The association of the healthy food diversity index with the risk of non-alcoholic fatty liver disease among the adult population.

BACKGROUND AND AIM: Dietary diversity index is a useful evaluation index for examining the role of dietary pattern in predicting chronic diseases risk, including non-alcoholic fatty liver disease(NAFLD). In the present study, we aimed to examine the possible association of dietary diversity using US Healthy Food Diversity(US HFD) index and the NAFLD risk in Iranian adults. METHODS: A total of 675 individuals (225 patients with NAFLD and 450 controls) aged 20-60 years were recruited for the current case-control study. Data on dietary intakes were determined using a validated food frequency questionnaire, and dietary diversity was calculated using the US HFD index. In patients with NAFLD, an ultrasound scan of the liver was used to detect NAFLD. Logistic regression models were used to estimate the odds ratios(ORs) and 95 % confidence interval(CI) of NAFLD across tertiles of the US HFD index. RESULTS: Mean ± SD age of the study population were 38.13 ± 8.85 years. The median (interquartile) score of the US HFD index in patients with NAFLD and healthy subjects was 0.08(0.07-0.09) and 0.09(0.08-0.10), respectively. In the age and sex-adjusted model, the odds of NAFLD were considerably reduced across tertiles of the US HFD index (OR:0.48; 95%CI:0.32-0.72, Ptrend<0.001). Also, in the final model, after adjusting for age, sex, waist-to-hip ratio, smoking, physical activity, marital status, socioeconomic status, and energy intake, the odds of NAFLD were significantly reduced across tertiles US HFD index (OR:0.55; 95%CI:0.31-0.97, Ptrend<0.001). Furthermore, for each SD increase in the US HFD index, the odds of NAFLD are reduced by 23 % (OR:0.77;95%CI:0.60-0.97,P-Value<0.001). CONCLUSIONS: Our findings revealed that greater adherence to dietary pattern with a high US HFD score, defined by higher intakes of fruits, vegetables, whole grains, legumes, nuts, low-fat dairy, seeds, soya products, and plant oils may be related to reducing the odds of NAFLD.

International diet quality index and revised diet quality index relationship with non-alcoholic fatty liver disease: a case-control study.

BACKGROUND/OBJECTIVES: Recent studies show the potential role of dietary quality and quantity in predicting the risk of chronic diseases, such as liver disease, therefore, in the present study, we aimed to assess the association of diet quality index International (DQI-I) and diet quality index revised (DQI-R) and their main components with the odds of non-alcoholic fatty liver disease (NAFLD) in adult populations. METHODS: The current case-control study was conducted on 225 patients with NAFLD and 450 controls. Dietary intake was assessed using a validated 168-item food frequency questionnaire, and DQI-I and DQI-R were calculated in participants. Multi-variable logistic regression was used to examine the association of DQI-I and DQI-R and their components with the odds of NAFLD. RESULTS: The mean (SD) age and BMI of participants (53% men) were 38.1 (8.8) years and 26.8 (4.3) kg/m2, respectively. In the final model, each one SD increment in the DQI-I score was associated with decreased odds of NAFLD (OR = 0.63; 95%CI = 0.40-0.98) (P = 0.040). Also, of DQI-I components, high adequacy score was related to lower odds of NAFLD (OR = 0.16; 95%CI = 0.06-0.40) (P < 0.001). Also, our findings showed that participants in the highest tertile of DQI-R score had lower odds of NAFLD compared to the lowest tertile of DQI-R (OR = 0.24; 95%CI = 0.10-0.53) (P < 0.001). Furthermore, of DQI-R components, high moderation score are linked to a lower risk of NAFLD (OR = 0.17;95%CI = 0.07-0.43) (P < 0.001). CONCLUSION: Our findings suggested that greater adherence to diet with a higher score of DQI-I and DQI-R may be associated with lower odds of NAFLD.

The association of healthy lifestyle score and risk of non-alcoholic fatty liver disease.

BACKGROUND: The combined role of important environmental factors as a single lifestyle index in predicting non-alcoholic fatty liver disease (NAFLD) risk is not fully assessed. Therefore, we aimed to investigate the association of healthy lifestyle factor score (HLS) with the odds of NAFLD in Iranian adults. METHODS: This case-control study was conducted on 675 participants, aged ≥ 20-60 years, including 225 new NAFLD cases and 450 controls. We measured dietary intake information using a validated food frequency questionnaire and determined diet quality based on the alternate healthy eating index-2010(AHEI-2010). The score of HLS was calculated based on four lifestyle factors, including a healthy diet, normal body weight, non-smoking, and high physical activity. An ultrasound scan of the liver was used to detect NAFLD in participants of the case group. Logistic regression models were used to determine the odds ratios(ORs) and 95% confidence interval(CI) of NAFLD across tertiles of HLS and AHEI. RESULTS: Mean ± SD age of the participants were 38.13 ± 8.85 years. The Mean ± SD HLS in the case and control groups was 1.55 ± 0.67 and 2.53 ± 0.87, respectively. Also, the Mean ± SD AHEI in the case and control groups was 48.8 ± 7.7 and 54.1 ± 8.1, respectively. Based on the age and sex-adjusted model, the odds of NAFLD were decreased across tertiles of AHEI (OR:0.18;95%CI:0.16-0.29,Ptrend<0.001) and HLS(OR:0.03;95%CI:0.01-0.05,Ptrend<0.001). Also, in the multivariable model, the odds of NAFLD were decreased across tertiles AHEI (OR:0.12;95%CI:0.06-0.24,Ptrend<0.001) and HLS(OR:0.02;95%CI:0.01-0.04,Ptrend<0.001). CONCLUSIONS: Our findings reported that higher adherence to lifestyle with a higher score of HLS was associated with decreased odds of NAFLD. Also, a diet with a high AHEI score can reduce the risk of NAFLD in the adult population.

Dietary advanced glycation end products are associated with an increased risk of non-alcoholic fatty liver disease in Iranian adults.

BACKGROUND: Dietary advanced glycation end products(AGEs) may contribute to increased inflammation and oxidative stress as risk factors for chronic diseases such as liver disease. In the current study, we aimed to examine the possible association of dietary AGEs with the odds of non-alcoholic fatty liver disease (NAFLD) in Iranian adults. METHODS: A total of 675 participants (225 newly diagnosed NAFLD cases and 450 controls), aged 20-60 years, were recruited for this case-control study. Nutritional data were measured using a validated food frequency questionnaire, and dietary AGEs were determined for all participants. An ultrasound scan of the liver performed the detection of NAFLD in participants of the case group without alcohol consumption and other causes of hepatic disorders. We used logistic regression models, adjusted for potential confounders, to estimate the odds ratios(ORs) and 95% confidence interval(CI) of NAFLD across tertiles of dietary AGEs. RESULTS: Mean ± SD age and body mass index of the participants were 38.13 ± 8.85 years and 26.85 ± 4.31 kg/m2, respectively. The median(IQR) of dietary AGEs in participants was 3262(2472-4301). In the sex and age-adjusted model, the odds of NAFLD were increased across tertiles of dietary AGEs intake(OR:16.48;95%CI:9.57-28.40, Ptrend<0.001). Also, in the final model, after controlling for confounding effects of BMI, smoking, physical activity, marital status, socio-economic status, and energy intake, the odds of NAFLD were increased across tertiles of dietary AGEs intake(OR:12.16; 95%CI:6.06-24.39, Ptrend<0.001). CONCLUSION: Our results showed that greater adherence to dietary pattern with high dietary AGEs intake was significantly related to increased odds of NAFLD.

Nitrate containing vegetables and dietary nitrate and nonalcoholic fatty liver disease: a case control study.

BACKGROUND: Vegetables is the main sources of dietary nitrate. Studies suggested the potential link between nitrate content of vegetables and reduce the risk of chronic diseases. We aimed to assess the association between nitrate-containing vegetables (NCVs) with odds of nonalcoholic fatty liver diseases (NAFLD) in Iranian adults. METHOD: This case-control study was performed on a total of 225 newly diagnosed NAFLD cases and 450 controls aged 20-60 years. Individuals' dietary intakes were determined using a valid and reliable food frequency questionnaire. RESULTS: The mean ± SD age and BMI of participants were 38.1 ± 8.8 years and 26.8 ± 4.3 kg/m2, respectively. In the fully adjusted model, the odds of NAFLD were decreased across tertiles of total NCVs [(adjusted OR: 0.20, 95%CI: 0.10-0.40), (Ptrend <  0.001)] and low-nitrate vegetables [(adjusted OR: 0.22, 95%CI: 0.11-0.48), (Ptrend <  0.001)]. Our results showed that each one SD increments in nitrate content of vegetables (adjusted OR: 0.73, 95%CI: 0.55-0.97) and nitrate content of fruits (adjusted OR: 0.59, 95%CI: 0.36-0.97) was associated with reduced odds of NAFLD (P <  0.05). However, there was a positive association between each one SD increments in nitrate content of dairy products and meats and processed meats with odds of NAFLD (adjusted OR: 1.34, 95%CI: 1.03-1.74), (P <  0.05). CONCLUSION: Our finding suggested that a higher intake of vegetable nitrate may be related to a decrease the odds of NAFLD.

Effects of time-restricted feeding (16/8) combined with a low-sugar diet on the management of non-alcoholic fatty liver disease: A randomized controlled trial.

OBJECTIVES: Emerging studies have employed time-restricted feeding (TRF) and a low-sugar diet alone in the management of non-alcoholic fatty liver disease (NAFLD), but their combination has not been tested. The aim of this study was to investigate the effects of TRF combined with a low-sugar diet on NAFLD parameters, cardiometabolic and inflammatory biomarkers, and body composition in patients with NAFLD. METHODS: A 12-wk randomized controlled trial was performed to compare the effects of TRF (16 h fasting/8 h feeding daily [16/8]) plus a low-sugar diet versus a control diet based on traditional meal distribution in patients with NAFLD. Changes in body composition, anthropometric indices, and liver and cardiometabolic markers were investigated. RESULTS: TRF 16/8 with a low-sugar diet reduced body fat (26.7 ± 5.4 to 24.2 ± 4.9 kg), body weight (83.8 ± 12.7 to 80.5 ± 12.1 kg), waist circumference (104.59 ± 10.47 to 101.91 ± 7.42 cm), and body mass index (29.1 ± 2.6 to 28 ± 2.7 kg/m2), as well as circulating levels of fasting blood glucose and liver (alanine aminotransferase, 34 ± 13.9 to 21.2 ± 5.4 U/L; aspartate aminotransferase, 26.3 ± 6.2 to 20.50 ± 4 U/L; γ-glutamyl transpeptidase, 33 ± 15 to 23.2 ± 11.1 U/L; fibrosis score, 6.3 ± 1 to 5.2 ± 1.2 kPa; and controlled attenuation parameter, 322.9 ± 34.9 to 270.9 ± 36.2 dB/m), lipids (triacylglycerols, 201.5 ± 35.3 to 133.3 ± 48.7 mg/dL; total cholesterol, 190 ± 36.6 to 157.8 ± 33.6 mg/dL; and low-density lipoprotein cholesterol, 104.6 ± 27.3 to 84 ± 26.3 mg/dL), and inflammatory markers (high-sensitivity C-reactive protein, 3.1 ± 1.1 to 2 ± 0.9 mg/L; and cytokeratin-18, 1.35 ± 0.03 to 1.16 ± 0.03 ng/mL). These results were statistically significant (P < 0.05) compared with the control group. CONCLUSIONS: TRF plus a low-sugar diet can reduce adiposity and improve liver, lipid, and inflammatory markers in patients with NAFLD.

Nutrient patterns and non-alcoholic fatty liver disease in Iranian Adul: A case-control study.

Backgrounds: The current literature boasts the importance of diet in preventing or managing liver complications. However, there is limited evidence on the association of nutrient patterns (NP) with these complications. In this case-control study, we aimed to examine the possible relationship between nutrient patterns and the risk of non-alcoholic fatty liver disease (NAFLD) amongst the adult Iranian population. Methods: This case-control study is being conducted at the Metabolic Liver Disease Research Center at Isfahan University of Medical Sciences in 2019. The study included 225 newly diagnosed cases of NAFLD and 450 controls. A validated semi-quantitative food frequency questionnaire (FFQ) assessed dietary intake. Principal component analysis using Varimax rotation obtained nutrient patterns. Logistic regression was performed to estimate NAFLD risk. Results: We identified four major nutrient patterns. The first nutrient pattern was high in consumption of lactose, animal protein, vitamin D, riboflavin, pantothenic acid, vitamin B12, calcium, phosphorus, zinc, and potassium. The second nutrient pattern included fiber, plant protein, vitamin A, thiamine, niacin, copper, and selenium, while the third featured plant protein, zinc, copper, magnesium, manganese, chromium, and selenium. The fourth was characterized by fructose, vitamin A, pyridoxine, vitamin C, and potassium. After adjusting for confounders, individuals in the highest tertile of NP4 had lower odds of NAFLD (OR: 0.56, 95% CI: 0.32-0.98, P_trend = 0.042); compared to those who were in the lowest tertile. Conclusion: High compliance to a nutrient pattern characterized by fructose, vitamin C, vitamin A, pyridoxine, and potassium mainly supplied from fruits, vegetables, and nuts is inversely proportional to the odds of NAFLD. Also our findings indicate a very high fiber intake, a relatively optimal dietary fat profile, and a pretty low sugar intake for cases and controls, unseen in western countries. However, these initial findings need to be approved with further studies to confirm the relationship between nutrient patterns and NAFLD.

Effects of the 5:2 intermittent fasting diet on non-alcoholic fatty liver disease: A randomized controlled trial.

Background and aims: Dietary regimens are crucial in the management of non-alcoholic fatty liver disease (NAFLD). The effects of intermittent fasting (IF) have gained attention in this regard, but further research is warranted. Thus, we aimed to ascertain the overall effects of the 5:2 IF diet (5 days a week of normal food intake and 2 consecutive fasting days) in patients with NAFLD compared to a control group (usual diet). Methods and results: A 12-week randomized controlled trial was performed to evaluate the effects of the 5:2 IF diet on anthropometric indices, body composition, liver indices, serum lipids, glucose metabolism, and inflammatory markers in patients with NAFLD. The IF group (n = 21) decreased body weight (86.65 ± 12.57-82.94 ± 11.60 kg), body mass index (30.42 ± 2.27-29.13 ± 1.95 kg/m2), waist circumference (103.52 ± 6.42-100.52 ± 5.64 cm), fat mass (26.64 ± 5.43-23.85 ± 5.85 kg), fibrosis (6.97 ± 1.94-5.58 ± 1.07 kPa), steatosis scores/CAP (313.09 ± 25.45-289.95 ± 22.36 dB/m), alanine aminotransferase (41.42 ± 20.98-28.38 ± 15.21 U/L), aspartate aminotransferase (34.19 ± 10.88-25.95 ± 7.26 U/L), triglycerides (171.23 ± 39.88-128.04 ± 34.88 mg/dl), high-sensitivity C-reactive protein (2.95 ± 0.62 -2.40 ± 0.64 mg/L), and cytokeratin-18 (1.32 ± 0.06-1.19 ± 0.05 ng/ml) values compared to the baseline and the end of the control group (n = 23)-p ≤ 0.05 were considered as significant. However, the intervention did not change the levels of high-density lipoprotein cholesterol, total cholesterol, low-density lipoprotein cholesterol, fasting blood sugar, insulin, HOMA-IR, and total antioxidant capacity. Conclusion: Adhering to the 5:2 IF diet can reduce weight loss and related parameters (fat mass and anthropometric indicators of obesity), as well as hepatic steatosis, liver enzymes, triglycerides, and inflammatory biomarkers in patients with NAFLD.

Dietary phytochemical index and the risk of non-alcoholic fatty liver disease: A case-control study among Iranian adults.

BACKGROUNDS: Dietary phytochemical index (DPI) is an inexpensive method for estimating the amounts of phytochemicals in foods. No study has investigated the association between DPI and non-alcoholic fatty liver disease (NAFLD). Our study aimed to compare DPI in patients with NAFLD and the control group. METHODS: This is a case-control study of 250 subjects with NAFLD and 450 healthy subjects attending the Metabolic Liver Disease Research Center as a referral center affiliated to Isfahan University of Medical Sciences. DPI was calculated based on data collected from a 168-item validated food frequency questionnaire. Sociodemographic data, physical activity, and anthropometric measures such as body weight, height, and waist circumference were determined. RESULTS: In the final adjusted model, the odds ratio (OR) of NAFLD across the DPI tertiles decreased significantly (OR = 0.55, 95 %CI = 0.31-0.95) (P-trend = 0.03). The highest vs. lowest tertiles of vegetable and olives PI were significantly associated with a lower risk of NAFLD (OR and 95 % CI = 0.26 (0.14-0.47); OR and 95 % CI = 0.51 (0.29-0.90), p for trend < 0.001, respectively), however, there was no significant relation between other PI components and NAFLD. CONCLUSION: This case-control study suggested that a higher PI score is associated with a reduced chance of NAFLD after adjusting for confounding variables. In addition, the highest tertile of vegetable and olives PI was significantly associated with a lower risk of NAFLD.

Wheat germ improves hepatic steatosis, hepatic enzymes, and metabolic and inflammatory parameters in patients with nonalcoholic fatty liver disease: A randomized, placebo-controlled, double-blind clinical trial.

Globally, Non-alcoholic fatty liver disease (NAFLD) has a rising prevalence with no definitive pharmacological treatments. The aim of this study was to assess the clinical effects of wheat germ in patients with NAFLD. Fifty participants with NAFLD were randomly allocated to take 40 g wheat germ (n = 25) or placebo (n = 25) in a randomized double-blind clinical trial over 12 weeks. Transient elastography (FibroScan) determined a diagnosis of NAFLD. After 12 weeks of intervention, reduction in serum alanine aminotransferase (p = 0.006) and γ-glutamyltransferase (p = 0.004), total cholesterol (p = 0.018), triglyceride (p = 0.046), and hepatic steatosis (p = 0.043) levels in the wheat germ group was significantly higher compared to the placebo group. Serum TAC levels in wheat germ group patients increased significantly higher than placebo group (p = 0.001). Reduction in serum hs-CRP level in the wheat germ group was significantly higher than in the placebo group (p = 0.031). In conclusion, our study shows that wheat germ consumption may improve total antioxidant capacity, hepatic steatosis, serum total cholesterol and triglyceride levels, alanine aminotransferase (ALT), and Gamma-glutamyl Transferase (GGT) in NAFLD patients. Longitudinal studies with larger sample sizes are needed to confirm biological effects of wheat germ on NAFLD patients.

The association between dietary inflammation scores and non-alcoholic fatty liver diseases in Iranian adults.

BACKGROUND: Potential dietary inflammation can precursor chronic diseases such as hepatic disorders. We aimed to examine the association of empirical dietary inflammatory patterns (EDIP) and dietary inflammation scores (DIS) with the risk of nonalcoholic fatty liver diseases (NAFLD) in Iranian adults. METHODS: This case-control study was conducted on 225 newly diagnosed NAFLD cases and 450 controls aged 20-60 years. The individuals' dietary data were collected using a validated food frequency questionnaire. The detection of NAFLD in subjects was done using the ultrasonography scan of the liver and confirmation of gastroenterologists. To calculate of EDIP score, the average daily intakes of each item (15 food items) were multiplied by the proposed weights, and then all the weighted values were summed. Also, to calculate the DIS score, each food item (18 food items) is multiplied by its specific weight to obtain the weighted values of each item. The weighted values were then standardized using the Z-score. Finally, the standardized weighted values of all the items were summed to get the overall DIS score for the individuals. Logistic regression models, adjusted for potential confounders, were used to estimate the odds ratios and 95% confidence interval (CI) of NAFLD across tertiles of EDIP and DIS. RESULTS: The mean (SD) age and BMI of the study population (53% male) were 38.1 (8.8) years and 26.8 (4.3) kg/m2, respectively. The median (IQR) of EDIP and DIS scores in individuals were 0.52 (0.34, 0.73), and 0.04 (- 0.55, 0.59), respectively. Based on the multivariable-adjusted model, after controlling for age, sex, physical activity, smoking, marital status, waist-to-hip ratio, and dietary energy intake, individuals in the second (OR 2.01, 95% CI 1.07-3.76) and third tertiles of DIS (OR 2.54, 95% CI 1.39-4.63) had a higher odds of NAFLD compared to the lowest tertile of DIS (Ptrend = 0.003). Also, in the final model, there is a significant direct association between EDIP score and odds of NAFLD [(OR T2 vs. T1 = 0.88, 95% CI 0.50-1.57) and (OR T3 vs. T1 = 1.82, 95% CI 1.02-3.23)], (Ptrend = 0.031). CONCLUSION: Our results suggested that higher scores of EDIP and DIS, indicating the high inflammatory potential of dietary pattern, are associated with increased odds of NAFLD in Iranian adults.

Does propolis have any effect on rheumatoid arthritis? A review study.

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which inflammation and oxidative stress play a key role in its pathophysiology. Complementary therapies along with medications may be effective in the control of RA. Propolis is a natural substance extracted from beehives, which have confirmed anti-inflammatory and antioxidant effects. The present study aimed to review the possible effects of propolis on inflammation, oxidative stress, and lipid profile in patients with RA. English articles in online databases such as PubMed­Medline, AMED, Google Scholar, EMBASE, Scopus, and Web of Science databases were searched. Pieces of evidence show that supplementation with propolis may have therapeutic effects on RA patients. Due to increased inflammation and oxidative stress in the affected joints of RA patients, propolis could inhibit the inflammatory cascades by inhibiting the nuclear factor kappa B pathway and reducing reactive oxygen species, malondialdehyde, and interleukin-17 by increasing some antioxidants. Therefore, inflammation and pain reduce, helping improve and control RA in patients. Further investigations are required with larger sample sizes and different doses of propolis to demonstrate the definite effects of propolis on various aspects of RA.

Dietary acid load and risk of type 2 diabetes mellitus: A case-control study.

AIM: The present study aimed to investigate the association between dietary acid load and the risk of type 2 diabetes (T2D) in Iranian adults. METHODS: This was a case-control study including 125 newly diagnosed T2D patients as cases and 190 healthy individuals as controls. A 168-item semi-quantitative food frequency questionnaire was applied to collect the participant's dietary intake information. Potential renal acid load (PRAL), net endogenous acid production (NEAP), protein/potassium ratio, animal protein/potassium ratio, and plant protein/potassium ratio were derived from the nutrient intake. RESULTS: We found that higher PRAL and NEAP scores are positively associated with the chance of T2D in the unadjusted model. Such that, when multiple potential confounders were taken into account, participants in the highest tertile of PRAL (OR: 4.37; 95% CI: 1.35-14.18) and NEAP score (OR: 2.24; 95% CI: 1.01-7.03) had a greater risk of T2D. No significant association was found between other indices including total protein/potassium ratio, animal protein/potassium ratio, and plant protein/potassium ratio, and T2D risk. CONCLUSION: The present findings suggest that high dietary acid load could be associated with the risk of T2D disease.

The effect of spirulina on type 2 diabetes: a systematic review and meta-analysis.

PURPOSE: The aim of the present study was to investigate the effect of spirulina on lipid profiles and glycemic related markers in type 2 diabetes patients. METHODS: PubMed, Scopus, Cochrane Library, ISI Web of Science, and Google Scholar were searched from inception to August 2020. All clinical trials which investigated the effect of spirulina supplementation on glycemic related markers and lipid profile among type 2 diabetes patients were included. Random effects modeling was utilized for pooling analysis to compensate for the between-study heterogeneity. RESULTS: Eight studies (9 arms) were included in the meta-analysis. We found a significant reduction in fasting blood glucose (-17.88 mg/dl; 95% CI: -26.99, -8.78; I 2 : 25%), triglyceride (-30.99 mg/dl; 95% CI: -45.20, -16.77; I 2 : 50%), total-cholesterol (-18.47 mg/dl; 95% CI: -33.54, -3.39; I 2 : 73%), LDL-C (-20.04 mg/dl; 95% CI: -34.06, -6.02; I 2 : 75%), VLDL (-6.96 mg/dl; 95% CI: -9.71, -4.22; I 2 : 33%), in addition to a significant increase in HDL-C (-6.96 mg/dl; 95% CI: -9.71, -4.22; I 2 : 33%), after spirulina administration. No significant effect was observed on HbA1C or post prandial blood sugar following spirulina consumption. CONCLUSION: The present study suggests that spirulina supplementation can elicit beneficial effects on fasting blood glucose and blood lipid profiles. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-021-00760-z.

Spinach consumption and nonalcoholic fatty liver disease among adults: a case-control study.

BACKGROUND: Spinach has high antioxidants and polyphenols and showed protective effects against liver diseases in experimental studies. We aimed to assess the association between dietary intake of spinach and odds of nonalcoholic fatty liver disease (NAFLD) in a case-control study among Iranian adults. METHODS: Totally 225 newly diagnosed NAFLD patients and 450 controls, aged 20-60 years, were recruited in this study. Participants' dietary intakes were collected using a valid and reliable 168-item semi-quantitative food frequency questionnaire (FFQ). The logistic regression test was used for assessing the association between total, raw, and boiled dietary spinach with the odds of NAFLD. RESULTS: The mean (SD) age and BMI of participants (53% male) were 38.1 (8.8) years and 26.8 (4.3) kg/m2, respectively. In the final adjusted model for potential confounders, the odds (95% CI) of NAFLD in individuals in the highest tertile of daily total and raw spinach intake was [0.36 (0.19-0.71), P_trend = 0.001] and [0.47 (0.24-0.89), P_trend = 0.008], respectively compared with those in the lowest tertile. Furthermore, in the adjusted analyses, an inverse association was observed between the highest yearly intake versus no raw spinach consumption and odds of NAFLD [(OR 0.41; 95% CI 0.18-0.96), P for trend = 0.013]. However, there was no significant association between higher boiled spinach intake and odds of NAFLD. CONCLUSIONS: The present study found an inverse association between total and raw spinach intake with the odds of NAFLD.

Dietary patterns and risk of non-alcoholic fatty liver disease.

BACKGROUND: Nutrition is a modifiable risk factor that plays an important role in the prevention or delaying of the onset of non-alcoholic fatty liver disease (NAFLD). Previous studies have focused on NAFLD and individual nutrients, which does not take into account combinations of food that are consumed. Therefore, we aimed to investigate the relationship between major dietary patterns and NAFLD. METHODS: This case-control study was conducted on 225 newly diagnosed NAFLD patients and 450 healthy controls. Usual dietary intake over the preceding year was assessed using a validated 168-item semi-quantitative food frequency questionnaire. Major dietary patterns were determined by exploratory factor analysis. RESULTS: Three dietary patterns, including "western dietary pattern", "healthy dietary pattern", and "traditional dietary pattern" were identified. Subjects in the highest tertile of healthy dietary pattern scores had a lower odds ratio for NAFLD than those in the lowest tertile. Compared with those in the lowest tertile, people in the highest tertile of "western dietary pattern" scores had greater odds for NAFLD. After adjusting for potential confounding factors, "western dietary pattern" had a positive significant effect on NAFLD occurrence. In contrast, "healthy dietary pattern" was associated with a decreased risk of NAFLD. Furthermore, Higher consumption of the "traditional dietary pattern" was significantly associated with NAFLD, albeit in the crude model only. CONCLUSION: This study indicated that healthy and western dietary patterns may be associated with the risk of NAFLD. The results can be used for developing interventions in order to promote healthy eating for the prevention of NAFLD.

Dietary polyphenols and the odds of non-alcoholic fatty liver disease: A case-control study.

OBJECTIVES: Few epidemiological data are available regarding the associations of dietary intakes of polyphenols with non-alcoholic fatty liver disease (NAFLD). We sought to examine the associations of dietary intake of polyphenols with the prevalence of NAFLD. METHODS: We analyzed data from a case-control study of 225 patients with NAFLD cases and 450 controls. All participants completed a validated 168-item food frequency questionnaire, the results of which were subsequently used to calculate dietary polyphenol. RESULTS: Based on multivariate logistic regression analysis, after adjustment for age and sex, it was shown that participants who were in the highest tertile of total flavonoids (OR = 0.65, 95% CI = 0.44-0.98) and total phenolic acids (OR = 0.63, 95% CI = 0.42-0.94) were associated with a lower odds of NAFLD compared with the lowest tertile. Although the association of total flavonoids and the odds of NAFLD disappeared after additional adjustment for BMI, physical activity, smoking, SES, dietary fat, and energy intake (OR = 0.67, 95% CI = 0.38-1.19). The odds of NAFLD was 66% lower (OR = 0.44, CI = 0.24-0.78, p for trend = 0.006) among participants who were in the highest tertile of lignans intake compared with the lowest tertile. CONCLUSION: Our study showed that a high intake of lignans lowers the odds of NAFLD. We strongly recommend that the concepts proposed in this study must be tested in future longitudinal researches, to determine the association of total and subgroup of polyphenol intake with different stages of fatty liver diseases.

Serum Vitamin D Levels and Risk of Liver Cancer: A Systematic Review and Dose-Response Meta-Analysis of Cohort Studies.

Data regarding the relationship between serum vitamin D levels and the risk of liver cancer are conflicting. Therefore, we performed a systematic review and dose-response meta-analysis of all available data of cohort studies on the association of 25-OH-vitamin-D levels with the risk of hepatocellular carcinoma. We conducted a systematic search in PubMed-MEDLINE, Scopus, Cochrane and Web of Science databases for prospective observational studies conducted on the general population from inception to May 2019. Six studies provided data from 6357 participants. According to the pooled HR, the subjects with the highest serum concentrations of vitamin D had a 47% lower risk of liver cancer vs. the subjects with the lowest serum concentrations of vitamin D (pooled HR: 0.53, 95% CI: 0.41-0.68; P < 0.001). There was no significant heterogeneity among the studies (P = 0.431, I2 = 0.0). The pooled HR from the random-effects dose-response model indicated an indirect significant linear association between vitamin D and the risk of liver cancer (coef = -0.017, P < 0.001). However, there was no significant nonlinear dose-response association between serum vitamin D and the risk of liver cancer (coef = -0.0001, P = 0.342). The evidence from this meta-analysis suggests that there may be an inverse relationship between serum vitamin D levels and the risk of liver cancer.

A healthy dietary pattern may be associated with primary insomnia among Iranian adults: A case-control study.

Objective: While it has been reported that both foods and nutrients for individuals are connected with sleep, there is no evidence regarding the association of dietary patterns, identified by factor analysis, with primary insomnia. The present study sought to evaluate the association between major dietary patterns and the chance of having primary insomnia. Methods: The present case-control study was performed using 444 people (111 cases and 333 control), aged 18 to 60 years, referred to Isfahan health centers. Dietary intake was assessed via a food frequency questionnaire in a case-control study in Isfahan, Iran. Principal component analysis was used to determine major dietary patterns. The presence of primary insomnia was measured via the insomnia severity index questionnaire, and the subjects were grouped as healthy or insomniac. Results: Three major dietary patterns were recognized, and named; Western, Iranian Traditional and Healthy, respectively. The cumulative percentage of variance explained by three dietary patterns was 48.2%. Those in second (OR = 0.30; 95%CI: 0.2-0.46) and third (OR = 0.22; 95%CI: 0.15-0.35) tertiles of healthy dietary pattern were less likely suffer with insomnia. This association remained significant only in the highest tertile after adjusting potential confounders (OR = 0.45; 95%CI: 0.32-0.95). We found no significant association between greater adherence to Western or Iranian traditional dietary patterns and primary insomnia. Conclusions: The findings showed that although no statistically significant association was observed between both Western and Iranian traditional dietary patterns with primary insomnia, people with greater adherence to the healthy dietary pattern are less likely to have primary insomnia.

The Association Between Dietary Intake of Sodium, Potassium, and Na:K Ratio with the Risk of NAFLD: A Case-Control Study Among Iranian Adults.

Backgrounds: Dietary sodium (Na) and potassium (K) relationship with chronic disease has drawn more attention recently. Epidemiological studies reported controversial findings about high salt and Na diets with the risk of nonalcoholic fatty liver disease (NAFLD) and studies about the association between K and NAFLD are scare. Present study aimed to examine the associations between dietary intake of Na, K, and Na:K ratio with the risk of NAFLD. Methods: We analyzed data from a case-control study of 225 patients with NAFLD cases and 450 controls. Dietary intake of Na and K measured using a validated 168 item food frequency questionnaire. Adjusted logistic regression models were used to report odds ratio (OR) 95% confidence interval (CI) of NAFLD across tertiles of Na, K, and Na:K ratio. Results: The mean ± standard deviation of age and body mass index of participants (47% female) were 38.1 ± 8.8 years and 26.8 ± 4.3 Kg/m2. In the age- and sex-adjusted model, there was any significant association between Na, K, and Na: K ratio with the risk of NAFLD. In the final adjusted model, the OR (95%CI) of the highest vs the lowest tertiles of K, Na, and Na:K was 0.39 (0.19-0.80), 0.71 (0.40-1.25), and 1.10 (0.61-1.97), respectively. Conclusion: The present study indicates that higher dietary K was related to lower odds of NAFLD; however, there was no association between dietary Na and Na: K ratio with odds of NAFLD.