Dietary inflammatory potential is associated with higher odds of hepatic steatosis in US adults: a cross-sectional study

Abstract

Objective: Inflammation plays a critical role in the progression of chronic liver diseases, and diet can modulate inflammation. Whether an inflammatory dietary pattern is associated with higher risk of hepatic steatosis or fibrosis remains unclear. We aimed to investigate the associations between inflammatory dietary pattern and the odds of hepatic steatosis and fibrosis.

Design: In this nationwide cross-sectional study, diet was measured using two 24-h dietary recalls. Empirical dietary inflammatory pattern (EDIP) score was derived to assess the inflammatory potential of usual diet, which has been validated to highly predict inflammation markers in the study population. Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were derived from FibroScan to define steatosis and fibrosis, respectively.

Setting: US National Health and Nutrition Examination Survey.

Participants: 4171 participants aged ≥18 years.

Results: A total of 1436 participants were diagnosed with S1 steatosis (CAP ≥ 274 dB/m), 255 with advanced fibrosis (LSM ≥ 9·7 kPa). Compared with those in the lowest tertile of EDIP-adherence scores, participants in the highest tertile had 74 % higher odds of steatosis (OR: 1·74, 95 % CI (1·26, 2·41)). Such positive association persisted among never drinkers, or participants who were free of hepatitis B and/or C. Similarly, EDIP was positively associated with CAP in multivariate linear model (P < 0·001). We found a non-significant association of EDIP score with advanced fibrosis or LSM (P = 0·837).

Conclusions: Our findings suggest that a diet score that is associated with inflammatory markers is associated with hepatic steatosis. Reducing or avoiding pro-inflammatory diets intake might be an attractive strategy for fatty liver disease prevention.

Keywords: Controlled attenuation parameter; Cross-sectional study; Diet; Hepatic steatosis; Inflammation.

Fig. 1

Association between empirical dietary inflammatory pattern scores and hepatic steatosis (≥S1) in NHANES (2017–2018)*. *Model was adjusted for age, sex, smoking status, race, education, family income to poverty ratio, marital status, physical activity, total energy, HBV, HCV, BMI and diabetes except for variables examined in the figure. Notably, the restricted multivariable cubic spline analysis showed significantly linear association between empirical dietary inflammatory pattern scores and hepatic steatosis (≥S1) (P for linearity = 0·002 and P for non-linearity = 0·157). Reference levels were set to the median EDIP value. Solid lines indicate OR, and dashed lines depict 95 % CI. EDIP, empirical dietary inflammatory pattern; HBV, hepatitis B Virus; HCV, hepatitis C Virus; NHANES, US National Health and Nutrition Examination Survey

Fig. 2

Subgroup analysis on the association of EDIP scores (per 1-sd increase) with hepatic steatosis (≥S1) in NHANES (2017–2018)*. *Model was adjusted for age, sex, smoking status, race, education, family income-poverty ratio, marital status, physical activity, total energy, HBV, HCV, BMI and diabetes except for variables examined in the figure. EDIP, empirical dietary inflammatory pattern; HBV, hepatitis B Virus; HCV, hepatitis C Virus; NHANES, US National Health and Nutrition Examination Survey