A higher flavonoid intake is associated with less likelihood of nonalcoholic fatty liver disease: results from a multiethnic study
Journal article, 2019

Limited information exists on the impact of flavonoid intake on nonalcoholic fatty liver disease (NAFLD). We evaluated the link between flavonoid intake, liver tests and risk of NAFLD in a randomly selected sample of US adults (from the National Health and Nutrition Examination Survey, NHANES, 2005–2010). Of the 17,685 participants, 46.9% were men and 45.4% had NAFLD. NAFLD patients had a significantly lower mean flavonoid intake than healthy individuals (111.3±3.6 vs. 201.3±2.3 mg/d, respectively; P<.001). Fatty liver index (FLI) and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were significantly higher in the first tertile (T1) of flavonoid intake compared with the highest tertile (T3: with the highest flavonoid intake) (FLI: 67.1 vs. 36.2, AST: 31.2 VS 26.8 U/L and, ALT: 34.2 vs. 24.2 U/L, respectively; P<.001 for all comparisons). Adjusted linear regression displayed significant and negative associations between FLI, AST, ALT and flavonoid intake (P<.001 for all comparisons). Multivariable logistic regression showed that the risk for NAFLD significantly decreased as flavonoid intake tertiles increased in a stepwise manner (odds ratio: 0.81, 95% confidence interval: 0.78–0.86). Moderation analysis revealed that C-reactive protein (CRP) strongly modulated the impact of flavonoid intake on FLI; participants with higher CRP levels benefited less from flavonoid intake compared with those with lower CRP concentrations. In conclusions, our results suggest a reverse significant association between flavonoid consumption, liver tests and the risk for NAFLD. Furthermore, CRP was shown to essentially moderate this relationship. These findings support recommendations for consumption of flavonoid-rich foods to prevent cardiometabolic diseases.

Fatty liver index

Aspartate aminotransferase

Flavonoid intake

Alanine aminotransferase

Nonalcoholic fatty liver disease

C-reactive protein


Mohsen Mazidi

Chalmers, Biology and Biological Engineering, Food and Nutrition Science

Niki Katsiki

Aristotle University of Thessaloniki

Maciej Banach

Polish Mother’s Memorial Hospital Research Institute

University of Zielona Góra

Medical University of Lodz

Journal of Nutritional Biochemistry

0955-2863 (ISSN)

Vol. 65 66-71

Subject Categories

Clinical Medicine

Public Health, Global Health, Social Medicine and Epidemiology

Nutrition and Dietetics



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