Association between ultra-processed foods consumption and risk of non-alcoholic fatty liver disease: a population-based analysis of NHANES 2011-2018
Abstract
Abstract An increasing number of studies have evaluated the association between ultra-processed foods (UPF) consumption and metabolic disorders. However, the association between UPF intake and non-alcoholic fatty liver disease (NAFLD) remains unclear. In this study, we analysed data from 6545 participants who were recruited in National Health and Nutrition Examination Surveys 2011–2018. UPF were defined in light of the NOVA food classification system and divided into quartiles based on its proportion of total weight intake. Complex logistic regression models were used to assess the association between UPF and NAFLD. Mediation analyses were conducted to reveal underlying mediators. We found that NAFLD patients consumed more UPF than controls (925·92 ± 18·08v. 812·70 ± 14·32 g/d,P< 0·001). Dietary intake of UPF (% weight) was negatively related to the Healthy Eating Index-2015 score (Spearmanr= −0·32,P< 0·001). In the multivariable model, the highest quartile compared with the lowest, the OR (95 % CI) were 1·83 (1·33, 2·53) for NAFLD (OR per 10 % increment: 1·15; 95 % CI: 1·09, 1·22;Pfor trend < 0·001) and 1·52 (1·12, 2·07) for insulin resistance (OR per 10 % increment: 1·11; 95 % CI: 1·05, 1·18;Pfor trend = 0·002). Mediation analyses revealed that poor diet quality, high saturated fat and refined grain intake partly mediated the association between UPF and NAFLD. In conclusion, high UPF intake was associated with an increased risk of NAFLD in US adults. Further prospective studies are needed to verify these findings.
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The Mediterranean diet advocates the reduction of sugars and refined carbohydrates, saturated fat, ultra-processed foods, and red and processed meat, which are all related to MASLD risk in observational studies.
“Notably, the Mediterranean diet advocates the reduction of sugars and re fi ned carbohydrates, saturated fat, ultra-processed foods, and red and processed meat, which are all related to MASLD risk in observational studies. 104,284,299 -301”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [301]
Cites
Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention
Younossi, Z., Anstee, Q. M., Marietti, M., Hardy, T., Henry, L., Eslam, M., George, J., & Bugianesi, E. (2018) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2017.109 · Cited by 5,249 · see citing works
EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease
(2016) · Journal of Hepatology · doi:10.1016/j.jhep.2015.11.004 · Cited by 4,836 · see citing works
The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing
Monteiro, C. A., Cannon, G., Moubarac, J.-C., Levy, R. B., Louzada, M. L. C., & Jaime, P. C. (2018) · Public Health Nutrition · doi:10.1017/s1368980017000234 · Cited by 2,333 · see citing works
Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome
Chassaing, B., Koren, O., Goodrich, J. K., Poole, A. C., Srinivasan, S., Ley, R. E., & Gewirtz, A. T. (2015) · Nature · doi:10.1038/nature14232 · Cited by 2,055 · see citing works
Hall, K. D., Ayuketah, A., Brychta, R., Cai, H., Cassimatis, T., Chen, K. Y., Chung, S. T., Costa, E., Courville, A., Darcey, V., et al. (2019) · Cell Metabolism · doi:10.1016/j.cmet.2019.05.008 · Cited by 1,971 · see citing works
Ultra‐processed products are becoming dominant in the global food system
Monteiro, C. A., Moubarac, J. ‐., Cannon, G., Ng, S. W., & Popkin, B. (2013) · Obesity Reviews · doi:10.1111/obr.12107 · Cited by 1,827 · see citing works
Treatment of NAFLD with diet, physical activity and exercise
Romero-Gómez, M., Zelber-Sagi, S., & Trenell, M. (2017) · Journal of Hepatology · doi:10.1016/j.jhep.2017.05.016 · Cited by 1,347 · see citing works
Hill, J. O., Wyatt, H. R., & Peters, J. C. (2012) · Circulation · doi:10.1161/circulationaha.111.087213 · Cited by 1,317 · see citing works
The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe
Younossi, Z. M., Blissett, D. B., Blissett, R., Henry, L. L., Stepanova, M., Younossi, Y., Racila, A., Hunt, S., & Beckerman, R. (2016) · Hepatology · doi:10.1002/hep.28785 · Cited by 1,289 · see citing works
Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome
Yki‐Järvinen, H. (2014) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(14)70032-4 · Cited by 1,260 · see citing works
Vessby, B., Uusitupa, M., Hermansen, K., Riccardi, G., Rivellese, A. A., Tapsell, L. C., Nälsén, C., Berglund, L., Louheranta, A., Rasmussen, B. M., et al. (2001) · Diabetologia · doi:10.1007/s001250051620 · Cited by 1,119 · see citing works
Consumption of ultra-processed foods and health status: a systematic review and meta-analysis
Pagliai, G., Dinu, M., Madarena, M. P., Bonaccio, M., Iacoviello, L., & Sofi, F. (2020) · British Journal Of Nutrition · doi:10.1017/s0007114520002688 · Cited by 1,031 · see citing works
Ahluwalia, N., Dwyer, J., Terry, A. L., Moshfegh, A., & Johnson, C. L. (2016) · Advances in Nutrition · doi:10.3945/an.115.009258 · Cited by 983 · see citing works
Srour, B., Fezeu, L. K., Kesse-Guyot, E., Allès, B., Méjean, C., Andrianasolo, R. M., Chazelas, E., Deschasaux, M., Hercberg, S., Galan, P., et al. (2019) · BMJ · doi:10.1136/bmj.l1451 · Cited by 955 · see citing works
Fructose and sugar: A major mediator of non-alcoholic fatty liver disease
Jensen, T., Abdelmalek, M. F., Sullivan, S. A., Nadeau, K. J., Cree‐Green, M., Roncal, C., Nakagawa, T., Kuwabara, M., Sato, Y., Kang, D., et al. (2018) · Journal of Hepatology · doi:10.1016/j.jhep.2018.01.019 · Cited by 952 · see citing works
Martínez Steele, E., Baraldi, L. G., Louzada, M. L. D. C., Moubarac, J.-C., Mozaffarian, D., & Monteiro, C. A. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-009892 · Cited by 838 · see citing works
Evaluation of the Healthy Eating Index-2015
Reedy, J., Lerman, J. L., Krebs-Smith, S. M., Kirkpatrick, S. I., Pannucci, T. E., Wilson, M. M., Subar, A. F., Kahle, L. L., & Tooze, J. A. (2018) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2018.05.019 · Cited by 822 · see citing works
Ultra-Processed Foods and Health Outcomes: A Narrative Review
Elizabeth, L., Machado, P. P., Zinöcker, M. K., Baker, P., & Lawrence, M. A. (2020) · Nutrients · doi:10.3390/nu12071955 · Cited by 740 · see citing works
Role of Dietary Fructose and Hepatic De Novo Lipogenesis in Fatty Liver Disease
Softic, S., Cohen, D. E., & Kahn, C. R. (2016) · Digestive Diseases and Sciences · doi:10.1007/s10620-016-4054-0 · Cited by 709 · see citing works
The Liver as an Endocrine Organ—Linking NAFLD and Insulin Resistance
Watt, M. J., Miotto, P. M., De Nardo, W., & Montgomery, M. K. (2019) · Endocrine Reviews · doi:10.1210/er.2019-00034 · Cited by 615 · see citing works
Martínez Steele, E., Popkin, B. M., Swinburn, B., & Monteiro, C. A. (2017) · Population Health Metrics · doi:10.1186/s12963-017-0119-3 · Cited by 585 · cited 1× · see citing works
“used principal component analysis and identified that UPF were poorer in fibre, potassium, magnesium and vitamin C and had more saturated fat and added sugars(54).”
MethodMendonça, R. D. D., Lopes, A. C. S., Pimenta, A. M., Gea, A., Martinez-Gonzalez, M. A., & Bes-Rastrollo, M. (2017) · American Journal of Hypertension · doi:10.1093/ajh/hpw137 · Cited by 488 · see citing works
Ultra-processed food consumption and excess weight among US adults
Juul, F., Martinez-Steele, E., Parekh, N., Monteiro, C. A., & Chang, V. W. (2018) · British Journal Of Nutrition · doi:10.1017/s0007114518001046 · Cited by 475 · see citing works
Srour, B., Fezeu, L. K., Kesse-Guyot, E., Allès, B., Debras, C., Druesne-Pecollo, N., Chazelas, E., Deschasaux, M., Hercberg, S., Galan, P., et al. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.5942 · Cited by 465 · cited 1× · see citing works
“There are also several cohort studies that reported a positive association of UPF intake with the risk of developing type 2 diabetes mellitus (13) , hypertension (14) , CVD (15) and all-cause mortality (16,17) .”
Ruhl, C. E., & Everhart, J. E. (2014) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13012 · Cited by 455 · see citing works
Luukkonen, P. K., Sädevirta, S., Zhou, Y., Kayser, B., Ali, A., Ahonen, L., Lallukka, S., Pelloux, V., Gaggini, M., Jian, C., et al. (2018) · Diabetes Care · doi:10.2337/dc18-0071 · Cited by 428 · see citing works
Fardet, A. (2016) · Food & Function · doi:10.1039/c6fo00107f · Cited by 356 · see citing works
Omega-3 Fatty Acids, Hepatic Lipid Metabolism, and Nonalcoholic Fatty Liver Disease
Scorletti, E., & Byrne, C. D. (2013) · Annual Review of Nutrition · doi:10.1146/annurev-nutr-071812-161230 · Cited by 326 · see citing works
Supra-Additive Effects of Combining Fat and Carbohydrate on Food Reward
DiFeliceantonio, A. G., Coppin, G., Rigoux, L., Thanarajah, S. E., Dagher, A., Tittgemeyer, M., & Small, D. M. (2018) · Cell Metabolism · doi:10.1016/j.cmet.2018.05.018 · Cited by 302 · see citing works
Zelber‐Sagi, S., Salomone, F., & Mlynarsky, L. (2017) · Liver International · doi:10.1111/liv.13435 · Cited by 273 · see citing works
Cho, Y., Kim, D., Seo, W., Gao, B., Yoo, S., & Song, B. (2019) · Hepatology · doi:10.1002/hep.30652 · Cited by 260 · see citing works
Oddy, W. H., Herbison, C. E., Jacoby, P., Ambrosini, G. L., O’Sullivan, T. A., Ayonrinde, O. T., Olynyk, J. K., Black, L. J., Beilin, L. J., Mori, T. A., et al. (2013) · The American Journal of Gastroenterology · doi:10.1038/ajg.2013.95 · Cited by 259 · see citing works
A review of total & added sugar intakes and dietary sources in Europe
Azaı̈s-Braesco, V., Sluik, D., Maillot, M., Kok, F. J., & Moreno, L. A. (2017) · Nutrition Journal · doi:10.1186/s12937-016-0225-2 · Cited by 258 · see citing works
Costa, C. S., Rauber, F., Leffa, P. D. S., Sangalli, C. N., Campagnolo, P. D. B., & Vítolo, M. R. (2018) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2018.11.003 · Cited by 255 · see citing works
Fructose and hepatic insulin resistance
Softic, S., Stanhope, K. L., Boucher, J., Divanovic, S., Lanaspa, M. A., Johnson, R. J., & Kahn, C. R. (2020) · Critical Reviews in Clinical Laboratory Sciences · doi:10.1080/10408363.2019.1711360 · Cited by 255 · see citing works
Birlouez‐Aragon, I., Saavedra, G., Tessier, F. J., Galinier, A., Ameur, L. A., Lacoste, F., Niamba, C.-N., Alt, N., Somoza, V., & Lecerf, J. (2010) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2009.28737 · Cited by 246 · see citing works
Kontogianni, M. D., Tileli, N., Margariti, A., Georgoulis, M., Deutsch, M., Tiniakos, D., Fragopoulou, E., Zafiropoulou, R., Manios, Y., & Papatheodoridis, G. (2014) · Clinical Nutrition · doi:10.1016/j.clnu.2013.08.014 · Cited by 221 · see citing works
Aljahdali, N. H., & Carbonero, F. G. (2017) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2017.1378865 · Cited by 216 · see citing works
Hyogo, H., Yamagishi, S., Iwamoto, K., Arihiro, K., Takeuchi, M., Sato, T., Ochi, H., Nonaka, M., Nabeshima, Y., Inoue, M., et al. (2007) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2007.04943.x · Cited by 188 · see citing works
The NOVA classification system: A critical perspective in food science
Petrus, R. R., Sobral, P. J. D. A., TADINI, C. C., & Gonçalves, C. B. (2021) · Trends in Food Science & Technology · doi:10.1016/j.tifs.2021.08.010 · Cited by 185 · see citing works
Moradi, S., Entezari, M. H., Mohammadi, H., Jayedi, A., Lazaridi, A.-V., Kermani, M. A. H., & Miraghajani, M. S. (2021) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2021.1946005 · Cited by 164 · see citing works
Scorletti, E., & Byrne, C. D. (2018) · Molecular Aspects of Medicine · doi:10.1016/j.mam.2018.03.001 · Cited by 161 · see citing works
Effect of diet-derived advanced glycation end products on inflammation
Kellow, N. J., & Coughlan, M. T. (2015) · Nutrition Reviews · doi:10.1093/nutrit/nuv030 · Cited by 154 · see citing works
Serum advanced glycation end products (AGEs) are associated with insulin resistance
Tan, K. C. B., Shiu, S. W. M., Wong, Y., & Tam, X. (2011) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.1188 · Cited by 111 · see citing works
Eslamparast, T., Tandon, P., & Raman, M. (2017) · Nutrients · doi:10.3390/nu9080800 · Cited by 108 · see citing works
Longitudinal associations between ultra-processed foods and blood lipids in childhood
Leffa, P. D. S., Hoffman, D. J., Rauber, F., Sangalli, C. N., Valmórbida, J. L., & Vítolo, M. R. (2020) · British Journal Of Nutrition · doi:10.1017/s0007114520001233 · Cited by 92 · see citing works
Back to the future: The Mediterranean diet paradigm
Naska, A., & Trichopoulou, A. (2013) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2013.11.007 · Cited by 89 · see citing works
Riazi, K., Raman, M., Taylor, L., Swain, M. G., & Shaheen, A. A. (2019) · Nutrients · doi:10.3390/nu11122878 · Cited by 83 · see citing works
Chen, X., Chu, J., Hu, W., Sun, N., He, Q., Liu, S., Feng, Z., Li, T., Han, Q., & Shen, Y. (2022) · European Journal of Public Health · doi:10.1093/eurpub/ckac104 · Cited by 71 · see citing works
Kim, D., Yoo, E. R., Li, A. A., Cholankeril, G. T., Tighe, S. P., Kim, W. K., Harrison, S. A., & Ahmed, A. (2019) · Liver International · doi:10.1111/liv.14110 · Cited by 66 · see citing works
Konieczna, J., Fiol, M., Colom, A., Martínez‐González, M. Á., Salas‐Salvadó, J., Corella, D., Soria-Florido, M. T., Martínez, J. A., Alonso‐Gómez, Á. M., Wärnberǵ, J., et al. (2022) · Nutrients · doi:10.3390/nu14194142 · Cited by 42 · see citing works
Liu, Z., Wang, J., Chen, S., Xu, C., & Zhang, Y. (2021) · Environmental Health · doi:10.1186/s12940-021-00783-2 · Cited by 12 · see citing works
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- Authors
- Liu, Z., Huang, H., Zeng, Y., Chen, Y., & Xu, C.
- Affiliations
- First Affiliated Hospital Zhejiang University (CN)
- Corresponding author
- Xu, Chengfu
- Venue
- British Journal Of Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2022-12-16
- Volume
- 130
- Issue
- 6
- Pages
- 996-1004
- ISSN
- 0007-1145 (ISSN-L)
- 1475-2662
- OpenAlex
- W4311670225
- Cited by
- 32
- References
- 52
- Citations by year
- 2026: 6 · 2025: 17 · 2024: 6 · 2023: 3
- FWCI
- 5.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal Of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- ultra-processed foods, non-alcoholic fatty liver disease, NOVA classification, insulin resistance, diet quality, saturated fat intake, Healthy Eating Index-2015, mediation analysis, NHANES
- MeSH terms
- Food, Processed, Adult, Energy Intake, Diet, Food Handling, Humans, Nutrition Surveys, Fast Foods, Non-alcoholic Fatty Liver Disease
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