There is little evidence for the associations of the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI) with the odds of nonalcoholic fatty liver disease (NAFLD). We present a nationwide cross-sectional study among US adults aged 18 years or older. Diet was assessed by 24-h recalls. Overall PDI, hPDI, and uPDI were constructed based on 18 food groups. NAFLD was defined based on controlled attenuation parameter derived via transient elastography (TE) in the absence of other causes of chronic liver disease. Among 3900 participants with eligible TE examination, 1686 were diagnosed with NAFLD. The overall PDI was not associated with NAFLD prevalence (comparing extreme tertiles of PDI score OR = 1.03, 95% CI 0.76, 1.38, p_trend = 0.609). However, hPDI was inversely (OR = 0.50, 95% CI 0.35, 0.72, p_trend < 0.001), while uPDI was positively associated with odds of NAFLD (OR = 1.37, 95% CI 0.93, 2.02, p_trend = 0.009) in the multivariable-adjusted models without body mass index (BMI). After further adjustment for BMI, only the association of hPDI with NAFLD remained statistically significant (OR = 0.64, 95% CI 0.46, 0.87, p_trend = 0.006). Such inverse association appeared stronger in non-Hispanic whites, but not in other racial/ethnic groups (p_interaction = 0.009). Our findings suggest that a plant-based diet rich in healthy plant foods might be associated with lower odds of NAFLD, particularly among US non-Hispanic whites. Clinical trials and cohort studies to validate our findings are needed.

中文翻译：

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健康的植物性饮食与降低非酒精性脂肪肝的几率有关

几乎没有证据表明总体植物性饮食指数 (PDI)、健康的 PDI (hPDI) 和不健康的 PDI (uPDI) 与非酒精性脂肪性肝病 (NAFLD) 的几率之间存在关联。我们在 18 岁或以上的美国成年人中进行了一项全国性的横断面研究。通过 24 小时回忆评估饮食。总体 PDI、hPDI 和 uPDI 是根据 18 个食物组构建的。NAFLD 是根据在没有其他慢性肝病原因的情况下通过瞬时弹性成像 (TE) 得出的受控衰减参数来定义的。在符合条件的 TE 检查的 3900 名参与者中，有 1686 名被诊断出患有 NAFLD。总体 PDI 与 NAFLD 患病率无关（比较 PDI 评分的极端三分位数 OR = 1.03，95% CI 0.76，1.38，p_趋势= 0.609）。然而，hPDI 呈负相关（OR = 0.50，95% CI 0.35，0.72，p_趋势< 0.001），而 uPDI 与 NAFLD 的几率呈正相关（OR = 1.37，95% CI 0.93，2.02，p_趋势= 0.009）没有体重指数（BMI）的多变量调整模型。进一步调整 BMI 后，只有 hPDI 与 NAFLD 的关联仍然具有统计学意义（OR = 0.64，95% CI 0.46，0.87，p_趋势= 0.006）。这种反向关联在非西班牙裔白人中似乎更强，但在其他种族/族裔群体中则不然（p_相互作用= 0.009）。我们的研究结果表明，富含健康植物性食物的植物性饮食可能与较低的 NAFLD 几率有关，尤其是在美国非西班牙裔白人中。需要临床试验和队列研究来验证我们的发现。