Association of dietary macronutrient composition and non-alcoholic fatty liver disease in an ageing population: the Rotterdam Study

Louise Jm Alferink; Jessica C Kiefte-de Jong; Nicole S Erler; Bart J Veldt; Josje D Schoufour; Robert J de Knegt; M Arfan Ikram; Herold J Metselaar; Harry LA Janssen; Oscar H Franco; Sarwa Darwish Murad

doi:10.1136/gutjnl-2017-315940

Association of dietary macronutrient composition and non-alcoholic fatty liver disease in an ageing population: the Rotterdam Study

Gut. 2019 Jun;68(6):1088-1098. doi: 10.1136/gutjnl-2017-315940. Epub 2018 Jul 31.

Authors

Affiliations

¹ Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
² Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
³ Department of Global Public Health, Leiden University College, The Hague, The Netherlands.
⁴ Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
⁵ Department of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, The Netherlands.
⁶ Toronto Centre of Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

PMID: 30064987
DOI: 10.1136/gutjnl-2017-315940

Abstract

Objective: A healthy lifestyle is the first-line treatment in non-alcoholic fatty liver disease (NAFLD), but specific dietary recommendations are lacking. Therefore, we aimed to determine whether dietary macronutrient composition is associated with NAFLD.

Design: Participants from the Rotterdam Study were assessed on (1) average intake of macronutrients (protein, carbohydrate, fat, fibre) using a Food Frequency Questionnaire and (2) NAFLD presence using ultrasonography, in absence of excessive alcohol, steatogenic drugs and viral hepatitis. Macronutrients were analysed using the nutrient density method and ranked (Q1-Q4). Logistic regression analyses were adjusted for sociodemographic, lifestyle and metabolic covariates. Moreover, analyses were adjusted for and stratified by body mass index (BMI) (25 kg/m²). Also, substitution models were built.

Results: In total, 3882 participants were included (age 70±9, 58% female). NAFLD was present in 1337 (34%) participants of whom 132 were lean and 1205 overweight. Total protein was associated with overweight NAFLD after adjustment for sociodemographic and lifestyle covariates (OR_Q4vsQ1 1.40; 95% CI 1.11 to 1.77). This association was driven by animal protein (OR_Q4vsQ1 1.54; 95% CI 1.20 to 1.98). After adjustment for metabolic covariates, only animal protein remained associated with overweight NAFLD (OR_Q4vsQ1 1.36; 95% CI 1.05 to 1.77). Monosaccharides and disaccharides were associated with lower overall NAFLD prevalence (OR_Q4vsQ1 0.66; 95% CI 0.52 to 0.83) but this effect diminished after adjustment for metabolic covariates and BMI. No consistent associations were observed for fat subtypes or fibre. There were no substitution effects.

Conclusion: This large population-based study shows that high animal protein intake is associated with NAFLD in overweight, predominantly aged Caucasians, independently of well-known risk factors. Contrary to previous literature, our results do not support a harmful association of monosaccharides and disaccharides with NAFLD.

Keywords: diet; epidemiology; fatty liver.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aging / metabolism*
Body Mass Index
Cohort Studies
Cross-Sectional Studies
Female
Healthy Lifestyle*
Humans
Logistic Models
Male
Micronutrients / administration & dosage*
Middle Aged
Netherlands
Non-alcoholic Fatty Liver Disease / diagnostic imaging
Non-alcoholic Fatty Liver Disease / diet therapy*
Overweight / complications*
Retrospective Studies
Risk Factors
Socioeconomic Factors
Ultrasonography, Doppler / methods

Substances

Micronutrients