背景:代谢功能障碍相关的脂肪性肝病(MAFLD)是一个重要的健康问题。饮食干预在MAFLD患者中具有重要作用。
目的:为MAFLD患者的饮食提供参考。
方法:在UKBiobank队列中确定MAFLD的存在。从饮食记录中得出9种饮食模式得分。多变量Cox回归模型用于估计风险比(HR)和95%置信区间(CI)。对比试验用于计算MAFLD状态的异质性。
结果:我们在基线时确定了175,300例MAFLD患者。与非MAFLD相比,MAFLD与慢性肝病(CLD)显着相关(HR:3.48,95%CI:3.15-3.84),严重肝病(SLD)(HR:2.87,95%CI:2.63-3.14),肝癌(HR:1.93,95%CI:1.67-2.23),和肝脏相关死亡(LRD)(HR:1.93,95%CI:1.67-2.23)。在整个队列中,替代地中海饮食(aMED)(HRCLD:0.53,95%CI:0.37-0.76;HRSLD:0.52,95%CI:0.37-0.72),行星健康饮食(PHD)(HRCLD:0.62,95%CI:0.47-0.81;HRSLD:0.65,95%CI:0.51-0.83),基于植物的低碳水化合物饮食(pLCD)(HRCLD:0.65,95%CI:0.49-0.86;HRSLD:0.66,95%CI:0.51-0.85),健康植物性饮食指数(hPDI)(HRCLD:0.63,95%CI:0.47-0.84;HRSLD:0.61,95%CI:0.47-0.78)与CLD和SLD的较低风险相关。此外,不健康的植物性饮食指数(uPDI)与CLD风险增加相关(HR:1.42,95%CI:1.09-1.85),SLD(HR:1.50,95%CI:1.19-1.90),和LRD(HR:1.88,95%CI:1.28-2.78)。上述关联在MAFLD亚组中始终保持强劲,而在非MAFLD组中表现不明显。然而,在不同MAFLD状态间未观察到显著异质性.
结论:这些发现强调了MAFLD对后续肝脏疾病发展的有害影响,以及饮食模式在管理MAFLD中的重要性。
BACKGROUND: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a significant health problem. Dietary intervention plays an important role in patients with MAFLD.
OBJECTIVE: We aimed to provide a reference for dietary patterns in patients with MAFLD.
METHODS: The presence of MAFLD was determined in the United Kingdom Biobank cohort. Nine dietary pattern scores were derived from the dietary records. Multivariable Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). The contrast test was employed to calculate the heterogeneity across MAFLD statuses.
RESULTS: We identified 175,300 patients with MAFLD at baseline. Compared with non-MAFLD, MAFLD was significantly associated with chronic liver disease (CLD) (HR: 3.48; 95% CI: 3.15, 3.84), severe liver disease (SLD) (HR: 2.87; 95% CI: 2.63, 3.14), liver cancer (HR: 1.93; 95% CI: 1.67, 2.23), and liver-related death (LRD) (HR: 1.93; 95% CI: 1.67, 2.23). In the overall cohort, the alternate Mediterranean diet (aMED) (HRCLD: 0.53; 95% CI: 0.37, 0.76; HRSLD: 0.52; 95% CI: 0.37, 0.72), planetary health diet (PHD) (HRCLD: 0.62; 95% CI: 0.47, 0.81; HRSLD: 0.65; 95% CI: 0.51, 0.83), plant-based low-carbohydrate diet (pLCD) (HRCLD: 0.65; 95% CI: 0.49, 0.86; HRSLD: 0.66; 95% CI: 0.51, 0.85), and healthful plant-based diet index (hPDI) (HRCLD: 0.63; 95% CI: 0.47, 0.84; HRSLD: 0.61; 95% CI: 0.47, 0.78) were associated with a lower risk of CLD and SLD. Additionally, unhealthful plant-based diet index (uPDI) was associated with increased risk of CLD (HR: 1.42; 95% CI: 1.09,1.85), SLD (HR: 1.50; 95% CI: 1.19, 1.90), and LRD (HR: 1.88; 95% CI: 1.28-2.78). The aforementioned associations remained consistently strong within the MAFLD subgroup while exhibiting less pronounced in the non-MAFLD group. However, no significant heterogeneity was observed across different MAFLD statuses.
CONCLUSIONS: These findings highlight the detrimental effects of MAFLD on the development of subsequent liver diseases and the importance of dietary patterns in managing MAFLD.