Systematic Review and Meta-analysis: The Role of Diet in the Development of Nonalcoholic Fatty Liver Disease

Elena Tsompanaki; Kessarin Thanapirom; Margarita Papatheodoridi; Pathik Parikh; Yasmin Chotai de Lima; Emmanuel A Tsochatzis

doi:10.1016/j.cgh.2021.11.026

Systematic Review and Meta-analysis: The Role of Diet in the Development of Nonalcoholic Fatty Liver Disease

Clin Gastroenterol Hepatol. 2023 Jun;21(6):1462-1474.e24. doi: 10.1016/j.cgh.2021.11.026. Epub 2021 Nov 25.

Authors

Elena Tsompanaki¹, Kessarin Thanapirom², Margarita Papatheodoridi¹, Pathik Parikh¹, Yasmin Chotai de Lima¹, Emmanuel A Tsochatzis³

Affiliations

¹ UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom.
² UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom; Division of Gastroenterology, Department of Medicine, Liver Fibrosis and Cirrhosis Research Unit, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
³ UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom. Electronic address: e.tsochatzis@ucl.ac.uk.

PMID: 34838723
DOI: 10.1016/j.cgh.2021.11.026

Abstract

Background & aims: The association of nonalcoholic fatty liver disease (NAFLD) with dietary factors is well established but not thoroughly investigated. This systematic review and meta-analysis synthesizes available evidence regarding the effect of nutrition on the presence and severity of NAFLD.

Methods: A literature search was conducted identifying studies published between January 1985 and May 2021. We included studies with a dietary assessment and anthropometry based on validated tools, performed by a qualified dietitian or a trained health professional. We examined differences between patients with NAFLD and healthy controls as well as patients with NAFLD and nonalcoholic steatohepatitis (NASH). Risk of bias was assessed with the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool.

Results: There were 60 eligible studies with 100,621 patients. The risk of bias was moderate for the majority of studies (41/60; 68%). According to meta-analyses, total caloric intake was higher in patients with NAFLD compared with controls (mean difference, 78.08; 95% confidence interval, 41.03-115.13). Macronutrient (protein, fat, and carbohydrate) consumption as proportion of total caloric intake and daily intake of fiber, caffeine and vitamins E, A, and C did not significantly differ between patients with NAFLD and controls. Soft drink consumption had a trend towards association with the presence of NAFLD. However, the odds ratio was 4.4 and the confidence intervals very wide. Finally, there was no significant difference in any comparison between patients with NAFLD and NASH, although the number of patients was relatively small. All meta-analyses had significant heterogeneity.

Conclusions: Overall, despite high heterogeneity among studies, this meta-analysis demonstrated that higher caloric intake is positively associated with NAFLD, whereas diet composition in macronutrients was not associated with the presence or severity of the disease.

Keywords: Carbohydrates; Fatty Acids; Fructose; Metabolic Syndrome; Obesity; Protein.

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Diet / adverse effects
Energy Intake
Humans
Non-alcoholic Fatty Liver Disease* / complications
Non-alcoholic Fatty Liver Disease* / epidemiology