Abstract：
BACKGROUND: Studies on the association between vegetarian diets and nonalcoholic fatty liver disease (NAFLD) are limited and have inconsistent results. This study aims to explore the association between vegetarian diets and NAFLD and compare the stage of fibrosis between vegetarians and nonvegetarians in a US representative sample.
METHODS: Cross-sectional data from 23,130 participants aged ≥20 years were obtained from the National Health and Nutrition Examination Survey, 2005-2018. Vegetarian status was classified based on two 24-h dietary recalls. We examined the association between vegetarian diets and the risk of NAFLD using the propensity score weighting method.
RESULTS: Vegetarian diets were significantly associated with decreases in hepatic steatosis index (HSI), US fatty liver index and nonalcoholic fatty liver disease fibrosis score with mean differences of -2.70 (95% confidence interval [CI]: -3.69, -1.70), -3.03 (95% CI: -7.15, -0.91) and -0.12 (95% CI: -0.26, -0.01), respectively. While modelling the risk of NAFLD, we estimated that vegetarians were 53% less likely to have NAFLD assessed by HSI (odds ratios [OR]: 0.47; 95% CI: 0.34, 0.65). The effect of vegetarian diets was higher among individuals with lower waist circumferences (OR: 0.20) than among those with higher waist circumferences (OR: 0.53, p interaction ${p}_{\\text{interaction}}\\,$ = 0.004). However, the association was largely attenuated after adjusting for body mass index and diabetes status. No significant association was identified between vegetarian diets and advanced fibrosis.
CONCLUSIONS: Vegetarian diets were associated with a lower prevalence of NAFLD among US adults, and the association appeared to be stronger in people with lower waist circumferences. Further studies are warranted to replicate our findings.
METHODS: Cross-sectional data from 23,130 participants aged ≥20 years were obtained from the National Health and Nutrition Examination Survey, 2005-2018. Vegetarian status was classified based on two 24-h dietary recalls. We examined the association between vegetarian diets and the risk of NAFLD using the propensity score weighting method.
RESULTS: Vegetarian diets were significantly associated with decreases in hepatic steatosis index (HSI), US fatty liver index and nonalcoholic fatty liver disease fibrosis score with mean differences of -2.70 (95% confidence interval [CI]: -3.69, -1.70), -3.03 (95% CI: -7.15, -0.91) and -0.12 (95% CI: -0.26, -0.01), respectively. While modelling the risk of NAFLD, we estimated that vegetarians were 53% less likely to have NAFLD assessed by HSI (odds ratios [OR]: 0.47; 95% CI: 0.34, 0.65). The effect of vegetarian diets was higher among individuals with lower waist circumferences (OR: 0.20) than among those with higher waist circumferences (OR: 0.53, p interaction ${p}_{\\text{interaction}}\\,$ = 0.004). However, the association was largely attenuated after adjusting for body mass index and diabetes status. No significant association was identified between vegetarian diets and advanced fibrosis.
CONCLUSIONS: Vegetarian diets were associated with a lower prevalence of NAFLD among US adults, and the association appeared to be stronger in people with lower waist circumferences. Further studies are warranted to replicate our findings.
摘要：
背景：关于素食与非酒精性脂肪性肝病（NAFLD）之间关系的研究有限，结果不一致。本研究旨在探索素食与NAFLD之间的关联，并比较美国代表性样本中素食者和非素食者之间的纤维化阶段。
方法：来自23,130名年龄≥20岁的参与者的横截面数据来自国家健康和营养检查调查，2005-2018。根据两次24小时饮食回忆对素食状态进行分类。我们使用倾向评分加权方法检查了素食饮食与NAFLD风险之间的关系。
结果：素食与肝脏脂肪变性指数（HSI）的降低显着相关，美国脂肪肝指数和非酒精性脂肪肝疾病纤维化评分平均差异为-2.70（95％置信区间[CI]：-3.69，-1.70），-3.03（95％CI：-7.15，-0.91）和-0.12（95％CI：-0.26，-0.01），分别。在模拟NAFLD的风险时，我们估计,通过HSI评估,素食者患NAFLD的可能性降低了53%(比值比[OR]:0.47;95%CI:0.34,0.65).在腰围较低（OR：0.20）的个体中，素食的效果要高于腰围较高的个体（OR：0.53，p交互作用${p}_{\\text{交互作用}}\\，$=0.004)。然而,在校正体重指数和糖尿病状态后,这种关联在很大程度上减弱.在素食饮食和晚期纤维化之间没有发现显着关联。
结论：在美国成年人中，素食与较低的NAFLD患病率相关，在腰围较低的人群中，这种关联似乎更强。需要进一步的研究来复制我们的发现。
方法：来自23,130名年龄≥20岁的参与者的横截面数据来自国家健康和营养检查调查，2005-2018。根据两次24小时饮食回忆对素食状态进行分类。我们使用倾向评分加权方法检查了素食饮食与NAFLD风险之间的关系。
结果：素食与肝脏脂肪变性指数（HSI）的降低显着相关，美国脂肪肝指数和非酒精性脂肪肝疾病纤维化评分平均差异为-2.70（95％置信区间[CI]：-3.69，-1.70），-3.03（95％CI：-7.15，-0.91）和-0.12（95％CI：-0.26，-0.01），分别。在模拟NAFLD的风险时，我们估计,通过HSI评估,素食者患NAFLD的可能性降低了53%(比值比[OR]:0.47;95%CI:0.34,0.65).在腰围较低（OR：0.20）的个体中，素食的效果要高于腰围较高的个体（OR：0.53，p交互作用${p}_{\\text{交互作用}}\\，$=0.004)。然而,在校正体重指数和糖尿病状态后,这种关联在很大程度上减弱.在素食饮食和晚期纤维化之间没有发现显着关联。
结论：在美国成年人中，素食与较低的NAFLD患病率相关，在腰围较低的人群中，这种关联似乎更强。需要进一步的研究来复制我们的发现。
