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- Title
Mediators of dietary diversity score (DDS) on NAFLD in Iranian adults: a structural equation modeling study.
- Authors
Doustmohammadian, Azam; Amirkalali, Bahareh; Gholizadeh, Esmaeel; Khoonsari, Mahmoodreza; Faraji, Amir Hossein; Nikkhah, Mehdi; Maadi, Mansooreh; Motamed, Nima; Mansourian, Mohsen Reza; Hajjar, Melika; Clark, Cain C. T.; Chaibakhsh, Samira; Tameshkel, Fahimeh Safarnezhad; Afzali, Arian; Zamani, Farhad
- Abstract
<bold>Background: </bold>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).<bold>Methods: </bold>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.<bold>Results: </bold>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 (Χ2/df = 4.72, GFI = 0.98, AGFI = 0.97, IFI = 0.95, CFI = 0.95, RMSEA = 0.03, and SRMR = 0.02).<bold>Conclusion: </bold>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.
- Publication
European Journal of Clinical Nutrition, 2023, Vol 77, Issue 3, p370
- ISSN
0954-3007
- Publication type
journal article
- DOI
10.1038/s41430-022-01240-0