The sulfur microbial diet and risk of nonalcoholic fatty liver disease: a prospective gene-diet study from the UK Biobank

Zhening Liu; Hangkai Huang; Jiaqi Ruan; Zejun Wang; Chengfu Xu

doi:10.1016/j.ajcnut.2023.11.012

The sulfur microbial diet and risk of nonalcoholic fatty liver disease: a prospective gene-diet study from the UK Biobank

Am J Clin Nutr. 2024 Feb;119(2):417-424. doi: 10.1016/j.ajcnut.2023.11.012. Epub 2023 Nov 23.

Authors

Zhening Liu¹, Hangkai Huang¹, Jiaqi Ruan¹, Zejun Wang², Chengfu Xu³

Affiliations

¹ Department of Gastroenterology, Zhejiang Provincial Clinical Research Centre for Digestive Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
² Department of Gastroenterology, Hospital of Integrated Traditional Chinese and Western Medicine of Linping District, Hangzhou, China.
³ Department of Gastroenterology, Zhejiang Provincial Clinical Research Centre for Digestive Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address: xiaofu@zju.edu.cn.

PMID: 38000660
DOI: 10.1016/j.ajcnut.2023.11.012

Abstract

Background: The gut microbiota is closely related to liver diseases. The dietary pattern associated with sulfur-metabolizing bacteria in stool has been found to influence intestinal health.

Objective: We aimed to investigate whether consuming the sulfur microbial diet is associated with nonalcoholic fatty liver disease (NAFLD).

Methods: We included 143,918 participants of European descent from the UK Biobank. Information on serving sizes used per diet component was recorded by an online 24-h dietary assessment tool (Oxford WebQ). The total sulfur microbial diet score was constructed by summing the product of β-coefficients and corresponding serving sizes. NAFLD was ascertained using hospital inpatient and death records. Cox proportional hazard models were used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI). Mediation analyses were used to investigate underlying mediators including body mass index, waist circumference, glucose, triglyceride, urate, and C-reactive protein. A polygenic risk score for NAFLD was constructed and stratified to assess whether the association is modified by genetic predisposition.

Results: After a median follow-up of 11.7 y (interquartile range: 11.3-12.5 y), we documented 1540 incident cases of NAFLD. After adjustment for covariates, we observed an overall J-shaped relationship between the sulfur microbial diet and risk of NAFLD. Those in the highest quartile of sulfur microbial diet score had a 46% increased risk of NAFLD [HR_Q4vsQ1 (95% CI): 1.46 (1.26, 1.69)]. We also found that this association is partly mediated by metabolic disorders and systemic inflammation. In addition, the positive association was stronger among individuals at higher genetic risk for NAFLD (P_interaction = 0.044).

Conclusions: The sulfur microbial diet had adverse associations with incident NAFLD, particularly in those at a higher genetic risk. Our study may provide evidence on the role of sulfur-metabolizing bacteria in the diet-NAFLD association.

Keywords: gene–diet interaction; nonalcoholic fatty liver disease; polygenic risk score; sulfur microbial diet.

MeSH terms

Biological Specimen Banks
Diet / adverse effects
Humans
Non-alcoholic Fatty Liver Disease* / etiology
Non-alcoholic Fatty Liver Disease* / genetics
Prospective Studies
Risk Factors
Sulfur
UK Biobank

Substances

Sulfur