The Mediterranean diet and physical activity, aiming at weight loss, have shown good results in achieving an improvement of this liver disease. However, concerns related to compliance and food accessibility limit the feasibility of this approach, and data on the long-term effects on liver-related outcomes are lacking. Insulin resistance is a central aspect in the pathophysiology of NAFLD; therefore, interventions aiming at the improvement of insulin sensitivity may be preferable. In this literature review, we provide a comprehensive summary of the available evidence on nutritional approaches in the management of NAFLD, involving low-calorie diets, isocaloric diets, and the novel schemes of intermittent fasting. In addition, we explore the harmful role of single nutrients on liver-specific key metabolic pathways, the role of gene susceptibility and microbiota, and behavioral aspects that may impact liver disease and are often underreported in clinical setting. At present, the high variability in terms of study populations and liver-specific outcomes within nutritional studies limits the generalizability of the results and highlights the urgent need of a tailored and standardized approach, as seen in regulatory trials in Non-Alcoholic Steatohepatitis (NASH).