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  The Liver Meeting
Digital Experience
November 13 - 16 - 2020
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Sugary Drinks, High Trans Fats
Lead Dietary Risks for Death With NAFLD

  AASLD The Liver Meeting Digital Experience, November 13-16, 2020
Mark Mascolini
Diets high in sugar-laden drinks and trans fatty acids pose the greatest risk of liver death with nonalcoholic fatty liver disease (NAFLD), according to a 195-country analysis of the Global Burden of Disease 2017 study [1]. Eating habits excluding components of a Mediterranean diet (focused on vegetables, fruits, nuts, beans, and whole grains) also proved risky.
Research links NAFLD to obesity, diabetes, hypertension, high lipids, and the metabolic syndrome, noted Inova Health System researchers and collaborators who conducted this study. Epidemics of NAFLD, type 2 diabetes, and obesity are rife in countries rich and poor. The research team planned this study to see whether eating habits also affect liver mortality due to NAFLD across the world.
Data came from the Global Burden of Disease, which has tracked 359 diseases and 84 risk factors in 195 countries since 1980 [2]. The diet study focused on death from liver cancer and cirrhosis due to NAFLD and death attributable to metabolic and dietary risk factors for the year 2017. The researchers determined associations between risk factors and outcomes with Socio-Demographic Index (SDI)-adjusted partial Spearman correlation coefficients and multivariable generalized linear regression models. SDI measures average income per capita, educational attainment, and total fertility at the country level.
In 2017 the researchers counted 184,095 liver deaths due to NAFLD, representing 8.6% of all liver deaths from all chronic liver diseases. The age-standardized rate of deaths attributable to dietary risk came to 140.24 per 100,000 deaths. In other words the cause of death could be traced to diet for 14 of every 10,000 deaths. Also in 2017, the analysis yielded 17.6 million deaths due to metabolic risks, which made up nearly one third of all-cause deaths.
The overall analysis confirmed strong correlations between dietary risk and liver death due to NAFLD (SDI-adjusted rho 0.131, P = 0.0691) and between metabolic risks and such deaths (SDI-adjusted rho 0.225, P = 0.0016).
Among dietary risks of liver death with NAFLD, the leading individual culprits were diets awash in sugar-sweetened beverages (SDI-adjusted rho 0.358, P = 0.0000), diets rich in red meat (SDI-adjusted rho 0.162, P = 0.0238), and diets low in the Mediterranean diet staples nuts and seeds (SDI-adjusted rho 0.154, P = 0.0318). Four individual metabolic risks contributed to a higher risk of NAFLD liver death: impaired kidney function, high body mass index, high systolic blood pressure, and high fasting glucose. The link between dietary and metabolic risks and NAFLD liver deaths proved strongest in two regions: (1) Central Europe, Eastern Europe, and Central Asia and (2) North Africa and the Middle East.
When the researchers used multivariable regression models to calculate percent change in age-standardized rates of NAFLD liver death in 2017, they linked diets dripping in trans fatty acids to almost a 3% rise in such deaths independent of metabolic risks (2.84 percent change, P = 0.0000). Impaired kidney function drove the NAFLD liver death rate up about three quarters of 1% (0.71 percent change, P = 0.0027).
The researchers concluded that specific dietary risks-not just metabolic risks-"independently drive the global burden of NAFLD." Besides diets high in trans fatty acids and sugar-sweetened drinks, they underlined the baneful role of diets thin on components of the Mediterranean diet.
1. Paik JM, Alqahtani S, Younossi Y, et al. Dietary risks for liver related mortality among nonalcoholic fatty liver disease (NAFLD): data from the Global Burden of Disease (GBD) 2017. AASLD The Liver Meeting Digital Experience, November 13-16, 2020. Abstract 141.
2. IHME. Global Burden of Disease (GBD). http://www.healthdata.org/gbd/2019