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ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutrition and Metabolism
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1564197
This article is part of the Research Topic Nutrient Metabolism and Complications of Type 2 Diabetes Mellitus View all 5 articles
Associations of Healthy Eating Index 2020 and its components with nonalcoholic fatty liver disease in type 2 diabetes patients and the mediating roles of metabolic indicators: NHANES 2007-2018
Provisionally accepted
Jingxiong Chen 1,2 Haizhou Diao 2 Yuling Zhang 2
Ben Hu 3
Kai Qian 2
Kaiguang Zhang 2 Tengyue Zhang 2
Jizhong Song 2*- 1 Bengbu Medical College, Bengbu, Anhui Province, China
- 2 Anhui Provincial Hospital, Hefei, China
- 3 The Second People's Hospital of Hefei, Hefei, Anhui Province, China
Background: Non-alcoholic fatty liver disease (NAFLD) represents a major public health issue, especially among individuals diagnosed with Type 2 diabetes mellitus (T2DM), where its prevalence can reach up to 70%. This research examines the relationship between the Healthy Eating Index 2020 (HEI-2020) and its individual components with the occurrence of NAFLD in T2DM patients, while also investigating the potential mediating effects of various metabolic indicators.spanning 2007 to 2018 were utilized. This cross-section study included 1,770 T2DM patients, who were divided into NAFLD and non-NAFLD groups using the Fatty Liver Index as a diagnostic tool. The HEI-2020, which assesses diet quality, was computed based on 24-hour dietary recall data. Key metabolic indicators such as the triglycerideglucose (TyG) index, metabolic score (MS), mean arterial pressure, uric acid levels, and total cholesterol were evaluated.The findings indicated that higher HEI-2020 scores were associated with a lower likelihood of NAFLD (odds ratio 0.978, 95% confidence interval: 0.959-0.998), with the strongest inverse associations observed in the top quartiles of diet quality.Whole fruits, greens and beans, and saturated fat were crucial dietary factors. Mediation analysis demonstrated that the TyG index and MS accounted for 5.11% and 36.94% of the relationship between HEI-2020 and NAFLD, respectively.Greater adherence to the HEI-2020 is associated with a lower likelihood of NAFLD in T2DM patients, with metabolic indicators partially mediating this association. Enhancing diet quality, particularly by increasing the consumption of whole fruits and greens while reducing saturated fat intake, may be important in managing metabolic health and liver function in this vulnerable population.
Keywords: Non-alcoholic fatty liver disease, type 2 diabetes mellitus, Healthy Eating Index 2020, Metabolic indicators, NHANES, Dietary quality
Received: 21 Jan 2025; Accepted: 26 Mar 2025.
Copyright: © 2025 Chen, Diao, Zhang, Hu, Qian, Zhang, Zhang and Song. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jizhong Song, Anhui Provincial Hospital, Hefei, China
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