Folate intake and non-alcoholic fatty liver disease in US adults

Background and Objectives: The relationship between dietary folate intake and non-alcoholic fatty liver disease (NAFLD) is controversial. This study aimed to investigate the relationship between dietary folate equivalent (DFE) intake and NAFLD in U.S. adults. Methods and Study Design: Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2014 were used. NAFLD was defined as a US fatty liver index (FLI) value >=30. DFE intake was assessed by two 24-hour dietary recall interviews. Multivariable logistic regression models and restricted cubic spline models were used to investigate the association between DFE intake and NAFLD risk. Results: A total of 6,603 adult participants were included in this study. After adjusting for multiple confounding factors, the odds ratios and 95% confidence intervals of NAFLD for the highest quartile versus lowest quartile of DFE intake was 0.77(0.59-0.99). In stratified analyses by sex, age, and body mass index (BMI), there were statistically significant negative associations between DFE intake and NAFLD risk in women and participants with BMI >=25. Dose-response analysis indicated a negative linear correlation between DFE intake and NAFLD risk. Conclusions: Dietary folate equivalent intake is negatively associated with NAFLD risk in the general U.S. adult population.