Association Between Nut Consumption and Non-alcoholic Fatty Liver Disease in Adults

Shunming Zhang; Jingzhu Fu; Qing Zhang; Li Liu; Ge Meng; Zhanxin Yao; Hongmei Wu; Xue Bao; Yeqing Gu; Min Lu; Shaomei Sun; Xing Wang; Ming Zhou; Qiyu Jia; Kun Song; Huiling Xiang; Yuntang Wu; Kaijun Niu


Liver International. 2019;39(9):1732-1741. 

In This Article

Abstract and Introduction


Background & Aims: Increased nut consumption has been associated with reduced inflammation, insulin resistance, and oxidative stress. Although these factors are closely involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD), few studies have focused on the association between nut consumption and NAFLD in the general population. We aimed to investigate the association of nut consumption and NAFLD in an adult population.

Methods: A total of 23 915 participants from Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) Cohort Study were included in this study. Information on dietary intake was collected using a validated food frequency questionnaire. Abdominal ultrasonography was done to diagnose NAFLD. Multivariable logistic regression was used to assess the association of nut consumption with NAFLD.

Results: After adjusting for sociodemographic, medical, dietary, and lifestyle variables, the odds ratios (95% confidence interval) for NAFLD across categories of nut consumption were 1.00 (reference) for <1 time/week, 0.91 (0.82, 1.02) for 1 time/week, 0.88 (0.76, 1.02) for 2-3 times/week, and 0.80 (0.69, 0.92) for ≥4 times/week (P for trend < 0.01). These associations were attenuated but remained significant after further adjustment for blood lipids, glucose, and inflammation markers.

Conclusions: Higher nut consumption was significantly associated with lower prevalence of NAFLD. Further prospective studies and randomized trials are required to ascertain the causal association between nut consumption and NAFLD.


Non-alcoholic fatty liver disease (NAFLD) is characterized by excessive fat accumulation in the liver, in the absence of causes for secondary hepatic fat accumulation, such as significant alcohol consumption, use of medications, or parenteral nutrition.[1] NAFLD has become the most common cause of chronic liver disease worldwide.[2] Global prevalence of NAFLD diagnosed by imaging was estimated to be 25.24% (95% confidence interval [CI]: 22.10-28.65) in adults.[2] Accumulating evidence suggests that individuals with NAFLD are at increased risk of type 2 diabetes, cardiovascular disease (CVD), and all-cause mortality.[3,4] However, there is no approved drug therapy for NAFLD, and the main clinical recommendations are lifestyle modifications, including diet.[5]

Nuts are rich sources of unsaturated fatty acids, fibre, minerals, vitamins, protein and other bioactive compounds such as phenolic antioxidants and phytosterols.[6,7] Epidemiological studies have also consistently associated the frequent nut consumption with reduced inflammation,[8,9] insulin resistance[10] and oxidative stress,[11] all of which are the important components in the pathogenetic mechanism of NAFLD.[12–14] Thus, it was hypothesized that high nut consumption may have a preventive effect on the development of NAFLD.

To date, data directly linking nut intake with NAFLD are sparse. We therefore conducted this population-based study to evaluate the association between nut consumption and prevalence of NAFLD.