Relationship between dietary patterns and non-alcoholic fatty liver disease: A systematic review and meta-analysis

J Gastroenterol Hepatol. 2021 Jun;36(6):1470-1478. doi: 10.1111/jgh.15363. Epub 2020 Dec 14.


Background and aim: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. Previous studies have investigated the association between dietary patterns and NAFLD, but their results are contradictory. Therefore, we carried out this meta-analysis to examine the association between dietary patterns and NAFLD.

Methods: We searched PubMed, Web of Science, Scopus, and Google Scholar databases until November 14, 2019, to identify the observational studies on the association between dietary patterns and NAFLD. We selected three dietary patterns of Western, Prudent, and Mediterranean. A random-effect model was used to compute the summary risk estimates. Odds ratios (ORs) that were reported for fully adjusted models and their confidence intervals (CIs) were extracted for meta-analysis. Heterogeneity between studies was assessed using Cochran's Q- and I2 tests. Eighteen articles (n = 24 867 participants) were entered our systematic review and meta-analysis.

Results: We determined that Western dietary patterns (n = 8787 participants) containing high levels of processed food, red meat, high-fat dairy, and refined grains could significantly increase NAFLD (OR = 1.56, CI = 1.27 to 1.92; P ≤ 0.001). However, the Prudent (n = 13 023 participants) (OR = 0.78, CI = 0.71 to 0.85; P ≤ 0.001) and Mediterranean dietary patterns (n = 3057 participants) (OR = 0.77, CI = 0.60 to 0.98; P = 0.41), defined by high intake of fruits, vegetables, whole grains, fish, and olive oil decreased the risk of this disease.

Conclusions: We found that Western dietary patterns increased the risk of NAFLD by 56%, although the Prudent and Mediterranean dietary patterns reduced the risk of this disease by 22% and 23%, respectively.

Keywords: Mediterranean diet; Western diet; dietary pattern; healthy diet; meta-analysis; non-alcoholic fatty liver disease; systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Diet, Healthy*
  • Diet, High-Fat / adverse effects
  • Diet, Mediterranean*
  • Diet, Western / adverse effects*
  • Fast Foods / adverse effects
  • Female
  • Food Handling
  • Humans
  • Male
  • Meat / adverse effects
  • Non-alcoholic Fatty Liver Disease / etiology*
  • Non-alcoholic Fatty Liver Disease / prevention & control
  • Risk