Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, 1025 E. 7th St., Bloomington, IN, USA.
Department of Nutrition and Health Science, College of Health, Ball State University, Muncie, IN, USA.
Dig Dis Sci. 2023 Oct;68(10):4009-4021. doi: 10.1007/s10620-023-08059-0. Epub 2023 Aug 3.
There is limited evidence of how dietary inflammatory potential influences nonalcoholic fatty liver disease (NAFLD) progression.
Our study aims to evaluate the association of dietary inflammatory index (DII) with liver fibrosis, a hallmark feature of NAFLD, among US adults.
Cross-sectional data consisting of 5,506 participants in the National Health and Nutrition Examination Survey from 2011 to 2018 were used. Energy adjusted-DII (E-DII) scores were calculated using 2 days of 24-h dietary recall data. We used a partial proportional odds model to determine risk at each stage of fibrosis according to the E-DII score.
The weighted prevalence of NAFLD (assessed by US fatty liver index) was 34.5%, with 23.2% (assessed by NAFLD Fibrosis Score) having mild fibrosis, 10.4% intermediate fibrosis, and 0.9% advanced fibrosis. When comparing the most pro-inflammatory diets to the most anti-inflammatory diets (AIDs) in the multivariable model, the marginal probability effect (MPE) of NAFLD, mild fibrosis and intermediate fibrosis increased by 11.7% (95% CI 6.6%, 16.9%), 7.0% (95% CI 3.5%, 10.4%) and 4.0% (95% CI 0.3%, 7.5%), respectively. The MPE of advanced fibrosis was not significant (MPE = 0.7%; 95% CI - 1.1%, 2.8%). Similar associations were observed when applying Fibrosis-4 and transient elastography as fibrosis diagnostic measurements.
An AID was associated with lower risk of development of NAFLD and early-stage of fibrosis among US adults. But the associations became attenuated and dissipated as the fibrogenesis became severe. Further studies are needed to re-confirm our observations.
目前关于饮食炎症潜能如何影响非酒精性脂肪性肝病（NAFLD）进展的证据有限。
本研究旨在评估美国成年人饮食炎症指数（DII）与肝纤维化的相关性，肝纤维化是 NAFLD 的一个标志特征。
使用 2011 年至 2018 年国家健康和营养调查的 5506 名参与者的横断面数据。使用 2 天的 24 小时膳食回顾数据计算能量调整-DII（E-DII）评分。我们使用部分比例优势模型根据 E-DII 评分确定每个纤维化阶段的风险。
NAFLD（通过美国脂肪肝指数评估）的加权患病率为 34.5%，其中 23.2%（通过 NAFLD 纤维化评分评估）有轻度纤维化，10.4%有中度纤维化，0.9%有晚期纤维化。在多变量模型中，将最具促炎作用的饮食与最具抗炎作用的饮食（AID）进行比较时，NAFLD、轻度纤维化和中度纤维化的边际概率效应（MPE）分别增加了 11.7%（95%CI 6.6%，16.9%）、7.0%（95%CI 3.5%，10.4%）和 4.0%（95%CI 0.3%，7.5%）。晚期纤维化的 MPE 不显著（MPE=0.7%；95%CI-1.1%，2.8%）。当应用纤维化 4 指数和瞬态弹性成像作为纤维化诊断测量时，也观察到类似的关联。
AID 与美国成年人 NAFLD 和早期纤维化阶段的风险降低相关。但随着纤维化的加重，相关性减弱并消失。需要进一步的研究来重新确认我们的观察结果。
