• Yang Xia, Limin Cao, Qing Zhang, Li Liu, Shunming Zhang, Ge Meng, Hongmei Wu, Yeqing Gu, Shaomei Sun, Xing Wang, Ming Zhou, Qiyu Jia, Kun Song, Qijun Wu, Kaijun Niu, and Yuhong Zhao.
• Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
• J. Intern. Med. 2022 Apr 1; 291 (4): 469-480.

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a strong risk factor for type 2 diabetes. However, no study has investigated whether dietary intake can modify this effect. Therefore, we aimed to investigate the effect of dietary pattern modification on the association between NAFLD and type 2 diabetes.MethodsA large prospective cohort study (n = 24,602) was conducted in China. NAFLD was diagnosed using liver ultrasonography considering alcohol consumption. Dietary data were assessed using a validated self-administered food frequency questionnaire. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsFollowing a 93,873 person-year follow-up, 787 (3.20%) participants developed type 2 diabetes. In a multivariable adjusted model, compared with participants without NAFLD, the HR (95% CI) of incident type 2 diabetes for NAFLD patients was 3.04 (2.51, 3.68). On subgroup analyses, the adjusted HRs (95% CIs) of incident type 2 diabetes for NAFLD patients with low (≤median score) and high (>median score) vegetable pattern intakes were 4.08 (3.05, 5.46) and 2.38 (1.85, 3.07) (p for interaction <0.01), respectively. Higher vegetable intake was also found to attenuate the risk effect of phenotype groups of NAFLD on incident type 2 diabetes, especially in the lean NAFLD group.ConclusionsThe present study demonstrated that NAFLD is a strong risk factor for type 2 diabetes in the Chinese population. Notably, adherence to a dietary pattern rich in vegetables can attenuate this risk, especially in lean NAFLD patients.© 2021 The Association for the Publication of the Journal of Internal Medicine.

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