A cross-sectional study assessing dietary intake and physical activity in Canadian patients with nonalcoholic fatty liver disease vs healthy controls

J Acad Nutr Diet. 2014 Aug;114(8):1181-94. doi: 10.1016/j.jand.2014.01.009. Epub 2014 Mar 14.


Background: Poor diet and a sedentary lifestyle can contribute to nonalcoholic fatty liver disease (NAFLD).

Objective: Our aim was to compare diet and physical activity of patients with NAFLD and healthy controls with current recommendations.

Design: This was a cross-sectional study.

Participants/settings: Seventy-four patients with biopsy-proven NAFLD (33 simple steatosis and 41 steatohepatitis [NASH]) and 27 healthy controls participated between 2003 and 2011.

Main outcome measures: Food records and activity logs were completed for 7 days. Results were compared with Dietary Reference Intakes and Canadian Physical Activity Guidelines. Plasma vitamin C was measured to assess food record accuracy.

Statistical analyses performed: Intake/activity for each participant was compared with the recommendations and proportion of subjects not meeting the requirements was calculated. Groups were compared by Kruskal-Wallis and Mann-Whitney U test or z-test with Bonferroni adjustment.

Results: More patients with NASH (58.5%) were obese compared with patients with simple steatosis (24.2%) and healthy controls (7.4%; P<0.01). Patients with NAFLD showed more insulin resistance than healthy controls. The reported energy intake was below estimated requirements in all groups (P≤0.001). The proportion of subjects from each group exceeding acceptable energy intake from fat was as follows: simple steatosis: 27.3%; NASH: 46.3%; healthy controls: 63.0% (simple steatosis vs health controls; P<0.05) and from saturated fat: simple steatosis: 42.4%; NASH: 70.7%; healthy controls: 63.0% (simple steatosis vs. NASH; P<0.05). In each group, >80% of subjects did not consume enough linoleic or linolenic acid, vitamin D, and vitamin E, and >60% exceeded the upper intake level for sodium. Only 53.1% of patients with simple steatosis and 53.8% of patients with NASH, but 84.6% of healthy controls, met recommendations for physical activity (P=0.020). Plasma vitamin C was normal, similar among groups, and correlated with vitamin C intakes.

Conclusions: All participants followed a similar Western diet with high fat and sodium intakes and suboptimal micronutrient intakes. However, physical activity was lower in NAFLD compared with healthy controls and was associated with higher body mass index and insulin resistance.

Keywords: Diet; Nonalcoholic fatty liver disease; Nutrient intake; Physical activity; Steatohepatitis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Ascorbic Acid / administration & dosage
  • Ascorbic Acid / blood
  • Body Mass Index
  • Canada
  • Case-Control Studies
  • Cross-Sectional Studies
  • Diet Records
  • Dietary Fats / administration & dosage
  • Energy Intake*
  • Fatty Liver / physiopathology
  • Fatty Liver / therapy*
  • Female
  • Guidelines as Topic
  • Healthy Volunteers
  • Humans
  • Insulin Resistance
  • Male
  • Middle Aged
  • Motor Activity*
  • Non-alcoholic Fatty Liver Disease
  • Nutrition Assessment
  • Prospective Studies
  • Sodium, Dietary / administration & dosage
  • Vitamin D / administration & dosage
  • Vitamin D / blood
  • Vitamin E / administration & dosage
  • Vitamin E / blood
  • Young Adult


  • Dietary Fats
  • Sodium, Dietary
  • Vitamin D
  • Vitamin E
  • Ascorbic Acid