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. 2023 Apr 3;21(1):123.
doi: 10.1186/s12916-023-02793-y.

Associations between an inflammatory diet index and severe non-alcoholic fatty liver disease: a prospective study of 171,544 UK Biobank participants

Fanny Petermann-Rocha  1   2 , Michael D Wirth  3   4 , Jirapitcha Boonpor  1   5 , Solange Parra-Soto  1   6 , Ziyi Zhou  7 , John C Mathers  8 , Katherine Livingstone  9 , Ewan Forrest  10 , Jill P Pell  7 , Frederick K Ho  7 , James R Hébert  4 , Carlos Celis-Morales  11   12
Affiliations

Associations between an inflammatory diet index and severe non-alcoholic fatty liver disease: a prospective study of 171,544 UK Biobank participants

Fanny Petermann-Rocha et al. BMC Med. .

Abstract

Background: Although non-alcoholic fatty liver disease (NAFLD) is linked to inflammation, whether an inflammatory diet increases the risk of NAFLD is unclear. This study aimed to examine the association between the Energy-adjusted Diet Inflammatory Index (E-DII) score and severe NAFLD using UK Biobank.

Methods: This prospective cohort study included 171,544 UK Biobank participants. The E-DII score was computed using 18 food parameters. Associations between the E-DII and incident severe NAFLD (defined as hospital admission or death) were first investigated by E-DII categories (very/moderately anti-inflammatory [E-DII < - 1], neutral [E-DII - 1 to 1] and very/moderately pro-inflammatory [E-DII > 1]) using Cox proportional hazard models. Nonlinear associations were investigated using penalised cubic splines fitted into the Cox proportional hazard models. Analyses were adjusted for sociodemographic, lifestyle and health-related factors.

Results: Over a median follow-up of 10.2 years, 1489 participants developed severe NAFLD. After adjusting for confounders, individuals in the very/moderately pro-inflammatory category had a higher risk (HR: 1.19 [95% CI: 1.03 to 1.38]) of incident severe NAFLD compared with those in the very/moderately anti-inflammatory category. There was some evidence of nonlinearity between the E-DII score and severe NAFLD.

Conclusions: Pro-inflammatory diets were associated with a higher risk of severe NAFLD independent of confounders such as the components of the metabolic syndrome. Considering there is no recommended treatment for the disease, our findings suggest a potential means to lower the risk of NAFLD.

Keywords: Diet; Incidence; Inflammation; Non-alcoholic fatty liver disease; Prospective studies.

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Conflict of interest statement

J.H owns a controlling interest in Connecting Health Innovations LLC (CHI), a company licensing the right to his invention of the Dietary Inflammatory Index (DII®) from the University of South Carolina to develop computer and smartphone applications for patient counselling and dietary intervention in clinical settings. In addition to their University of South Carolina appointments, M.W was an employee of CHI.

All the other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Diagram of participants included in the analyses
Fig. 2
Fig. 2
Association between the E-DII and severe NAFLD. A nonlinear association between the E-DII and severe NAFLD was investigated using penalised cubic splines fitted in Cox proportional hazard models. Analyses were performed using the same information reported in Table 2
See this image and copyright information in PMC

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