Park Song-Yi, Noureddin Mazen, Boushey Carol, Wilkens Lynne R, Setiawan Veronica W
Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Curr Dev Nutr. 2020 Feb 20;4(3):nzaa024. doi: 10.1093/cdn/nzaa024. eCollection 2020 Mar.
Epidemiological data on the role of overall dietary patterns in nonalcoholic fatty liver disease (NAFLD) are limited, especially from population-based prospective studies.
We investigated the associations between dietary patterns assessed by predefined diet quality indexes (DQIs) and NAFLD risk by cirrhosis status in African Americans, Japanese Americans, Latinos, Native Hawaiians, and whites from the Multiethnic Cohort (MEC).
A nested case-control analysis was conducted within the MEC. NAFLD cases were identified by linkage to 1999-2016 Medicare claims. Four DQIs-Healthy Eating Index (HEI)-2015, Alternative Healthy Eating Index-2010, alternate Mediterranean diet score, and Dietary Approaches to Stop Hypertension (DASH) score-were calculated from a validated FFQ administered at baseline. Conditional logistic regression was used to estimate the ORs and 95% CIs with adjustment for multiple covariates.
Analyses included 2959 NAFLD cases (509 with cirrhosis; 2450 without cirrhosis) and 29,292 matched controls. Higher scores for HEI-2015 (i.e., highest compared with lowest quintile OR: 0.83; 95% CI: 0.73, 0.94; for trend = 0.002) and DASH (OR: 0.78; 95% CI: 0.69, 0.89; for trend < 0.001), reflecting favorable adherence to a healthful diet, were inversely associated with NAFLD risk. Whereas there were no differences by sex or race/ethnicity, the inverse association was stronger for NAFLD with cirrhosis than for NAFLD without cirrhosis ( for heterogeneity = 0.03 for HEI-2015 and 0.05 for DASH).
Higher HEI-2015 and DASH scores were inversely associated with NAFLD risk in this ethnically diverse population. The findings suggest that having better diet quality may reduce NAFLD risk with more benefit to NAFLD with cirrhosis.
关于整体饮食模式在非酒精性脂肪性肝病（NAFLD）中的作用的流行病学数据有限，尤其是来自基于人群的前瞻性研究的数据。
我们通过预定义的饮食质量指数（DQIs）评估的饮食模式与多民族队列（MEC）中非洲裔美国人、日裔美国人、拉丁裔、夏威夷原住民和白人的肝硬化状态的NAFLD风险之间的关联进行了调查。
在MEC中进行了巢式病例对照分析。通过与1999 - 2016年医疗保险索赔记录的关联来识别NAFLD病例。从基线时实施的经过验证的食物频率问卷（FFQ）中计算出四个DQIs——2015年健康饮食指数（HEI） - 2015、替代健康饮食指数 - 2010、替代地中海饮食评分和终止高血压膳食方法（DASH）评分。使用条件逻辑回归来估计调整多个协变量后的OR值和95%置信区间（CIs）。
分析纳入了2959例NAFLD病例（509例有肝硬化；2450例无肝硬化）和29292例匹配对照。HEI - 2015（即最高五分位数与最低五分位数相比，OR：0.83；95% CI：0.73，0.94；趋势P = 0.002）和DASH（OR：0.78；95% CI：0.69，0.89；趋势P < 0.001）得分较高，反映出对健康饮食的良好依从性，与NAFLD风险呈负相关。虽然按性别或种族/族裔没有差异，但与无肝硬化的NAFLD相比，肝硬化的NAFLD的负相关更强（HEI - 2015的异质性P = 0.03，DASH的异质性P = 0.05）。
在这个种族多样化的人群中，较高的HEI - 2015和DASH得分与NAFLD风险呈负相关。研究结果表明，拥有更好的饮食质量可能会降低NAFLD风险，对肝硬化的NAFLD更有益。
