Crosstalk between dietary patterns, obesity and nonalcoholic fatty liver disease

Table 2 Characteristics of the observational studies on the association between different dietary patterns and nonalcoholic fatty liver disease

Ref.	Country/Region	Dietary pattern	Food items in dietary patterns	Type of study	N, age	Main results	Associations
Oddy et al[52]	Australia	Western	Takeaway foods, confectionery, red meat, refined grains, processed meats, chips, sauces, full-fat dairy products and soft drinks	P	995. FFQ completed at 14 yr and liver ultrasound at 17 yr	Higher western pattern score at 14 yr was associated with ↑ risk of NAFLD at 17 yr (OR: 1.59; 95%CI: 1.17–2.14; P < 0.05) before adjustment to BMI	↑
		Healthy	Whole grains, fruit, vegetables, legumes, fish			A healthy diet at 14 yr appeared protective against NAFLD at 17 yr in centrally obese adolescents (OR: 0.63; 95%CI 0.41-0.96; P < 0.05)	↓
Salehi-Sahlabadi et al[34]	Iran	Western	Fast foods, soft drinks, processed meat, high-fat dairy products, hydrogenated fats, mayonnaise, salty snacks, sugar sweetened desserts, organ meats and refined grains	C-C	675 (450 with NAFLD) NAFLD: 38.6 ± 8.7 yr; Controls: 37.9 ± 8.9 yr	The western pattern was associated with ↑ risk for NAFLD after adjustment for age, sex, BMI, PA, SES and EI	↑
		Healthy	Fish, skinless poultry, low-fat dairy, fresh fruits, natural juices, canned fruits, dried fruits, vegetables, nuts, olive and garlic			A healthy pattern was associated with ↓ risk for NAFLD, after controlling for mentioned variables	↓
		Traditional	Red meat, organ meats, skinless poultry, eggs, yogurt drink, tea, legumes, tomato sauce, sugar sweetened-desserts, potato, condiments, salt, pickles and broth			Lack of association between traditional pattern and risk of NAFLD adjusted for mentioned variables	↔
Chung et al[60]	Korea	Western and high-carbohydrate	Processed meats, bread, soft drinks, pork, noodles, beef, cakes, snacks, beef soup, sugar, coffee, chicken, processed fish and refined grains	C-S	1190 (331 with NAFLD) NAFLD: 53 ± 9 yr; Controls: 51 ± 10 yr	Lack of association between Western/high-carbohydrate pattern and risk of NAFLD after adjustment for age, sex, WC, smoking status, EI, diabetes and hypertension	↔
		Traditional	Vegetables; fermented vegetables such as kimchi and jjangajji; fish and seafood; mush-rooms; fermented, processed, natural soybeans			↑ Adherence to the traditional pattern was associated with ↑ risk of NAFLD (OR: 1.85; 95%CI: 1.11-3.08; P < 0.05) after controlling for mentioned variables	↑
		Simple meal	Fruits, root and yellow vegetables, eggs, dairy products and nuts			↑ Adherence to the simple meal pattern was associated with ↓ risk of NAFLD (OR: 0.59; 95%CI: 0.34-1.00; P < 0.05), after controlling for mentioned variables	↓
Dehghanseresht et al[54]	Iran	Ordinary	Sweets, oils, fruits, white meats, refined grains, tea and coffee, salt, biscuits, snacks as well as red and organ meats	C-C	244 (122 with NAFLD) aged 19–70 yr	↑ Adherence to the ordinary pattern was associated with ↑ risk of NAFLD; P < 0.001	↑
		Traditional	Red and organ meats, dairy products, condiments, salt, tea and coffee and low intake of fruits			↑ Adherence to the traditional pattern was associated with ↑ risk of NAFLD P < 0.001	↑
		Vegetables and dairy (healthy pattern)	Vegetables, whole grains, legumes and nuts and dairy products			↑ Adherence to the vegetables and dairy pattern was ↓ association with NAFLD risk (OR: 0.23; 95%CI: 0.09–0.58; P < 0.05)	↓
		Fast food	Sauces, pickles, fast foods, soft drinks, snacks and biscuits			No association between Fast food patterns and the risk of NAFLD	↔
Yang et al[57]	China	Traditional Chinese	Staple food, coarse grains, fruits, eggs, fish and shrimp, milk and tea	C-S	999 (345 with NAFLD) aged 45–60 yr	No association between traditional pattern and the risk of NAFLD	↔
		Animal food	Kelp/seaweed and mushroom, pork, beef, mutton, poultry, cooked meat, eggs, fish and shrimp, beans and grease			After controlling for potential confounders, animal food patterns had ↑ prevalence rate for NAFLD (PR: 1.35; 95%CI: 1.06–1.72; P < 0.05	↑
		Grains-vegetables (healthy pattern)	Coarse grains, tubers, vegetables, mushroom and kelp/seaweed, cooked meat and beans			After adjustment for BMI, a vegetable pattern had ↓ prevalence rate for NAFLD (PR: 0.78; 95%CI: 0.62–0.98, P < 0.05).	↓
		High-salt	Rice, pickled vegetables, processed meat, bacon, salted duck egg, salted fish and tea			No association between high salt and the risk of NAFLD	↔
Jia et al[65]	China	High-carbohydrate/sweet	Fruits, cakes and candied fruits	C-S	4365 (1339 with NAFLD: adults	↑ Adherence to a high-carbohydrate/sweet pattern was associated with ↑ the prevalence of NAFLD in females but not in males	↑ only in females not in males
Kalafati et al[55]	Greece	Fast food	Energy-dense foods rich in saturated fat and sugar and included fast foods, sweetened soft drinks, fried potatoes and savory and puff pastry snacks	C-C	351 (134 with NAFLD) Case: 50.0 ± 10.5 yr; Control 44.0 ± 11.0 yr	↑ Adherence to a fast-food pattern was associated with ↑ odds for NAFLD after adjustment for age, sex, EI, PA, pack-yr smoked, education, MS (P < 0.01)	↑
		Prudent (healthy pattern)	Oil-based cooked vegetables, legumes, potatoes, fruits, vegetables and fatty fish			↑ Adherence to the prudent pattern was associated with ↓ TG and uric acid levels (β: -5.96; P < 0.05; β: -0.15; P < 0.05, respectively)	↓
		High-protein	Red meat, poultry, eggs			The high protein pattern was not associated with any NAFLD-related biomarker	↔
		The unsaturated FA	Nuts, chocolate and other foods rich in unsaturated FA			Individuals in the second quartile of the unsaturated FA pattern had ↓ odds of developing NAFLD vs the first quartile after being adjusted for mentioned confounders (P < 0.05)	↓
Tutunchi et al[56]	Iran	Healthy	Vegetables, legumes, fruits and low-fat dairy products	C-C	210 (105 with NAFLD) Cases 46 ± 9 yr; Controls 45 ± 9 yr	A healthy pattern was associated with ↓ odds of NAFLD (OR: 0.34; 95%CI: 0.16–0.81) after controlling for sex, education, PA, BMI, WC	↓
		Western	Sweet, hydrogenated fat, red and processed meat and soft drink dietary patterns			↑ Adherence to the western pattern was related to ↑ risk of NAFLD (OR: 2.68; 95%CI: 1.31–4.16), after controlling to mentioned confounders	↑
Zhang et al[61]	China	Sugar-rich	Strawberry, kiwi fruit, persimmon, sweets, candied fruits, Chinese cakes	P	17360 free from NAFLD at baseline; During a median follow-up of 4.2 yr, 4034 with NAFLD, aged > 18 yr	After adjusting for age, sex, BMI, smoking, alcohol, education, occupation, income, PA, EI, personal and family history of the disease, depressive symptoms, dietary supplement use, inflammation markers, WHR and each other dietary pattern score, the sugar-rich pattern was associated with ↑ risk of NAFLD (HR: 1.11; 95%CI 1.01, 1.23)	↑
		Vegetable (healthy pattern)	Cucumber, green leafy vegetables, Chinese cabbage, celery, pumpkin			After adjusting for mentioned confounders, vegetable diet was associated with ↓ risk of NAFLD (HR 0.96; 95%CI: 0.86, 1.07)	↓
		Animal food	Animal organs, animal blood, preserved eggs, instant noodles, pork skin, sausage			After adjusting for mentioned confounders, animal food diet was associated with ↑ risk of NAFLD (HR: 1.22; 95%CI: 1.10, 1.36)	↑
Alferink et al[62]	The Netherlands	Vegetable and fish (healthy pattern)	Vegetables, poultry, fish and fruit	P	963 (343 with NAFLD) Baseline: 71.0 yr; Follow-up: 75 yr	No associations between vegetable and fish diet and NAFLD	↔
		Red meat and alcohol	Red, refined or organ meat, salty snacks and beer or spirits and low intake of fruit and tea			No associations between red meat and alcohol pattern and NAFLD	↔
		Traditional	Vegetable oils and stanols and margarine or butter, potatoes, whole grains and sweet snacks or desserts			↑ Adherence to the Traditional pattern was associated with ↓ risk of NAFLD (OR: 0.40; 95%CI 0.15–1.00) adjustment for sex, age, baseline education level, PA, EI, alcohol intake and follow-up time, BMI, baseline type 2 diabetes mellitus and baseline hypertension	↓
		Salty snacks and sauces	Savory food groups such as nuts, legumes, salty snacks and sauces			No associations between salty snacks and sauces pattern and NAFLD	↔
		High-fat dairy and refined grain	Fruit juice, refined grains, high-fat dairy products and sweet snacks or desserts			No associations between high-fat dairy and refined grain pattern and NAFLD	↔
Fakhoury-Sayegh et al[64]	Lebanon	Traditional	Vegetables, chickpeas, red beans, lentils, peas, vegetable oil/olives	C-C	222 (112 with NAFLD) Cases: 40 ± 6 yr; Controls: 39 ± 13 yr	↑ Adherence to traditional pattern ↓ the odds of NAFLD (OR: 0.30; CI 95%: 0.11–0.86; P < 0.05) adjusted for MS, EI, education, PA, family history, smoking, place of residence and profession	↓
		High fruits	Fruits and fruit juices			↑ Adherence to high fruits pattern ↑ the odds of NAFLD (OR: 4.061; 95%CI: 1.320–12.100, P < 0.05, adjusted for mentioned confounders	↑
		The high meat and fast food diet: (Western-like dietary pattern)	Meat such as pork, chicken, beef meat and hotdog			↑ Adherence to Western pattern ↑ the odds of NAFLD (OR: 4.081; 95%CI: 1.36–12.28, P < 0.05) adjusted for mentioned confounders	↑
Nakashita et al[58]	Japan	Healthy	Seaweeds, vegetables, mushrooms, pulses, potatoes and starches	C-S	281 men (89 with NAFLD) NAFLD: 62 (57–67) yr; Controls: 61 (56–67) yr	A healthy pattern was correlated with the ↓ risk of NAFLD	↓
		Western	Fats and oils, meat, seasonings, spices			No correlation between western pattern and NAFLD	↔
		Snacks	Sugars and starches, beverages (tea, coffee, fruit juice, soft drinks), fruits			No correlation between snacks pattern and NAFLD	↔
Adriano et al[59]	Brazil	Healthy	Fruits, vegetables/legumes, white meat, olive oil, margarine, bread/toast (with significant negative loading for beef)	C-S	229 older adults (74.7% women) NAFLD: 67.0 ± 5.0 yr; Controls: 70.1 ± 7.0 yr	↑ Adherence to the healthy pattern was associated with ↓ prevalence of NAFLD (PR: 0.70; 95%CI: 0.50, 0.98, P < 0.05) after adjustment for sex, age, EI, BMI, smoking status, PA, family income and use of hypoglycemic drugs	↓
		Regional snacks (Northeast of Brazil)	Tea/coffee, dairy products, cassava flour/tapioca/cuscus, butter and olive oil			↑ Adherence to the regional snacks pattern was associated with the ↑ prevalence of NAFLD (PR: 1.42; 95%CI: 1.02, 1.92, P < 0.05) after adjustment for mentioned confounders	↑
		Energy-dense	Processed cold meats, beef, viscera, sweet products/desserts/sugar, soft drinks, tubers/spaghetti/pastries			No association between energy density pattern and NAFLD	↔
		Traditional	Rice, beans, bread/toast, tea/coffee, sweet products/desserts/sugar			No association between traditional pattern and NAFLD	↔

BMI: Body mass index; C-C: Case-control; C-S: Cross-sectional; CI: Confidence interval; EI: Energy intake; FA: Fatty acid; FFQ: Food frequency questionnaire; HR: Hazard ratio; NAFLD: Nonalcoholic fatty liver disease; MS: Metabolic syndrome; OR: Odds ratio; P: Prospective; PA: Physical activity; PR: Prevalence ratio; SES: Socioeconomic status; TG: Triglyceride; WC: Waist circumference; WHR: Waist-to-hip ratio.