Author information
1The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, UK.
2The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, UK; Danish Cancer Institute, Copenhagen, Denmark; Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
3The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, UK; Department of Nutrition, Food Science and Gastronomy, XIA, School of Pharmacy and Food Sciences, INSA, University of Barcelona, 08921 Barcelona, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain.
4The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, UK; Department of Nutritional Sciences, University of Vienna, Vienna, Austria; Center for Public Health, Medical University of Vienna, Vienna, Austria. Electronic address: t.kuhn@qub.ac.uk.
5The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, UK. Electronic address: a.cassidy@qub.ac.uk.
Abstract
Background and aims: Mechanistic studies and short-term randomised trials suggest higher intakes of dietary flavonoids may protect against non-alcoholic fatty liver disease (NAFLD).
Objective: We aimed to perform the first population-based study with long-term follow-up on flavonoid consumption, incident NAFLD, and validated NAFLD biomarkers.
Methods: In a prospective study, we assessed the associations between flavonoid intake based on ≥2 24-hour dietary assessments and NAFLD risk among 121,064 adults aged 40 to 69 years by multivariable Cox regression analyses. We further assessed the associations between flavonoid intake and MRI-derived liver fat (subset of n = 11,435) and liver-corrected T1 values (cT1, subset of n = 9,570), a marker of steatosis, more sensitive to inflammatory pathology.
Results: Over 10 years of follow-up, 1081 cases of NAFLD were identified. Participants in the highest quartile (Q4) of the Flavodiet Score (FDS) reflecting the consumption of foods high in flavonoids, had a 19% lower risk of NAFLD compared to the lowest quartile (Q1) (HR (95%CI): 0.81 (0.67, 0.97), P trend = 0.02). Moreover, participants in the Q4 of the FDS had a lower liver fat and cT1 values, compared to those in Q1 (liver fat: relative difference Q1 vs Q4: -5.28%, P trend = <0.001; cT1: relative difference Q1 vs Q4: -1.73%, P trend = <0.001). When compared to low intakes, high intakes of apples and tea were associated with lower NAFLD risk (apples: HR (95%CI): 0.78 (0.67, 0.92), P trend = <0.01; tea: HR (95%CI): 0.86 (0.72, 1.02), P trend = 0.03). Additionally, when compared to low intakes, high apple, tea, and dark chocolate intakes were significantly associated with lower liver fat values, while high tea and red pepper intakes were significantly associated with lower cT1 values.
Conclusion: The consumption of flavonoid-rich foods was associated with a reduced risk of NAFLD among middle-aged adults.