A flavonoid-rich diet is associated with lower risk and improved imaging biomarkers of nonalcoholic fatty liver disease: a prospective cohort study

William Bell; Amy Jennings; Alysha S Thompson; Nicola P Bondonno; Anna Tresserra-Rimbau; Tilman Kühn; Aedín Cassidy

doi:10.1016/j.ajcnut.2024.09.022

A flavonoid-rich diet is associated with lower risk and improved imaging biomarkers of nonalcoholic fatty liver disease: a prospective cohort study

Am J Clin Nutr. 2024 Sep 26:S0002-9165(24)00791-3. doi: 10.1016/j.ajcnut.2024.09.022. Online ahead of print.

Authors

William Bell¹, Amy Jennings¹, Alysha S Thompson¹, Nicola P Bondonno², Anna Tresserra-Rimbau³, Tilman Kühn⁴, Aedín Cassidy⁵

Affiliations

¹ The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom.
² The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom; Danish Cancer Institute, Copenhagen, Denmark; Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.
³ The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom; Department of Nutrition, Food Science, and Gastronomy, XIA, School of Pharmacy and Food Sciences, Institute of Nutrition and Food Safety, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.
⁴ The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom; 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.
⁵ The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom. Electronic address: a.cassidy@qub.ac.uk.

PMID: 39341459
DOI: 10.1016/j.ajcnut.2024.09.022

Abstract

Background: Mechanistic studies and short-term randomized trials suggest higher intakes of dietary flavonoids may protect against nonalcoholic fatty liver disease (NAFLD).

Objectives: 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-h dietary assessments and NAFLD risk among 121,064 adults aged 40-69 y by multivariable Cox regression analyses. We further assessed the associations between flavonoid intake and magnetic resonance imaging-derived liver fat (a subset of n = 11,435) and liver-corrected T1 values (cT1; a subset of n = 9570), a marker of steatosis, more sensitive to inflammatory pathology.

Results: Over 10 y of follow-up, 1081 cases of NAFLD were identified. Participants in the highest quartile (Q4) of the flavodiet score reflecting the consumption of foods high in flavonoids, had a 19% lower risk of NAFLD compared to the lowest quartile (Q1) [hazard ratio (HR) (95% confidence interval (CI): 0.81 (0.67, 0.97), P-trend = 0.02)]. Moreover, participants in the Q4 of the flavodiet score had lower liver fat and cT1 values than those in Q1 (liver fat: relative difference Q1 compared with Q4: -5.28%, P-trend = <0.001; cT1: relative difference Q1 compared with 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, whereas high tea and red pepper intakes were significantly associated with lower cT1 values.

Conclusions: The consumption of flavonoid-rich foods was associated with a reduced risk of NAFLD among middle-aged adults.

Keywords: flavonoid-rich foods; flavonoids; liver fat; liver-corrected T1; nonalcoholic fatty liver disease; prospective.