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Plant-based diet patterns, genetic predisposition, and the risk of non-alcoholic fatty liver disease
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Description: Non-alcoholic fatty liver disease has emerged as the most common chronic liver disorder in parallel with the epidemic of obesity1. A healthy lifestyle primarily a weight-loss associated diet is recommended for the management of NAFLD, while prior studies have shown that the Mediterranean diet (MED), which is relatively rich in the plant food source, might favorably affect NAFLD independent of weight loss2. In addition, the green-Mediterranean diet (MED + green tea and Mankai green shake) decreased the intrahepatic fat content compared to the MED alone, which indicates that the plant-based food might be beneficial for NAFLD3. However, whether the plant-based diet is beneficial for the primary prevention of NAFLD remains largely unknown. Plant-based diet patterns characterized by lower intake of meat and higher intake of fruits, vegetables, whole grains, legumes, nuts, and seeds are gaining attention as both health and environmental sustainability benefits4. Previous studies have developed three versions of plant-based diet indices, an overall plant-based diet index (PDI), which emphasized the intake of all plant food; a healthful plant-based diet index (hPDI), which emphasized the consumption of healthful plant-based food such as whole grains, vegetables, nuts, and legumes; and an unhealthful plant-based index (uPDI), which emphasized the consumption of less healthful plant-based food which have been shown to be associated with increased risk of several diseases5. Previous studies have observed the inverse association of PDI and hPDI with the liver fat content and the prevalence of fatty liver6, 7, while evidence on the associations of PDI, hPDI, and uPDI with the incidence of NAFLD is limited. In addition, for individuals with different genetic susceptibility, whether these associations remain the same and whether healthy plant-based food could attenuate the genetic risk is unknown.