title: Low physical activity and energy dense Malaysian foods are associated with non-alcoholic fatty liver disease in centrally obese but not in non-centrally obese patients with diabetes mellitus.
abstract: OBJECTIVE
  To study the dietary intake and level of physical activity (PA) of patients with diabetes mellitus and the association with non-alcoholic fatty liver disease (NAFLD).
  
  
  METHODS
  Consecutive adult patients with type 2 diabetes mellitus seen in our hospital diabetes clinic were enrolled. The Global Physical Activity Questionnaire and a semi-quantitative food-frequency questionnaire were used to assess PA and dietary intake, respectively. Diagnosis of NAFLD was ultrasound-based and following exclusion of significant alcohol intake and other causes of chronic liver disease.
  
  
  RESULTS
  Data for 299 patients were analyzed (mean age 63.3±10.5 years old, 41.1% male). Prevalence of NAFLD was 49.2%. Patients with low PA were more likely to have NAFLD (OR=1.75, 95% CI=1.03-2.99, p=0.029). There was no significant difference in energy intake, intake of macronutrients and percentage energy intake from each macronutrient, high sugar food, high cholesterol food and high SFA food between patients with and without NAFLD. Among centrally obese patients, patients with low PA and in the highest quartile of percentage energy intake from fat (OR=4.03, 95% CI=1.12-15.0, p=0.015), high cholesterol food (OR=3.61, 95% CI=1.37-9.72, p=0.004) and high SFA food (OR=2.67, 95% CI=1.08-6.67, p=0.019) were most likely to have NAFLD. Among those who were not centrally obese, PA and percentage energy intake from fat, high cholesterol food and high SFA food was not associated with NAFLD.
  
  
  CONCLUSIONS
  Low PA and high percentage energy intake from fat, high cholesterol food and high SFA food is associated with NAFLD in centrally obese but not in non-centrally obese patients with diabetes mellitus.
authors.affiliation: Gastroenterology and Hepatology Unit, Gastrointestinal Endoscopy Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Email: wahkheong2003@hotmail.com.
authors.forename: Wah-Kheong
authors.initials: WK
authors.lastname: Chan
authors.affiliation: Endocrinology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Alexander Tong-Boon
authors.initials: AT
authors.lastname: Tan
authors.affiliation: Endocrinology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Shireene Ratna
authors.initials: SR
authors.lastname: Vethakkan
authors.affiliation: Department of Dietetics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Pei-Chien
authors.initials: PC
authors.lastname: Tah
authors.affiliation: Department of Bio-Medical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Anushya
authors.initials: A
authors.lastname: Vijayananthan
authors.affiliation: Gastroenterology and Hepatology Unit, Gastrointestinal Endoscopy Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Khean-Lee
authors.initials: KL
authors.lastname: Goh
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002791:Cholesterol, Dietary / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004032:Diet; D059305:Diet, High-Fat; D019422:Dietary Sucrose / Q000008:administration & dosage; D002149:Energy Intake; D005502:Food; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008875:Middle Aged; D009043:Motor Activity; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology*; D009765:Obesity / Q000150:complications*; D056128:Obesity, Abdominal / Q000150:complications*; D011795:Surveys and Questionnaires; D055105:Waist Circumference
chemical_list: D002791:Cholesterol, Dietary; D019422:Dietary Sucrose