Higher ultra-processed food intake is associated with adverse liver outcomes: a prospective cohort study of UK Biobank participants

Longgang Zhao; Alyssa Clay-Gilmour; Jiajia Zhang; Xuehong Zhang; Susan E Steck

doi:10.1016/j.ajcnut.2023.10.014

Higher ultra-processed food intake is associated with adverse liver outcomes: a prospective cohort study of UK Biobank participants

Am J Clin Nutr. 2024 Jan;119(1):49-57. doi: 10.1016/j.ajcnut.2023.10.014. Epub 2023 Oct 21.

Authors

Longgang Zhao¹, Alyssa Clay-Gilmour², Jiajia Zhang², Xuehong Zhang³, Susan E Steck⁴

Affiliations

¹ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
² Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
³ Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
⁴ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States. Electronic address: stecks@mailbox.sc.edu.

PMID: 37871746
DOI: 10.1016/j.ajcnut.2023.10.014

Abstract

Background: Ultra-processed food (UPF) intake has been positively associated with obesity and diabetes. The relationship between UPF intake and liver health has been scarcely studied.

Objectives: We aimed to evaluate the association of UPF intake with risk of adverse liver outcomes including nonalcoholic fatty liver disease (NAFLD), liver fibrosis/cirrhosis, liver cancer, severe liver disease, and serum biomarkers of liver health.

Methods: A total of 173,889 participants aged 40 to 69 y from the UK Biobank were included. UPF intake was defined using 24-h dietary recalls and NOVA classification. Liver outcome data were obtained from cancer registry, in-hospital records, and death registries. Serum biomarkers were measured at baseline. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between UPF and adverse liver outcomes adjusting for demographics, lifestyle factors, body mass index, and diabetes. We used multinomial logistic regression to evaluate associations between UPF and liver function biomarkers.

Results: After a median follow-up of 8.9 y, we documented 1108 NAFLD, 350 liver fibrosis/cirrhosis, 134 liver cancer, and 550 severe liver disease cases. Higher UPF intake was associated with increased risk of NAFLD (HR_{Quartile 4 vs. Quartile 1}: 1.43; 95% CI: 1.21, 1.70; P_trend < 0.001), liver fibrosis/cirrhosis (HR: 1.18; 95% CI: 0.87, 1.59; P_trend = 0.009), and severe liver disease (HR: 1.50; 95% CI: 1.19, 1.90; P_trend < 0.001) but not with liver cancer (HR: 1.00; 95% CI: 0.63, 1.58; P_trend = 0.88). Higher UPF intake was associated with elevated levels of C-reactive protein, alkaline phosphatase, aspartate aminotransferase, γ-glutamyltransferase, and triglycerides and lower cholesterols (all P_trend < 0.001).

Conclusions: Higher UPF intake is associated with an increased risk of NAFLD, liver fibrosis and cirrhosis, and severe liver disease and adverse levels of multiple clinical biomarkers, suggesting the potential importance of reducing UPF intake to improve liver health.

Keywords: NAFLD; biomarker; cirrhosis; cohort; liver cancer; liver health; prospective; ultra-processed food.

MeSH terms

Biological Specimen Banks
Biomarkers
Diabetes Mellitus*
Diet / adverse effects
Fast Foods
Food, Processed
Humans
Liver Cirrhosis / epidemiology
Liver Cirrhosis / etiology
Liver Neoplasms*
Non-alcoholic Fatty Liver Disease* / epidemiology
Non-alcoholic Fatty Liver Disease* / etiology
Prospective Studies
UK Biobank

Substances

Biomarkers