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Carbohydrates, glycemic index and diabetes mellitus

Associations between dietary factors and markers of NAFLD in a general Dutch adult population



The objective of this sudy was to assess the relationship between dietary intake and fatty liver as scored by the validated Fatty Liver Index (FLI) in a large cross-sectional study among a general Dutch adult population. Diet is known to affect liver fat accumulation in humans.


1128 men and women aged 20–70 years were included. Dietary intake was assessed using a validated semiquantitative food frequency questionnaire. FLI was derived from body mass index (BMI), waist circumference, triglycerides and gamma-glutamyltransferase. Associations were adjusted for energy intake, alcohol intake, age, sex, education, smoking and prevalence of hypertension and diabetes.


In this population (mean age 53.0±11.4 years; BMI 25.9±4.0 kg/m2; FLI 35.0±27.7), the prevalence of fatty liver as indicated by an FLI>60 was 21.5%. Subjects in the highest FLI category were more likely to be male, older and less physically active. Total protein intake and animal protein intake were positively associated with the highest FLI score versus the lowest (odds ratio (OR) 1.25 per 1 en%, 95% confidence interval (CI) 1.15–1.37 and OR 1.27, 95% CI 1.17–1.38, respectively); for vegetable protein, an inverse association was observed (OR 0.81, 95% CI 0.69–0.94). A similar positive association with FLI was observed when carbohydrates and fat were iso-calorically exchanged for total and animal proteins.


Subjects in the high FLI group consumed more protein, especially from animal origin, less carbohydrates and less dietary fibre. The presence of fatty liver was associated with a higher intake of animal protein and total fat, soft drinks and snacks.

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AR is supported by the Dutch Dairy Association.

Author contributions

EF designed and developed the protocol; AR and DS analysed the data; AR, DS, MM and EF interpreted the data; AR, DS, MM, EF and FK wrote the manuscript. All authors read and approved the final manuscript.

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Correspondence to A Rietman.

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The authors declare no conflict of interest.

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Rietman, A., Sluik, D., Feskens, E. et al. Associations between dietary factors and markers of NAFLD in a general Dutch adult population. Eur J Clin Nutr 72, 117–123 (2018).

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