Association Between Consumption of Edible Seaweeds and Newly Diagnosed Non-alcohol Fatty Liver Disease

The TCLSIH Cohort Study

Huiping Li; Yeqing Gu; Xiaohui Wu; Sabina Rayamajhi; Shanshan Bian; Qing Zhang; Ge Meng; Li Liu; Hongmei Wu; Shunming Zhang; Yawen Wang; Tingjing Zhang; Xuena Wang; Amrish Thapa; Shaomei Sun; Xing Wang; Qiyu Jia; Kun Song; Kaijun Niu


Liver International. 2021;41(2):311-320. 

In This Article

Abstract and Introduction


Background & Aims: Seaweeds are rich sources of anti-oxidants and anti-inflammatory properties, which are beneficial to non-alcoholic fatty liver disease (NAFLD). However, whether seaweed consumption is associated with NAFLD is unknown. We investigated the association of seaweed consumption with newly diagnosed NAFLD in a large-scale adult population.

Methods: This cross-sectional study involved 24 572 participants aged over 18 years. NAFLD was diagnosed by results of liver ultrasonography and alcohol intake. Dietary information was assessed using a validated and standardized 100-item food frequency questionnaire. Multivariate logistic analysis was used to evaluate the association between seaweed consumption and NAFLD.

Results: The prevalence of newly diagnosed NAFLD was 20.1%. After adjustment for sociodemographic characteristics, lifestyle factors, and other dietary intakes, the multivariable adjusted odds ratios (95% confidence intervals) of newly diagnosed NAFLD across seaweed consumption were 1.00 (reference) for almost never, 1.03 (0.93, 1.15) for <1 time/wk, 1.01 (0.90, 1.13) for 1 time/wk, and 0.84 (0.73, 0.96) for >1 times/wk (P for trend < .001). Stratified analyses suggested a potential effect modification by obesity status; the odds ratios (95% confidence intervals) across extreme quartiles was 0.77 (0.66, 0.91) in non-obese participants and 1.02 (0.79, 1.33) in obese participants (P for interaction < .001).

Conclusion: Seaweed consumption is negatively associated with NAFLD, especially in non-obese participants.


Non-alcoholic fatty liver disease (NAFLD) is a pathologic condition defined as accumulation of triglycerides (TG) in the liver in absence of excessive alcohol intake.[1] It encompasses a large spectrum of liver damage, ranging from simple hepatic steatosis to non-alcoholic steatohepatitis, liver fibrosis, with some cases developing liver cirrhosis and hepatocellular carcinoma.[2] The current prevalence of NAFLD is approximately 20%-30% in Western countries and 15%-30% in China.[3] Given its association with insulin resistance, hypertension, dyslipidaemia and obesity, NAFLD has been considered to be the hepatic manifestation of metabolic syndrome (MetS).[4] In addition, NAFLD also contributes to an increased risk of cardiovascular morbidity and mortality.[5] Thus, prevention of NAFLD is important for public health. To our knowledge, there are currently no specific therapy and registered drug for the treatment of NAFLD,[6] while lifestyle interventions, including diet modification and increased physical activity (PA), are recommended for the treatment of this disease.[7]

Seaweeds are classified into Rhodophyta (red), Phaeophyta (brown) and Chlorophyta (green) marine macroalgae.[8] An animal study showed that seaweeds could improve insulin sensitivity by increasing serum adiponectin concentrations,[9] which underlies the pathogenesis of NAFLD.[10] Moreover a review demonstrated that seaweeds may ameliorate the signs of MetS.[11] These protective effects could be due to some components of seaweeds, including fibres, polysaccharides, minerals, vitamins and omega-3 fatty acids.[8] These components possess anti-inflammatory activities by activating anti-inflammatory responses and/or suppressing the pro-inflammatory responses, and antioxidative effects by reducing lipid oxidation and increasing the endogenous antioxidant enzymes superoxide dismutase.[12] Furthermore, several animal studies have suggested that seaweed supplementation may have a protective effect against NAFLD.[13,14] Therefore, it was hypothesized that edible seaweed consumption might have a beneficial effect in the prevention of NAFLD.

Only a randomized clinical trial has shown that seaweed supplementation could be considered as an adjunctive therapy to improve liver function in patients with NAFLD.[15] However, no epidemiologic data are available on the effect of seaweeds on NAFLD. Therefore, the objective of the present study was to examine the association of edible seaweed consumption and newly diagnosed NAFLD in a large adult population.