Associations between Ultra-processed Foods and Risk of Non-alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes: A Cross-sectional Study

Background and Objectives: Non-alcoholic fatty liver disease is closely associated with metabolic disorders such as obesity and type 2 diabetes.This study investigated the relationship between ultra-processed food consumption and development of non-alcoholic fatty liver disease in individuals with type 2 diabetes. Materials and Methods:In this cross-sectional study, 200 individuals with type 2 diabetes were included; of which, 133 had non-alcoholic fatty liver disease and 67 did not, based on Fibroscan results.Dietary intake was assessed using food frequency questionnaire and processed food consumption was estimated using NOVA classification system.Demographic and clinical data were collected as well.Logistic regression models were used to assess the association between ultra-processed food intake and the risk of developing non-alcoholic fatty liver disease.Results: Body mass index was significantly higher in people with non-alcoholic fatty liver disease (p < 0.001).Although no significant differences were seen in total calorie intake between the groups, individuals with non-alcoholic fatty liver disease had significantly higher consumptions of ultra-processed (NOVA 4) (p = 0.006) and processed foods (NOVA 3) (p = 0.032).Logistic regression analysis indicated that higher ultra-processed food intake was significantly associated to an increased risk of non-alcoholic fatty liver disease in individuals with type 2 diabetes.After adjusting for all confounding factors, the risk of non-alcoholic fatty liver disease in individuals in the highest tertile of ultra-processed food intake was more than 3 times higher than those in the first tertile of ultra-processed food intake (OR = 3.23, 95% CI: 1.27, 8.22, p = 0.019). Conclusion:This study has detected that consumption of ultra-processed foods is associated to an increased risk of nonalcoholic fatty liver disease in individuals with type 2 diabetes, indicating the importance of diet managing in liver health.