Article Text

Download PDFPDF
IDDF2023-ABS-0257 Protein intake and non-alcoholic fatty liver disease: a cross-sectional analysis on the national health and nutrition examination survey
  1. Kexin Sun1,
  2. Edmund Anthony Severn Nelson2,
  3. Hugh Simon Hung-San Lam1,
  4. Lai-Ling Hui3
  1. 1Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
  2. 2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
  3. 3Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong


Background Lifestyle modification is the first-line treatment for non-alcoholic fatty liver disease (NAFLD). There are inconsistent findings on the associations between protein intake and the risk of NAFLD. So far, no studies have investigated their associations using data from the National Health and Nutrition Examination Survey (NHANES), which is regularly conducted in the United States (US) covering a wide range of health-related aspects. Here we aim to study the associations between the intake of different sources of protein with the risk of NAFLD using cross-sectional data from NHANES 2007 - pre-pandemic March 2020.

Methods Dietary information was collected through two 24-hour dietary recalls. NAFLD was defined as a US fatty liver index (USFLI) above 30, an algorithm including age, ethnicity, waist circumference and level of gamma-glutamyl transferase, fasting insulin and fasting glucose. Multivariable logistic regression was applied to assess the association between daily protein intake in quantiles and NAFLD status, adjusting for potential demographic and lifestyle confounders and intake of other energy-generating nutrients. Total protein was further divided into subtypes, namely dairy (milk and milk products), muscle (meat, poultry, fish and mixtures), egg, animal (including dairy, muscle and egg) and plant (legumes, nuts, seeds, grain products, fruits and vegetables) protein to evaluate individual effects.

Results In total, 8364 people aged 20 or above were included. NAFLD prevalence was 33.6% based on USFLI. Daily intake of dairy protein was negatively associated with NAFLD risk [odds ratio (OR)Q4vsQ10.68, 95% confidence interval (CI) 0.54-0.86. Total, plant, animal (overall), muscle and egg protein intake was not significantly associated with NAFLD.

Conclusions Our analysis of this large population-based sample indicated that the risk of NAFLD is associated with a dietary pattern poor in dairy protein, independent of other risk factors. Further intervention studies are warranted to investigate the causal roles of different types of protein in the development and prognosis of NAFLD.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.