TY - JOUR
T1 - Mediators of dietary diversity score (DDS) on NAFLD in Iranian adults
T2 - a structural equation modeling study
AU - Doustmohammadian, Azam
AU - Amirkalali, Bahareh
AU - Gholizadeh, Esmaeel
AU - Khoonsari, Mahmoodreza
AU - Faraji, Amir Hossein
AU - Nikkhah, Mehdi
AU - Maadi, Mansooreh
AU - Motamed, Nima
AU - Mansourian, Mohsen Reza
AU - Hajjar, Melika
AU - Clark, Cain C T
AU - Chaibakhsh, Samira
AU - Tameshkel, Fahimeh Safarnezhad
AU - Afzali, Arian
AU - Zamani, Farhad
N1 - Funding Information:
This research was conducted by a grant from the research council of Iran University of Medical Sciences of Iran (IUMS) (grant NO: 99–2–30–19054).
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2023/3
Y1 - 2023/3
N2 - Background: The current study examines the association between the Dietary Diversity Score (DDS) and nonalcoholic fatty liver disease (NAFLD) in Iranian adults using structural equation modeling (SEM). Methods: A sample of 3220 adults from the Amol Cohort Study was recruited for this cross-sectional study. Dietary acid load (DAL) and DDS were calculated using the data obtained from a validated food frequency questionnaire. Anthropometric parameters, blood pressure, biochemical measurements, and liver ultrasonography were evaluated according to standard protocols. Results: DDS was neither directly nor indirectly associated with a greater prevalence of NAFLD. In the second model (DDS sub-scores model), the association of DAL with NAFLD was fully mediated through waist circumference (WC) (of DAL to WC: β = 0.14, P < 0.0001, and of WC to NAFLD: β = 0.50, P < 0.001). Vegetable and fruit diversity scores had a significant negative indirect relationship with NAFLD prevalence through DAL (β = −0.06, P = 0.001, β = −0.10, P < 0.001, respectively). Meat diversity score was positively associated with NAFLD prevalence in a full mediational process through DAL (β = 0.12, P < 0.001). The SEM fit indices suggested a reasonably adequate fit of the data to the DDS model (Χ2/df = 4.76, GFI = 0.98, AGFI = 0.97, IFI = 0.97, CFI = 0.97, RMSEA = 0.03, and SRMR = 0.02) and its sub-scores model (Χ
2/df = 4.72, GFI = 0.98, AGFI = 0.97, IFI = 0.95, CFI = 0.95, RMSEA = 0.03, and SRMR = 0.02). Conclusion: Meat diversity and lack of vegetable and fruit diversity were indirectly associated with NAFLD prevalence through DAL and WC mediators. Interventions for NAFLD may be more successful if they target a lower intake of animal protein sources and dietary diversity, particularly vegetable and fruit diversity.
AB - Background: The current study examines the association between the Dietary Diversity Score (DDS) and nonalcoholic fatty liver disease (NAFLD) in Iranian adults using structural equation modeling (SEM). Methods: A sample of 3220 adults from the Amol Cohort Study was recruited for this cross-sectional study. Dietary acid load (DAL) and DDS were calculated using the data obtained from a validated food frequency questionnaire. Anthropometric parameters, blood pressure, biochemical measurements, and liver ultrasonography were evaluated according to standard protocols. Results: DDS was neither directly nor indirectly associated with a greater prevalence of NAFLD. In the second model (DDS sub-scores model), the association of DAL with NAFLD was fully mediated through waist circumference (WC) (of DAL to WC: β = 0.14, P < 0.0001, and of WC to NAFLD: β = 0.50, P < 0.001). Vegetable and fruit diversity scores had a significant negative indirect relationship with NAFLD prevalence through DAL (β = −0.06, P = 0.001, β = −0.10, P < 0.001, respectively). Meat diversity score was positively associated with NAFLD prevalence in a full mediational process through DAL (β = 0.12, P < 0.001). The SEM fit indices suggested a reasonably adequate fit of the data to the DDS model (Χ2/df = 4.76, GFI = 0.98, AGFI = 0.97, IFI = 0.97, CFI = 0.97, RMSEA = 0.03, and SRMR = 0.02) and its sub-scores model (Χ
2/df = 4.72, GFI = 0.98, AGFI = 0.97, IFI = 0.95, CFI = 0.95, RMSEA = 0.03, and SRMR = 0.02). Conclusion: Meat diversity and lack of vegetable and fruit diversity were indirectly associated with NAFLD prevalence through DAL and WC mediators. Interventions for NAFLD may be more successful if they target a lower intake of animal protein sources and dietary diversity, particularly vegetable and fruit diversity.
KW - Animals
KW - Humans
KW - Non-alcoholic Fatty Liver Disease/epidemiology
KW - Iran/epidemiology
KW - Cross-Sectional Studies
KW - Cohort Studies
KW - Latent Class Analysis
KW - Diet
KW - Vegetables
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U2 - 10.1038/s41430-022-01240-0
DO - 10.1038/s41430-022-01240-0
M3 - Article
C2 - 36443393
SN - 0954-3007
VL - 77
SP - 370
EP - 379
JO - European Journal of Clinical Nutrition
JF - European Journal of Clinical Nutrition
IS - 3
ER -