Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Nutrition and Health (including climate and ecological aspects)

Higher plain water intake is related to lower newly diagnosed nonalcoholic fatty liver disease risk: a population-based study

European Journal of Clinical Nutrition volume 75, pages 1801–1808 (2021)Cite this article

Subjects

Abstract

Background/objectives

High plain water intake (PWI) lowered body weight, reduced total energy intake, and increased fat oxidation and energy consumption. Because such factors are closely linked to metabolic disorders, which are the main risk factors for nonalcoholic fatty liver disease (NAFLD) onset, it was speculated that higher PWI was associated with a lower risk of NAFLD. However, no prior human studies have examined such relationship. Therefore, the purpose of this study was to evaluate the relationship between PWI and newly diagnosed NAFLD in a large-scale adult population.

Subjects/methods

A total of 16,434 participants from 2010 to 2019 in Tianjin, China, were included in this cross-sectional study. PWI was assessed by using a validated self-administered food frequency questionnaire, and it was categorized into three subgroups for analysis: ≤3 cups/day, 4–7 cups/day, and >7 cups/day. NAFLD was diagnosed by abdominal ultrasound. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the relationship between PWI and NAFLD.

Results

Among 16,434 participants, 20.5% (3,364) had newly diagnosed NAFLD. After controlling for demographic characteristics, lifestyle risk factors, and dietary intake, the adjusted ORs (95% CIs) for having NAFLD across PWI categories were 1.00 (reference) for ≤3 cups/day, 0.84 (0.72, 0.97) for 4–7 cups/day, and 0.77 (0.63, 0.94) for >7 cups/day in males and 1.00 (reference) for ≤3 cups/day, 1.02 (0.81, 1.27) for 4–7 cups/day, and 1.08 (0.78, 1.49) for >7 cups/day in females, respectively.

Conclusions

This study is the first to show that higher PWI is independently related to lower newly diagnosed NAFLD among males, but not females. Further studies are needed to explore the causal relationship.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Anstee QM, McPherson S, Day CP. How big a problem is non-alcoholic fatty liver disease? BMJ. 2011;343:d3897.

    Article  PubMed  Google Scholar 

  2. Sapp V, Gaffney L, EauClaire SF, Matthews RP. Fructose leads to hepatic steatosis in zebrafish that is reversed by mechanistic target of rapamycin (mTOR) inhibition. Hepatology. 2014;60:1581–92.

    Article  CAS  PubMed  Google Scholar 

  3. Gorden DL, Ivanova PT, Myers DS, McIntyre JO, VanSaun MN, Wright JK, et al. Increased diacylglycerols characterize hepatic lipid changes in progression of human nonalcoholic fatty liver disease; comparison to a murine model. PLoS ONE. 2011;6:e22775.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lonardo A, Ballestri S, Marchesini G, Angulo P, Loria P. Nonalcoholic fatty liver disease: a precursor of the metabolic syndrome. Dig Liver Dis. 2015;47:181–90.

    Article  PubMed  Google Scholar 

  5. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–31.

    Article  CAS  PubMed  Google Scholar 

  6. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84.

    Article  PubMed  Google Scholar 

  7. Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL, et al. How common is non-alcoholic fatty liver disease in the Asia-Pacific region and are there local differences? J Gastroenterol Hepatol. 2007;22:788–93.

    Article  PubMed  Google Scholar 

  8. Hallsworth K, Avery L, Trenell MI. Targeting lifestyle behavior change in adults with NAFLD during a 20-min consultation: summary of the dietary and exercise literature. Curr Gastroenterol Rep. 2016;18:11.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Guo Y, Xiong Y, Sheng Q, Zhao S, Wattacheril J, Flynn CR. A micro-RNA expression signature for human NAFLD progression. J Gastroenterol. 2016;51:1022–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Sawka MN, Cheuvront SN, Carter R 3rd. Human water needs. Nutr Rev. 2005;63:S30–9.

    Article  PubMed  Google Scholar 

  11. Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010;68:439–58.

    Article  PubMed  Google Scholar 

  12. Stookey JJ. Negative, null and beneficial effects of drinking water on energy intake, energy expenditure, fat oxidation and weight change in randomized trials: a qualitative review. Nutrients. 2016;8:19.

    Article  PubMed Central  Google Scholar 

  13. Charriere N, Miles-Chan JL, Montani JP, Dulloo AG. Water-induced thermogenesis and fat oxidation: a reassessment. Nutr Diabetes. 2015;5:e190.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Boschmann M, Steiniger J, Hille U, Tank J, Adams F, Sharma AM, et al. Water-induced thermogenesis. J Clin Endocrinol Metab. 2003;88:6015–9.

    Article  CAS  PubMed  Google Scholar 

  15. Kocelak P, Zak-Golab A, Rzemieniuk A, Smetek J, Sordyl R, Tyrka A, et al. The influence of oral water load on energy expenditure and sympatho-vagal balance in obese and normal weight women. Arch Med Sci. 2012;8:1003–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rochlani Y, Pothineni NV, Kovelamudi S, Mehta JL. Metabolic syndrome: pathophysiology, management, and modulation by natural compounds. Ther Adv Cardiovasc Dis. 2017;11:215–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Ballestri S, Zona S, Targher G, Romagnoli D, Baldelli E, Nascimbeni F, et al. Nonalcoholic fatty liver disease is associated with an almost twofold increased risk of incident type 2 diabetes and metabolic syndrome. Evidence from a systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31:936–44.

    Article  CAS  PubMed  Google Scholar 

  18. Meng G, Liu F, Fang L, Li C, Zhang Q, Liu L, et al. The overall computer/mobile devices usage time is related to newly diagnosed non-alcoholic fatty liver disease: a population-based study. Ann Med. 2016;48:568–76.

    Article  PubMed  Google Scholar 

  19. Su Q, Yu B, He H, Zhang Q, Meng G, Wu H, et al. Nut consumption is associated with depressive symptoms among Chinese adults. Depress Anxiety. 2016;33:1065–72.

    Article  PubMed  Google Scholar 

  20. Yu B, Yu F, Su Q, Zhang Q, Liu L, Meng G, et al. A J-shaped association between soy food intake and depressive symptoms in Chinese adults. Clin Nutr. 2018;37:1013–8.

    Article  CAS  PubMed  Google Scholar 

  21. Gao X, Fan JG, Study Group of L, Metabolism CSoE. Diagnosis and management of non-alcoholic fatty liver disease and related metabolic disorders: consensus statement from the Study Group of Liver and Metabolism, Chinese Society of Endocrinology. J Diabetes. 2013;5:406–15.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chitturi S, Farrell GC, Hashimoto E, Saibara T, Lau GK, Sollano JD, et al. Non-alcoholic fatty liver disease in the Asia-Pacific region: definitions and overview of proposed guidelines. J Gastroenterol Hepatol. 2007;22:778–87.

    Article  PubMed  Google Scholar 

  23. Zeng MD, Fan JG, Lu LG, Li YM, Chen CW, Wang BY, et al. Guidelines for the diagnosis and treatment of nonalcoholic fatty liver diseases. J Dig Dis. 2008;9:108–12.

    Article  PubMed  Google Scholar 

  24. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95.

    Article  PubMed  Google Scholar 

  25. Qu NN, Li KJ. Study on the reliability and validity of international physical activity questionnaire (Chinese Vision, IPAQ). Zhonghua Liu Xing Bing Xue Za Zhi. 2004;25:265–8.

    PubMed  Google Scholar 

  26. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.

    Article  CAS  PubMed  Google Scholar 

  27. Pan A, Malik VS, Schulze MB, Manson JE, Willett WC, Hu FB. Plain-water intake and risk of type 2 diabetes in young and middle-aged women. Am J Clin Nutr. 2012;95:1454–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Carroll HA, Davis MG, Papadaki A. Higher plain water intake is associated with lower type 2 diabetes risk: a cross-sectional study in humans. Nutr Res. 2015;35:865–72.

    Article  CAS  PubMed  Google Scholar 

  29. Milla-Tobarra M, Garcia-Hermoso A, Lahoz-Garcia N, Notario-Pacheco B, Lucas-de la CruzL, Pozuelo-Carrascosa DP, et al. The association between water intake, body composition and cardiometabolic factors among children—the Cuenca study. Nutr Hosp. 2016;33:312.

    Article  PubMed  Google Scholar 

  30. Tate DF, Turner-McGrievy G, Lyons E, Stevens J, Erickson K, Polzien K, et al. Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial. Am J Clin Nutr. 2012;95:555–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Meng G, Zhang B, Yu F, Li C, Zhang Q, Liu L, et al. Soft drinks consumption is associated with nonalcoholic fatty liver disease independent of metabolic syndrome in Chinese population. Eur J Nutr. 2018;57:2113–21.

    Article  CAS  PubMed  Google Scholar 

  32. Siddiqi Z, Karoli R, Fatima J, Khanduri S, Varshneya S, Ahmad SS. Soft drinks consumption and the risk of nonalcoholic fatty liver disease. J Assoc Physicians India. 2017;65:28–32.

    PubMed  Google Scholar 

  33. Illescas-Zarate D, Espinosa-Montero J, Flores M, Barquera S. Plain water consumption is associated with lower intake of caloric beverage: cross-sectional study in Mexican adults with low socioeconomic status. BMC Public Health. 2015;15:405.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Campbell SM. Hydration needs throughout the lifespan. J Am Coll Nutr. 2007;26:585S–7S.

    Article  PubMed  Google Scholar 

  35. Ranjbar R, Khamesipour F, Jonaidi-Jafari N, Rahimi E. Helicobacter pylori isolated from Iranian drinking water: vacA, cagA, iceA, oipA and babA2 genotype status and antimicrobial resistance properties. FEBS Open Bio. 2016;6:433–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Dulloo AG. The search for compounds that stimulate thermogenesis in obesity management: from pharmaceuticals to functional food ingredients. Obes Rev. 2011;12:866–83.

    Article  CAS  PubMed  Google Scholar 

  37. Hursel R, Westerterp-Plantenga MS. Catechin- and caffeine-rich teas for control of body weight in humans. Am J Clin Nutr. 2013;98:1682S–93S.

    Article  CAS  PubMed  Google Scholar 

  38. Jordan J, Shannon JR, Black BK, Ali Y, Farley M, Costa F, et al. The pressor response to water drinking in humans: a sympathetic reflex? Circulation. 2000;101:504–9.

    Article  CAS  PubMed  Google Scholar 

  39. Scott EM, Greenwood JP, Gilbey SG, Stoker JB, Mary DA. Water ingestion increases sympathetic vasoconstrictor discharge in normal human subjects. Clin Sci. 2001;100:335–42.

    Article  CAS  Google Scholar 

  40. Bruno S, Maisonneuve P, Castellana P, Rotmensz N, Rossi S, Maggioni M, et al. Incidence and risk factors for non-alcoholic steatohepatitis: prospective study of 5408 women enrolled in Italian tamoxifen chemoprevention trial. BMJ. 2005;330:932.

    Article  PubMed  PubMed Central  Google Scholar 

  41. McKenzie J, Fisher BM, Jaap AJ, Stanley A, Paterson K, Sattar N. Effects of HRT on liver enzyme levels in women with type 2 diabetes: a randomized placebo-controlled trial. Clin Endocrinol. 2006;65:40–4.

    Article  CAS  Google Scholar 

  42. Tchernof A, Belanger C, Morisset AS, Richard C, Mailloux J, Laberge P, et al. Regional differences in adipose tissue metabolism in women: minor effect of obesity and body fat distribution. Diabetes. 2006;55:1353–60.

    Article  CAS  PubMed  Google Scholar 

  43. Jensen MD, Cardin S, Edgerton D, Cherrington A. Splanchnic free fatty acid kinetics. Am J Physiol Endocrinol Metab. 2003;284:E1140–8.

    Article  CAS  PubMed  Google Scholar 

  44. Milic S, Lulic D, Stimac D. Non-alcoholic fatty liver disease and obesity: biochemical, metabolic and clinical presentations. World J Gastroenterol. 2014;20:9330–7.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was supported by grants from the National Natural Science Foundation of China (nos 81941024, 81872611, 91746205, and 81673166).

Author information

Author notes

  1. These authors contributed equally: Xing Wang, Shiyu Lin

Authors and Affiliations

  1. Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China

    Xing Wang, Qing Zhang, Li Liu, Shaomei Sun, Qiyu Jia, Kun Song & Kaijun Niu

  2. Obstetrics and Gynecology Department, Tianjin Medical University General Hospital, Tianjin, China

    Shiyu Lin

  3. Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China

    Shinan Gan, Ying Yang, Ge Meng, Zhanxin Yao, Dong Zheng, Hongmei Wu, Shunming Zhang, Yawen Wang, Tingjing Zhang, Yuntang Wu & Kaijun Niu

  4. Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China

    Yeqing Gu

  5. Institute of Environmental and Operational Medicine, Tianjin, China

    Zhanxin Yao

  6. College of Pharmacy, Tianjin Medical University, Tianjin, China

    Xiao-Hui Wu

  7. Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China

    Kaijun Niu

  8. Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China

    Kaijun Niu

Authors
  1. Xing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shiyu Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shinan Gan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yeqing Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ying Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qing Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Li Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ge Meng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zhanxin Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Dong Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hongmei Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Shunming Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yawen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Tingjing Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Shaomei Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Qiyu Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Kun Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Xiao-Hui Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Yuntang Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Kaijun Niu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Xing Wang, SL, and YG drafted the manuscript. SG, YY, QZ, LL, GM, ZY, DZ, HW, and SZ interpreted the results and contributed to the discussions. YWang, TZ, SS, QJ, KS, Xiao-Hui Wu, QJ, and YWu contributed to collect the data. KN and QZ designed the study, analyzed the data, reviewed and edited the manuscript, and had full access to all the data and took responsibility for the integrity of the data. All authors approved the final version.

Corresponding authors

Correspondence to Qing Zhang or Kaijun Niu.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, X., Lin, S., Gan, S. et al. Higher plain water intake is related to lower newly diagnosed nonalcoholic fatty liver disease risk: a population-based study. Eur J Clin Nutr 75, 1801–1808 (2021). https://doi.org/10.1038/s41430-021-00891-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-021-00891-9

This article is cited by

Search

Advanced search

Quick links