Dietary Patterns and Long-Term Outcomes in Patients with NAFLD: A Prospective Analysis of 128,695 UK Biobank Participants

Large longitudinal studies exploring the role of dietary patterns in the assessment of long-term outcomes of NAFLD are still lacking. We conducted a prospective analysis of 128,695 UK Biobank participants. Cox proportional hazards models were used to estimate the risk associated with two dietary patterns for long-term outcomes of NAFLD. During a median follow-up of 12.5 years, 1925 cases of end-stage liver disease (ESLD) and 12,466 deaths occurred in patients with NAFLD. Compared with patients in the lowest quintile, those in the highest quintile of the diet quality score was negatively associated with the risks of ESLD and all-cause mortality (HR(Q5vsQ1): 0.76, 95% CI: 0.66–0.87, p < 0.001; HR(Q5vsQ1): 0.84, 95% CI: 0.79–0.88, p < 0.001, respectively). NAFLD patients with high-quality carbohydrate patterns carried a 0.74-fold risk of ESLD and a 0.86-fold risk of all-cause mortality (HR(Q5vsQ1): 0.74, 95% CI: 0.65–0.86, p < 0.001; HR(Q5vsQ1): 0.86, 95% CI: 0.82–0.91, p < 0.001, respectively). For prudent dietary patterns rich in vegetables, fruits and fish, the adjusted HR (Q5vsQ1) (95% CI) was 0.87 (0.76–0.99) and 0.94 (0.89–0.99) for ESLD and all-cause mortality of NAFLD patients. There was a U-shaped association between the meat-rich dietary pattern and all-cause mortality in patients with NAFLD. These findings suggest that a diet characterized by a high-quality, high intake of vegetables, fruits, fish and whole grains as well as an appropriate intake of meat, was associated with a lower risk of adverse outcomes of NAFLD.