A new study published in The Journal of Nutrition demonstrated associations of higher diet quality scores with favorable hepatic fat and fibrosis measures, suggesting that healthy diet may reduce the progression of liver disease.

The rise in the prevalence of nonalcoholic fatty liver disease (NAFLD) parallels the rise in obesity. Higher diet quality is associated with a lower risk of NAFLD, which comprises a spectrum of pathological disorders including risk of liver-related events. Early detection and lifestyle modification are crucial for NAFLD prevention and early intervention. However, liver biopsies remain the gold standard method to evaluate fibrosis, which may not always be feasible due to cost, invasiveness, and poor patient acceptance. An alternative noninvasive technique, vibration-controlled transient elastography (VCTE) can be used to measure hepatic fat and fibrosis with good accuracy for identifying early compared with advanced stages of fibrosis. However, studies designed to comprehensively examine the relationship between diet quality and VCTE-derived hepatic fibrosis measures are limited. 

To bridge this knowledge gap, Ma (Tufts University) and colleagues conducted a cross-sectional association analysis to examine the relationship between multiple diet quality scores and hepatic fibrosis assessed using VCTE in well-established community-based studies – the Framingham Heart Study (FHS) and the National Health and Nutrition Examination Surveys (NHANES). To provide a more reliable estimation of the relationship between diet quality and hepatic fibrosis measures, a meta-analysis of combined data was conducted.

To assess dietary quality, cross-sectional associations between 3 dietary quality scores – the Dietary Approaches to Stop Hypertension score, the Alternative Healthy Eating Index, and a modified Mediterranean-style – were analyzed. Hepatic fat and fibrosis were measured by VCTE in 2532 FHS participants and 3295 participants of the NHANES.

Study results demonstrated an inverse association between diet quality scores and hepatic fat and fibrosis measures in adults using data from both independent sources – FHS and NHANES. Data also showed that adjustment for hepatic fat and body mass index substantially reduced the association strength between diet quality scores and hepatic fibrosis measures, which suggests that hepatic fat and general adiposity explain a large proportion of the association between diet quality and hepatic fibrosis. Taken together, these observations suggest that improved diet quality may reduce excessive hepatic fat accumulation and its progression to hepatic fibrosis. 


Gao V, Long MT, Singh SR, Kim Y, Zhang X, Rogers G, Jacques PF, Levy D, Ma J. A Healthy Diet is Associated with a Lower Risk of Hepatic Fibrosis. The Journal of Nutrition, Volume 153, Issue 5, May 2023, Pages 1587-1596, doi.org/10.1016/j.tjnut.2023.03.038

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