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Association between nut intake and non-alcoholic fatty liver disease risk: a retrospective case-control study in a sample of Chinese Han adults
  1. Bing bing Chen1,
  2. Ying Han2,
  3. Xinting Pan1,
  4. Jianhui Yan1,
  5. Wenjuan Liu1,
  6. Yangfan Li1,
  7. Xu Lin3,
  8. Shanghua Xu4,
  9. Xian-E Peng1,3
  1. 1 Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
  2. 2 Fujian Hypertension Research Institute, VIP ward, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
  3. 3 Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fujian, China
  4. 4 Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
  1. Correspondence to Dr Xian-E Peng; fmuxe{at}


Objectives Nut consumption has been associated with a lower risk of type 2 diabetes, metabolic syndrome and insulin resistance. However, its effect on the risk of non-alcoholic fatty liver disease (NAFLD) is unknown. Therefore, we investigated the relationship between nut consumption and NAFLD risk.

Setting and participants We conducted a retrospective case-control study including 534 patients diagnosed with NAFLD and 534 controls matched by sex and age (±5 years) from the Affiliated Nanping First Hospital of Fujian Medical University in China.

Main outcome measures Information on dietary intake was collected using a semiquantitative food frequency questionnaire and nut consumption was calculated. Nut consumption was categorised using quartiles based on the distribution of daily nut intake of the controls. Binary logistic regression models were used to estimate ORs and the 95% CIs for the association between nut consumption and NAFLD risk.

Results After adjusting for potential confounding variables, nut consumption was not associated with NAFLD risk in the overall sample. When the fully adjusted model was stratified by sex, a significant inverse association was found between high nut consumption and NAFLD only among the men in the highest quartile (OR=0.43; 95% CI 0.26 to 0.71; P trend = 0.01). The inverse association of nut consumption with NAFLD risk in men remained significant after controlling for other known or suspected risk factors for NAFLD.

Conclusions Diets with a higher intake of nuts may be associated with a decreased risk of NAFLD, particularly in men.

  • Lipid disorders

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  • BbC and YH contributed equally.

  • Contributors BbC and YH are joint first authors. X-EP obtained funding. X-EP, XL and SX designed the study. XP, JY,YL and WL collected the data. BbC and YH were involved in data cleaning and verification. BbC and XP analysed the data. BbC and YH drafted the manuscript. X-EP, YL and JY contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. All authors have read and approved the final manuscript.

  • Funding This work was supported by the National Natural Science Foundation of China (grant number 81473047), the National Natural Science Foundation of Fujian Province (grant number 2019J01316), and the Joint Innovation Project of Science and Technology of Fujian Province (grant number 2017Y9104).

  • Competing interests None declared.

  • Ethics approval Local ethics committees of Fujian Medical University (ethics number 2014096).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Extra data can be accessed via the Dryad data repository at with the doi:10.5061/dryad.8nn2j46.