Food Habits and their Relationship to the Incidence of Non-Alcoholic Fatty Liver Disease in Various Social Classes in Pakistan

Abstract

Background: The prevalence of non-alcoholic fatty liver disease (NAFLD) has been rising at a rapid pace in the context of Pakistan due to lifestyle changes and increasing metabolic risk factors. International research has already identified Western-type food habits to be a consistent risk factor for NAFLD. However, no study in Pakistan has investigated variations based on socioeconomic factors. Objectives To evaluate the relationship of empirically identified dietary patterns to NAFLD and ascertain the existence of differences in these relationships based on socioeconomic groups in the city of Lahore. Methods: A case–control study was performed at Mansoora Hospital, recruiting 60 NAFLD patients proven by ultrasound scan and 60 controls. Food habits were recorded through a semiquantitative food-frequency questionnaire. Principal components analysis was used to extract large dietary factors. Logistic regression models estimated the odds of NAFLD according to the tertiles of each factor's adherence, adjusted for various factors. The role of SES was explored considering interaction with jointly defined education-income groups. Results: A high Western dietary pattern was positively related to the odds of NAFLD (adjusted OR: 2.94; 95% CI: 1.20-7.19; p trend=0.011), and the protective effect of the prudent dietary pattern was evident (adjusted OR: 0.28; 95% CI: 0.11-0.70; p trend=0.003). The effect of the Western pattern was maximal in the Conclusion: The Western dietary pattern confers a high risk of NAFLD, which increases substantially in higher socioeconomic groups. Stratified dietary treatment trials are greatly needed.