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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

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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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

Trial registrations

ClinicalTrials.gov NCT03179657.

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Acknowledgements

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

Funding

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.

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Author notes

  1. Zhan-yong Chen, Meng Liu are contributed equally to this article.

Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China

    Zhan-yong Chen, Meng Liu, Li-peng Jing, Mian-li Xiao, Hong-li Dong, Geng-dong Chen & Yu-ming Chen

  2. The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China

    Zhan-yong Chen

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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.

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Correspondence to Yu-ming Chen.

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Chen, Zy., Liu, M., Jing, Lp. et al. 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. Eur J Nutr 59, 941–951 (2020). https://doi.org/10.1007/s00394-019-01953-2

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