Liver & Energy Metabolism Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Am J Gastroenterol. 2023 Aug 1;118(8):1381-1387. doi: 10.14309/ajg.0000000000002182. Epub 2023 Jan 13.
Dietary and lifestyle changes are the first line of therapy for nonalcoholic fatty liver disease (NAFLD), the most prevalent liver disease in the western world. Nutrition literacy is the ability to understand nutrition information and implement that knowledge. We aimed to compare indicators of nutrition literacy in subjects with and without NAFLD in a representative US cohort.
In a cross-sectional study using data from the National Health and Nutrition Examination Survey 2017-2018 cycle, we included 2,938 adult subjects with complete dietary and vibration-controlled transient elastography data and no alternative reason for hepatic steatosis. Nutrition literacy was assessed using questionnaires. Diet perception accuracy was assessed by comparing self-reported diet quality with objective diet quality scores-the Healthy Eating Index and alternative Mediterranean diet score-to assess real-world application of nutrition knowledge.
Nutrition literacy was not different between subjects with or without NAFLD ( P = 0.17): more than 90% of subjects reported using nutrition labels, and most of them correctly identified the meaning of daily value. Subjects with NAFLD had a lower-quality diet (Healthy Eating Index, P = 0.018; alternative Mediterranean diet, P = 0.013) and rated their diet as poorer ( P < 0.001). On self-assessment, only 27.8% of subjects overestimated their diet quality, while 37.5% consumed more calories than their self-assessed needs. Both accuracy measures were similar between subjects with NAFLD and those without ( P = 0.71 and 0.63, respectively). Subjects with NAFLD were more likely to report being advised to lose weight (42.1% vs 16.5%, P < 0.001) or to attempt losing weight (71.9% vs 60.9%, P < 0.001). Diet quality was not better in subjects with NAFLD who received dietary recommendations.
Subjects with NAFLD have poor diet quality despite receiving medical recommendations to lose weight and having nutrition literacy and perception that are comparable with subjects without NAFLD. Educational approaches may not be sufficient to promote weight loss and improve diet quality in NAFLD.
对于非酒精性脂肪性肝病（NAFLD），即西方世界最常见的肝脏疾病，饮食和生活方式的改变是一线治疗方法。营养素养是理解营养信息和实施该知识的能力。我们旨在比较具有和不具有 NAFLD 的美国代表性队列人群中的营养素养指标。
在一项使用 2017-2018 年全国健康和营养调查（NHANES）数据的横断面研究中，我们纳入了 2938 名有完整饮食和振动控制瞬态弹性成像数据且无其他肝脂肪变性替代原因的成年受试者。使用问卷调查评估营养素养。通过比较自我报告的饮食质量与客观的饮食质量评分（健康饮食指数和替代地中海饮食评分）来评估营养知识的实际应用，从而评估饮食感知准确性。
NAFLD 患者与非 NAFLD 患者之间的营养素养没有差异（P=0.17）：超过 90%的受试者报告使用营养标签，并且他们中的大多数正确识别了每日价值的含义。NAFLD 患者的饮食质量较差（健康饮食指数，P=0.018；替代地中海饮食，P=0.013），并且自评饮食质量较差（P<0.001）。在自我评估中，只有 27.8%的受试者高估了自己的饮食质量，而 37.5%的受试者摄入的卡路里超过了自我评估的需求。NAFLD 患者与非 NAFLD 患者的两种准确性测量值均相似（P=0.71 和 0.63）。NAFLD 患者更有可能被告知需要减肥（42.1%比 16.5%，P<0.001）或试图减肥（71.9%比 60.9%，P<0.001）。接受饮食建议的 NAFLD 患者的饮食质量并没有改善。
尽管接受了减肥的医疗建议，并且营养素养和感知与非 NAFLD 患者相当，但 NAFLD 患者的饮食质量仍然较差。教育方法可能不足以促进 NAFLD 患者的体重减轻和改善饮食质量。
