Ultra-processed food consumption and the risk of non-alcoholic fatty liver disease in the tianjin chronic low-grade systemic inflammation and health cohort study
Abstract
BACKGROUND: Growing evidence supports a link between ultra-processed food consumption and human health outcomes. However, the association between ultra-processed food consumption and non-alcoholic fatty liver disease (NAFLD) is not known. We aimed to explore the association between ultra-processed food consumption and risk of NAFLD. METHODS: The prospective study included 16 168 participants aged 18-90 years from the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study. Information on ultra-processed food consumption was collected at baseline using a validated food frequency questionnaire. NAFLD was defined as the presence of sonographic fatty liver in the absence of significant alcohol intake (≥210 g/week for men and ≥140 g/week for women, respectively) and other liver diseases. Multivariable Cox proportional hazards models were used to examine the association between ultra-processed food consumption and risk of NAFLD. RESULTS: During 56 935 person-years of follow-up, we documented 3752 incident NAFLD cases. After adjusting for age, sex, body mass index, smoking, alcohol drinking, education, occupation, income, physical activity, total energy intake, personal and family history of disease and overall diet quality, the multivariable hazard ratios (95% confidence interval) of NAFLD across increasing quartiles of ultra-processed food consumption were 1.00 (reference), 0.99 (0.90, 1.08), 1.13 (1.03, 1.25) and 1.18 (1.07, 1.30), respectively (P for trend <0.0001). The hazard ratio (95% confidence interval) per one standard deviation increase in ultra-processed food consumption, equivalent to a 62.7 g/1000 kcal per day, was 1.06 (1.03, 1.09), P = 0.0001. CONCLUSIONS: Our study indicates that higher ultra-processed food consumption is associated with a higher risk of NAFLD. This finding suggests that ultra-processed food, which is widely consumed worldwide, might be a modifiable dietary target to reduce the risk of NAFLD.
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Observational prospective studies show an inverse association of MASLD development with the Mediterranean diet or similar healthy dietary patterns, and a direct association with unhealthy patterns.
“Observational prospective studies show an inverse association of MASLD development with the Mediterranean diet or similar healthy dietary patterns, 102,103 and a direct association with unhealthy patterns.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [104]
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 [104]
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- Authors
- Zhang, S., Gan, S., Zhang, Q., Liu, L., Meng, G., Yao, Z., Wu, H., Gu, Y., Wang, Y., Zhang, T., Wang, X., Sun, S., Wang, X., Zhou, M., Jia, Q., Song, K., Qi, L., & Niu, K.
- Affiliations
- Tianjin Medical University (CN)
- Tianjin Medical University General Hospital (CN)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Tulane University (US)
- Corresponding author
- Niu, Kaijun
- ORCID
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-09-16
- Volume
- 51
- Issue
- 1
- Pages
- 237-249
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- OpenAlex
- W3200619739
- Cited by
- 113
- References
- 48
- Citations by year
- 2026: 18 · 2025: 33 · 2024: 23 · 2023: 22 · 2022: 15 · 2021: 2
- FWCI
- 13.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81941024, 91746205, 81872611, 81673166)
- National Key Research and Development Project-Study on Diet and Nutrition Assessment and Intervention Technology (2020YFC2006300)
- National Health Commission of China (SPSYYC 2020015)
- Nutrition Research Foundation—DSM Research Fund (2016-046, 2014-071, 2016-023)
- 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, dietary risk factors, food processing, diet quality
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Diet, Female, Humans, Inflammation, Male, Middle Aged, Prospective Studies, Risk Factors, Cohort Studies, Young Adult, Non-alcoholic Fatty Liver Disease
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