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

Abstract

Objective: Previous studies have shown that the Dietary Approaches to Stop Hypertension (DASH) diet might contribute to managing risk factors of non-alcoholic fatty liver disease (NAFLD), but evidence is limited. We examined the association of DASH diet score (DASH-DS) with NAFLD, as well as the intermediary effects of serum retinol-binding protein-4 (RBP4), serum high-sensitivity C-reactive protein (hs-CRP), serum TAG, homeostasis model assessment of insulin resistance (HOMA-IR) and BMI.

Design: We performed a cross-sectional analysis of a population-based cohort study. Dietary data and lifestyle factors were assessed by face-to-face interviews and the DASH-DS was then calculated. We assessed serum RBP4, hs-CRP and TAG and calculated HOMA-IR. The presence and degree of NAFLD were determined by abdominal sonography.

Setting: Guangzhou, China.

Participants: Guangzhou Nutrition and Health Study participants, aged 40-75 years at baseline (n 3051).

Results: After adjusting for potential covariates, we found an inverse association between DASH-DS and the presence of NAFLD (Ptrend = 0·009). The OR (95 % CI) of NAFLD for quintiles 2-5 were 0·78 (0·62, 0·98), 0·74 (0·59, 0·94), 0·69 (0·55, 0·86) and 0·77 (0·61, 0·97), respectively. Path analyses indicated that a higher DASH-DS was associated with lower serum RBP4, hs-CRP, TAG, HOMA-IR and BMI, which were positively associated with the degree of NAFLD.

Conclusions: Adherence to the DASH diet was independently associated with a marked lower prevalence of NAFLD in Chinese adults, especially in women and those without abdominal obesity, and might be mediated by reducing RBP4, hs-CRP, TAG, HOMA-IR and BMI.

Trial registration: ClinicalTrials.gov NCT03179657.

Keywords: Cross-sectional study; Dietary Approaches to Stop Hypertension diet; Non-alcoholic fatty liver disease; Nutrition.

Fig. 1

Flowchart of participants in the present study: middle-aged and elderly adults aged 40–75 years at baseline, Guangzhou Nutrition and Health Study, China, 2010–2013

Fig. 2

Path model showing the mediation of the association between the Dietary Approaches to Stop Hypertension (DASH) diet score (DASH-DS) and non-alcoholic fatty liver disease (NAFLD) by serum retinol-binding protein-4 (RBP4), serum TAG, homeostasis model assessment of insulin resistance (HOMA-IR), BMI and serum high-sensitivity C-reactive protein (hs-CRP) among middle-aged and elderly adults (n 3051) aged 40–75 years at baseline, Guangzhou Nutrition and Health Study, China, 2010–2013 (goodness-of-fit index = 0·957; adjusted goodness-of-fit index = 0·828). *P < 0·05, **P < 0·01, ***P < 0·001