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. 2025 Jun 21;17(1):237.
doi: 10.1186/s13098-025-01801-w.

The newly proposed dietary index for gut microbiota and its association with the risk of nonalcoholic fatty liver disease: the mediating role of body mass index

Shengnan Meng  1 , Luonan Li  1 , Shijie Yin  1 , Yuxuan Zhao  1 , Yaning Liu  1 , Yuxi Zhang  2 , Xiaolin Zhang #  3 , Fengxue Yu #  4   5
Affiliations

The newly proposed dietary index for gut microbiota and its association with the risk of nonalcoholic fatty liver disease: the mediating role of body mass index

Shengnan Meng et al. Diabetol Metab Syndr. .

Abstract

Background and aims: Nonalcoholic fatty liver disease (NAFLD) is strongly associated with dietary habits and the gut microbiota. The dietary index for the gut microbiota (DI-GM) is a newly proposed index that reflects gut microbial diversity based on dietary intake. However, its relationship with NAFLD remains unclear. This study aimed to explore the association between DI-GM and the risk of NAFLD.

Methods: In this cross-sectional study, we utilized data from the NHANES 2009-2018. Multivariable logistic regression, restricted cubic spline curves (RCS), subgroup analysis, and mediation analysis were used to evaluate the association between DI-GM and the risk of NAFLD.

Results: A total of 4,923 participants were included in the study. According to the fully adjusted model, a significant inverse association was observed between DI-GM and NAFLD (OR = 0.883, 95% CI: 0.835-0.932, P < 0.001). After stratification by quartiles, compared with participants in the first quartile of DI-GM score, those in the fourth quartile had a 36.5% lower odds of developing NAFLD (OR = 0.635, 95% CI: 0.481-0.839, P = 0.002). Mediation analysis revealed that 72.69% of the association between DI-GM and NAFLD was mediated by BMI (P < 0.001). Subgroup analysis suggested that the association between DI-GM and NAFLD might be influenced by race (P for interaction < 0.05). RCS analysis revealed a linear correlation between DI-GM and NAFLD (P for nonlinear = 0.883).

Conclusions: DI-GM is negatively associated with NAFLD risk, with BMI mediating this relationship and race being a significant influencing factor.

Keywords: BMI; DI-GM; Dietary patterns; Gut-liver axis; Mediation effect; NAFLD; NHANES.

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Conflict of interest statement

Declarations. Ethical approval: The NHANES database was approved by the ethics review board of the National Center for Health Statistics. Informed consent: Written informed consent was provided by every participant before their inclusion in the database. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study population flow chart
Fig. 2
Fig. 2
Mediation effect of BMI on the association between DI-GM and NAFLD. Adjustment factors included age, sex, race, poverty-income ratio, education level, hypertension, diabetes, smoking, FPG, AST, and ALT
Fig. 3
Fig. 3
Restricted cubic spline of the DI-GM and NAFLD. Adjustment factors included age, sex, race, poverty-income ratio, education level, hypertension, diabetes, smoking, FPG, AST, and ALT
See this image and copyright information in PMC

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