Does Consumption of Ultra-Processed Foods Matter for Liver Health? Prospective Analysis among Older Adults with Metabolic Syndrome
Jadwiga Konieczna, Miguel Fiol, Antoni Colom, Miguel Ángel Martínez‐González, Jordi Salas‐Salvadó, Dolores Corella, María Trinidad Soria-Florido, J. Alfredo Martínéz, Ángel M. Alonso‐Gómez, Julia Wärnberǵ, Jesús Vioqué, José López‐Miranda, Ramón Estruch, M. Rosa Bernal‐López, José Lapetra, Lluís Serra‐Majem, Aurora Bueno‐Cavanillas, Josep A. Tur, Vicente Martín, Xavier Pintó, José J. Gaforio, Pilar Matía‐Martín, Josép Vidal, Clotilde Vázquez, Lidia Daimiel, Emilio Ros, Maira Bes‐Rastrollo, María Pascual, José V. Sorlí, Albert Goday, M. Ángeles Zulet, Anai Moreno-Rodríguez, Francisco Jesús Carmona González, Rafael Valls-Enguix, J. M. Janer, Antoni Sureda, Rosa Casas, Ana María Gómez‐Pérez, José Manuel Santos‐Lozano, Francisco Javier Basterra-Gortari, María Ángeles Martínez, Carolina Ortega‐Azorín, Joan Bayó, Itziar Abete, Itziar Salaverria‐Lete, Miguel Ruiz‐Canela, Nancy Babió, Lourdes Carrés, Dora Romaguera
Abstract
Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver alterations that can result in severe disease and even death. Consumption of ultra-processed foods (UPF) has been associated with obesity and related comorbidities. However, the link between UPF and NAFLD has not been sufficiently assessed. We aimed to investigate the prospective association between UPF consumption and liver health biomarkers. Methods: We followed for 1 year 5867 older participants with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus trial. A validated 143-item semi-quantitative food frequency questionnaire was used to evaluate consumption of UPF at baseline, 6, and 12 months. The degree of processing for foods and beverages (g/day) was established according to the NOVA classification system. The non-invasive fatty liver index (FLI) and hepatic steatosis index (HSI) were used to evaluate liver health at three points in time. The associations between changes in UPF consumption (percentage of total daily dietary intake (g)) and liver biomarkers were assessed using mixed-effects linear models with repeated measurements. Results: In this cohort, UPF consumption at baseline was 8.19% (SD 6.95%) of total daily dietary intake in grams. In multivariable models, each 10% daily increment in UPF consumption in 1 year was associated with significantly greater FLI (β 1.60 points, 95% CI 1.24;1.96 points) and HSI (0.43, 0.29; 0.57) scores (all p-values < 0.001). These associations persisted statistically significant after adjusting for potential dietary confounders and NAFLD risk factors. Conclusions: A higher UPF consumption was associated with higher levels of NAFLD-related biomarkers in older adults with overweight/obesity and MetS.