Adherence to the Dietary Approaches to Stop Hypertension Diet and Non-alcoholic Fatty Liver Disease

Yuanyuan Sun; Shuohua Chen; Xinyu Zhao; Yanhong Wang; Yanqi Lan; Xiaozhong Jiang; Xiang Gao; Shouling Wu; Li Wang


Liver International. 2022;42(4):809-819. 

In This Article

Abstract and Introduction


Background and Aims: The evidence of the relationship between dietary approaches to stop hypertension (DASH) and non-alcoholic fatty liver disease (NAFLD) is limited. Thus, we conducted a cohort-based case-control study to examine whether adherence to the DASH diet was associated with lower NAFLD risk in China.

Methods: We included 11 888 participants (2529 incident NAFLD and 9359 non-NAFLD) from the Kailuan cohort with no history of hepatitis B/C infection and alcohol drinking. DASH score was calculated based on the energy-adjusted consumption of vegetables, fruits, dairy, beans, grains, meats, fat, sodium and beverage, collected by a validated food frequency questionnaire. We used Logistic regression analysis to determine the NAFLD's risk according to the DASH score.

Results: Higher DASH score was associated with lower risk of NAFLD. Compared with the lowest quintile of DASH score, the highest DASH quintile had a lower risk of occurring NAFLD, with odds ratio (OR) of 0.82 (95% confidence interval [CI]: 0.70–0.96) in the multivariate model. Stratified analysis showed that the inverse association was only observed in women (OR = 0.67, 95% CI: 0.48–0.94), and participants with overweight/obesity (OR = 0.79, 95% CI: 0.66–0.94), fasting blood glucose <6.1 mmol/L (OR = 0.80, 95%: 0.67–0.96), low density lipoprotein ≥3.4 mmol/L (OR = 0.71, 95% CI: 0.53–0.96), high density lipoprotein ≥1.0 mmol/L (OR = 0.81, 95% CI: 0.69–0.96), ALT < 40 U/L (OR = 0.79, 95% CI:0.67–0.93) and C-reactive protein ≥2.0 mg/L (OR = 0.56, 95% CI: 0.40–0.78).

Conclusions: Adherence to the DASH diet was inversely associated with a lower risk of NAFLD in the Chinese population. DASH diet should be highly recommended, especially for women and people with overweight/obesity and a high CRP level.


Non-alcoholic fatty liver disease (NAFLD), which occurs in a quarter of the population worldwide, has become a major cause of liver disease and caused serious disease burden due to the associated risk of progression to cirrhosis, liver cancer and the increased risk of extra-hepatic diseases, such as cardiovascular disease, type 2 diabetes, chronic kidney disease and extra-hepatic cancers.[1–3] Lifestyle intervention aiming at a moderate amount of weight loss and increased physical activity has been considered the most established first-line treatment for this disease.[4,5] Previous studies suggested that adherence to a healthy dietary pattern could improve liver steatosis even without weight loss.[4] Dietary approaches to stop hypertension (DASH) diet, characterized by being rich in fruits, vegetables, whole grains, low-fat dairy products and legumes/nuts but low in saturated fat, sodium and added sugars, has been reported to be beneficial to NAFLD. A two-arm parallel randomized controlled clinical trial showed that an 8-week DASH diet significantly reduced weight and improved metabolic status for overweight or obese patients with NAFLD.[6] Two observational studies also reported an inverse relationship between the DASH diet with NAFLD.[7,8] However, these studies were based on the prevalent NAFLD cases, which may exist prevalence-incidence bias or small sample size. There still needs more evidence to explore the relationship between adherence to the DASH diet and the incidence risk of NAFLD. Based on the Kailuan cohort, our study aimed to examine the association between adherence to the DASH diet, including the individual dietary component, and NAFLD risk.