Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala, Sweden; Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
Am J Clin Nutr. 2024 Jul;120(1):187-195. doi: 10.1016/j.ajcnut.2024.05.018. Epub 2024 May 24.
Short-term trials have shown a reduction in liver fat when saturated fatty acids (SFAs) are substituted with polyunsaturated fatty acids (PUFA), or with low-glycemic carbohydrates. However, few cohort studies have been conducted to investigate the associations of replacing SFA and SFA-rich foods with different macronutrients and foods in more severe stages of liver disease; nonalcoholic fatty liver disease (NAFLD) cirrhosis and hepatocellular carcinoma (HCC).
To investigate associations between the substitution of SFA and SFA-rich foods with other macronutrients and foods and NAFLD cirrhosis and HCC in a middle-aged to elderly Swedish population of n = 77,059 males and females.
Time-to-event analyses were performed to investigate associations between the food and macronutrient substitutions and NAFLD cirrhosis and HCC. Multivariable Cox regression models were constructed to estimate hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). Statistical isocaloric and equal-mass substitutions were performed using the leave-one-out method. Prespecified nutrient and food substitutions of interest were SFA with carbohydrates, SFA with fiber, SFA with PUFA, butter with margarine and vegetable oils, unprocessed red meat with fish, and milk with fermented milk.
Over a median follow-up of 24 y, 566 cases of NAFLD cirrhosis and 205 cases of HCC were registered. Overall, dietary substitutions showed no clear associations with either NAFLD cirrhosis or HCC. Substituting SFA with carbohydrates showed an HR of 0.87 (95% CI: 0.74, 1.02) for HCC and 1.00 (95% CI: 0.89, 1.11) for NAFLD cirrhosis. Substituting milk with fermented milk showed an HR of 0.93 (95% CI: 0.85, 1.01) for HCC and 0.97 (95% CI: 0.92, 1.03) for NAFLD cirrhosis.
No clear associations were observed between diet and NAFLD cirrhosis or HCC. Although accompanied by low precision, possible lowered risks of HCC by substituting SFA with carbohydrates or milk with fermented milk might be of interest, but needs replication in other cohorts.
短期试验表明，用多不饱和脂肪酸（PUFA）或低血糖碳水化合物替代饱和脂肪酸（SFA）可减少肝脏脂肪。然而，很少有队列研究调查在更严重的肝脏疾病阶段（非酒精性脂肪性肝病[NAFLD]肝硬化和肝细胞癌[HCC]）用不同的宏量营养素和食物替代 SFA 和富含 SFA 的食物的关联。
在瑞典中年至老年的 77059 名男性和女性人群中，调查用其他宏量营养素和食物替代 SFA 和富含 SFA 的食物与 NAFLD 肝硬化和 HCC 之间的关联。
进行时间事件分析以研究食物和宏量营养素替代与 NAFLD 肝硬化和 HCC 之间的关联。构建多变量 Cox 回归模型，使用 95%置信区间（CI）估计风险比（HR）。使用单因素剔除法进行统计等热量和等质量替代。预设的感兴趣的营养素和食物替代物为 SFA 与碳水化合物、SFA 与纤维、SFA 与 PUFA、黄油与人造黄油和植物油、未加工的红肉与鱼以及牛奶与发酵乳。
在中位数为 24 年的随访期间，登记了 566 例 NAFLD 肝硬化和 205 例 HCC。总体而言，饮食替代与 NAFLD 肝硬化或 HCC 均无明显关联。用碳水化合物替代 SFA 与 HCC 的 HR 为 0.87（95%CI：0.74，1.02），与 NAFLD 肝硬化的 HR 为 1.00（95%CI：0.89，1.11）。用发酵乳替代牛奶与 HCC 的 HR 为 0.93（95%CI：0.85，1.01），与 NAFLD 肝硬化的 HR 为 0.97（95%CI：0.92，1.03）。
饮食与 NAFLD 肝硬化或 HCC 之间未观察到明显关联。虽然精确度较低，但用碳水化合物替代 SFA 或用发酵乳替代牛奶可能会降低 HCC 的风险，但需要在其他队列中复制。
