Substitutions of saturated fat intakes with other macronutrients and foods and risk of NAFLD cirrhosis and all-cause hepatocellular carcinoma: a prospective cohort study

• Background: Short-term trials have shown a reduction in liver fat when saturated fatty acids (SFA) are substituted with polyunsaturated fatty acids (PUFA), or with low-glycemic carbohydrates. However, few large-scale cohort studies have been conducted to investigate the associations of replacing SFA and SFA-rich foods with different macronutrients and foods on more severe stages of liver disease; non-alcoholic fatty liver disease (NAFLD) cirrhosis and hepatocellular carcinoma (HCC). Methods: In a middle-aged to elderly Swedish population of n=77 059 men and women, time-to-event analysis was performed to investigate the associations between the substitutions of SFA and SFA-rich foods with other macronutrients and foods and NAFLD cirrhosis and HCC, respectively. Multivariable Cox regression models were constructed to estimate hazard ratios (HR) with corresponding 95% confidence intervals (CI). Statistical isocaloric and equal-mass substitutions were performed using the leave-one-out method. Prespecified nutrient and food substitutions of interest were: SFA with carbohydrates, SFA with fiber, SFA with PUFA, butter with margarine and vegetable oils, unprocessed red meat with fish, and milk with fermented milk.Results: Over a median follow-up of 24 years, 566 cases of NAFLD cirrhosis and 205 cases of HCC were registered. Overall, dietary substitutions showed no statistically significant associations with neither NAFLD cirrhosis nor HCC. Substituting SFA with carbohydrates showed a HR of 0.87 (95% CI: 0.74-1.02)) for HCC and 1.00 (95% CI: 0.89-1.11) for NAFLD cirrhosis. Substituting milk with fermented milk showed a HR of 0.93 (95% CI: 0.85-1.01) for HCC and 0.97 (95% CI: 0.92-1.03) for NAFLD cirrhosis. Conclusion: No clear associations were observed between diet and NAFLD cirrhosis nor HCC. Although accompanied by low precision, findings on the substitution of SFA with carbohydrates and milk with fermented milk and HCC are interesting, but needs replication in other cohorts.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Näringslära (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Nutrition and Dietetics (hsv//eng)

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