Spinach consumption, risk for NAFLD among Iranian adults
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Researchers found an inverse association between spinach consumption and the risk for nonalcoholic fatty liver disease, according to BMC Gastroenterology.
“Different aspects of diet have been investigated with NAFLD’s risk. ... Using common foods like spinach to improve diet quality may provide a simple and inexpensive way to reduce the risk of chronic diseases such as NAFLD,” Ebrahim Mokhtari, MS, Nutrition and Endocrine Research Center at Shahid Beheshti University of Medical Sciences, and colleagues wrote. “However, whether individuals receiving higher dietary spinach than those who did not have a different risk of developing NAFLD has not been assessed in previous studies.”
In a case-control study among Iranian adults, researchers analyzed 225 patients newly diagnosed with NAFLD and 450 controls (mean age 38.1 years; 53% men; mean BMI 26.8 kg/m2) to investigate the association between spinach intake and the odds for NAFLD. Participants completed a 168-item semi-quantitative food frequency questionnaire. Researchers used logistic regression to assess the association between total spinach intake, raw spinach intake and boiled spinach intake with NAFLD.
Compared with the lowest tertile of spinach intake, all three spinach intake categories in the highest tertile correlated with lower odds for NAFLD (total intake OR = 0.47; 95% CI, 0.24-0.89; raw intake OR = 0.36; 95% CI, 0.19-0.7 and boiled intake OR = 0.76; 95% CI, 0.42-1.38). Further, adjusted analyses yielded an inverse association between the highest yearly intake vs. no raw spinach consumption and odds for NAFLD (OR = 0.41; 95% CI, 0.18–0.96).
“Spinach is one of the richest sources of ingredients such as polyphenol and antioxidants. If its beneficial effects on chronic disease are approved in future studies, it could easily be used as a powder to enrich the nutritional values of homemade foods or products such as dairy or other foods,” Mokhtari and colleagues concluded. “We suggest that our hypothesis of the association between dietary spinach and NAFLD odds be examined in more studies with higher design power, like large cohort studies and clinical trials.”
Perspective
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This study is consistent with prior observational research showing that healthy dietary patterns are associated with a reduced risk for NAFLD. The demographic data for cases and controls revealed the NAFLD patients had higher BMI and less physical activity and consumed more high-fat dairy products, fewer vegetables, and specifically, less total, raw and boiled spinach.
Given the overall difference in vegetable consumption between the two groups, and the differences in BMI and physical activity, it is impossible to say with certainty that spinach consumption alone prevents NAFLD. The result is nonetheless interesting and further underscores the importance of a healthy lifestyle, particularly diet, in reducing the risk for NAFLD.
With the rapidly increasing rates of obesity and metabolic syndrome, NAFLD is the most common cause of chronic liver disease worldwide and could easily become the most common cause of cirrhosis. The pathophysiology of NAFLD is complex and includes the multi-hit hypothesis. Lifestyle modification is of paramount importance on an individual and global health level, patients should be counseled to attain regular aerobic exercise and educated on the importance of a diverse, plant-based diet. Partnering with primary care teams and our colleagues in nutrition is essential.
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