Sweetened Soft Drinks Consumption And Risk Of Non-alcoholic Fatty Liver Disease

Background Nonalcoholic fatty liver disease(NAFLD)is the most common chronic liver disease worldwide.To date,a relatively high epidemic proportion of NAFLD not only has raised heavy alarm in public health but also has resulted in a heavy financial burden.Soft drinks are defined as water-based flavored beverages without alcohol(< 0.5%).Several studies with a relatively small sample have suggested a positive link between soft drinks consumption and NAFLD.However,compared with other countries the per capita soft drinks intake in China is very low.Study has been published by our research group which assessed the relationship of a low consumption of soft drinks to NAFLD,although a limitation of cross-sectional design.Thus,the present research aims to further discuss the effect of sweetened soft drinks on NAFLD in Tianjin population and specifically in male and female.Methods Current research has been conducted on basis of Tianjin Chronic Low-Grade Systemic Inflammation and Health(TCLSIH)cohort study.We randomly recruited 12,115 adults.NAFLD was diagnosed by liver ultrasonography.Sweetened soft drinks were assessed by a validated semi-quantitative food frequency questionnaire(FFQ).The final categories of the frequency of sweetened soft drinks consumption according to the frequency distribution of Tianjin population were divided into three levels as ‘never’,‘less than once per week’ and ‘no less than once per week’.We take advantage of variance or logistic regression analysis to show the baseline characteristics and use Cox Proportional Hazards models to assess the relationship between sweetened soft drinks consumption and incidence of NAFLD and further stratified by gender and body mass index(BMI).BMI has been categorized into 4 groups based on Chinese standards and as follows: Underweight(BMI < 18.5),normal(18.5 ≤ BMI < 24),overweight(24 ≤ BMI < 28)and obese(BMI ≥ 28).Results In the study population,mean age is 39.48(± 11.34).Of participants 41.1%(4,975)were male and 58.9%(7,140)were female.During the follow-up(mean 2.40 years),the incidence rate of NAFLD was 16.5% and the cumulative incidence was68.75 per 1,000 person-years.After adjustments,finding of Cox regression analysis showed that the risk of NAFLD was increased with increasing of soft drinks consumption and the HR(95%CI)were 1.00(ref.),1.07(0.94,1.22)and 1.43(1.27,1.61)(P for trend <0.0001).After stratified by gender,only in male was the soft drinks consumption significantly associated with a higher risk for NAFLD: The HR(95%CI)for NAFLD across increasing frequency of soft drinks were 1.00(ref.),1.62(0.90,1.25)and 1.37(1.17,1.60)(P for trend <0.0001).With regard to women,the HR(95%CI)for NAFLD across increasing frequency of soft drinks were 1.00(ref.),1.01(0.82,1.25),1.21(0.98,1.49)(P for trend =0.09).After stratified by BMI,finding revealed that higher soft drinks intake is a significant risk factor for NAFLD in individuals with standard BMI: The HR(95%CI)for NAFLD across increasing frequency of soft drinks were 1.00(ref.),1.23(1.00,1.50)and 1.76(1.46,2.12).(P for trend <0.0001).Conclusions Present data suggested that the risk of NAFLD is increased with higher sweetened soft drinks intake in Chinese population.This relationship is most significant in male and/or with standard BMI.Though detailed mechanism remains unclear,findings pave the way for effective and efficient prevention of NAFLD in Chinese.