Erythrocyte membrane n-3 polyunsaturated fatty acids are inversely associated with the presence and progression of nonalcoholic fatty liver disease in Chinese adults: a prospective study

  • Zhan-yong Chen
  • Meng Liu
  • Li-peng Jing
  • Mian-li Xiao
  • Hong-li Dong
  • Geng-dong Chen
  • Yu-ming ChenEmail author
Original Contribution



Previous studies have shown that high-dose supplementation with n-3 polyunsaturated fatty acids (PUFAs) may benefit patients with nonalcoholic fatty liver disease (NAFLD), but the association of n-3 PUFAs with NAFLD among individuals with normal diets is only speculative. We investigated the cross-sectional and prospective associations between n-3 PUFAs and NAFLD in Chinese adults.


This community-based prospective study included 3049 men and women (40–75 years) in Guangzhou, China, whose participants completed an NAFLD ultrasound evaluation and erythrocyte PUFA tests. A total of 2660 participants underwent the second NAFLD evaluation approximately 3 years later. α-Linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in erythrocytes were measured by gas chromatography.


After adjusting for potential confounders, we observed inverse associations between DHA, DHA + EPA, total n-3 PUFAs and the presence of NAFLD in the cross-sectional analysis. The adjusted odds ratios (95% confidence interval) of NAFLD for the highest (vs. lowest) tertile were 0.74 (0.61, 0.90) for DHA, 0.82 (0.67, 1.00) for EPA, 0.73 (0.60, 0.88) for DHA + EPA and 0.74 (0.61, 0.91) for total n-3 PUFAs  (all P values≤0.05). Over the average 3.12 years of follow-up, higher levels of DHA was associated with an improvement of NAFLD. The hazard ratio of improved NAFLD for the highest tertile was 1.18 (95% CI 1.09, 1.33) for DHA. Pathway analyses showed that favorable associations may be mediated by improvements in inflammatory markers (e.g., interleukin 1 beta and tumor necrosis factor alpha-like).


Erythrocyte membrane n-3 PUFAs are inversely associated with the presence and progression of NAFLD in Chinese adults.

Trial registrations NCT03179657.


Erythrocyte membrane n-3 polyunsaturated fatty acids Nonalcoholic fatty liver disease Prospective study 



We thank all the participants and the coordination staff in the GNHS cohort study gratefully.

Author contributions

YMC conceived and designed the research; ZYC, ML, LPJ, MLX, HLD and GDC collected the data; ZYC performed the data analysis, ZYC and YMC wrote the paper; and YMC had primary responsibility for the final content. All authors read and approved the final manuscript.


This study was supported by the National Science Foundation of China (No. 81472965, 81773416); the 5010 Program for Clinical Researches (No. 2007032) by the Sun Yat-sen University. The funders had no role in study design, collection, analysis and interpretation of data, writing of the report and in the decision to submit the article for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

394_2019_1953_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 21 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Epidemiology, School of Public HealthSun Yat-sen UniversityGuangzhouChina
  2. 2.The First Affiliated HospitalSun Yat-sen UniversityGuangzhouChina

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