Figure 1: naflc cases

Table 3: association between frequency of consuming fried foods and nafld prevalence

The association between the frequency of consuming fried foods and nafld prevalence demonstrates a clear trend (table 3), where higher consumption of fried foods is significantly associated with increased nafld prevalence. Among participants who consumed fried foods daily, 89.6% (200 out of 223) were diagnosed with nafld, while only 10.4% did not have the condition. Similarly, those who consumed fried foods 2-3 times a week had a nafld prevalence of 71.6%, with 28.4% remaining unaffected. In contrast, participants who consumed fried foods once a week or less had much lower nafld prevalence rates, with only 7.4% of those eating fried foods once a week and 3.6% of those eating them less than once a week being diagnosed with the condition. The chi-square test produced a significant p-value of 0.001 for all consumption frequencies, indicating a strong and statistically significant association between the frequency of fried food consumption and the prevalence of nafld. This suggests that frequent consumption of fried foods is a significant risk factor for developing nafld (figure 2).

Figure 2: association between the frequency of consuming fried foods and nafld prevalence

Table 4: association between frequency of consuming high-fat dairy products and nafld prevalence

The association between the frequency of consuming high-fat dairy products and nafld prevalence indicates a significant correlation, with higher consumption linked to a greater prevalence of nafld (table 4). Among participants who consumed high-fat dairy products daily, 76.2% (212 out of 278) were diagnosed with nafld, while 23.8% did not have the condition. Those who consumed these products 2-3 times a week had an even higher nafld prevalence of 81%, with 19% unaffected. In contrast, participants who consumed high-fat dairy products less frequently, such as once a week or less, had much lower nafld prevalence rates. Specifically, 16% of those consuming these products once a week and 27.2% of those consuming them less than once a week were diagnosed with nafld. The chi-square test revealed a significant p-value of 0.001 across all frequencies of consumption, indicating a statistically significant association between the intake of high-fat dairy products and the prevalence of nafld. These findings suggest that frequent consumption of high-fat dairy products is a considerable risk factor for developing nafld (figure 3).


Figure 3: association between the frequency of consuming high-fat dairy products and nafld prevalence

Table 5: association between frequency of consuming fruits and vegetables and nafld prevalence

The association between the frequency of consuming fruits and vegetables and nafld prevalence highlights a significant inverse relationship (table 5). Among participants who consumed fruits and vegetables daily, only 33.5% (56 out of 167) were diagnosed with nafld, while a majority of 66.5% did not have the condition. Conversely, those who consumed fruits and vegetables only once a week showed a much higher nafld prevalence of 83.4%, with only 16.6% of participants remaining unaffected. The chi-square test produced a significant p-value of 0.001, indicating a strong and statistically significant association between lower frequency of fruit and vegetable consumption and higher nafld prevalence. These findings suggest that regular consumption of fruits and vegetables may be protective against the development of nafld.

Table 6: association between physical activity levels and nafld prevalence

The association between physical activity levels and nafld prevalence reveals a significant inverse relationship (table 6), where lower levels of physical activity are associated with higher nafld prevalence. Among participants who reported no physical activity, 89.6% (200 out of 223) were diagnosed with nafld, while only 10.4% were not affected. Those engaging in less than 1 hour of physical activity per week had a nafld prevalence of 71.4%, with 28.6% remaining unaffected. In contrast, participants who engaged in 1-2 hours and 3-4 hours of physical activity per week had much lower nafld prevalence rates of 31.8% and 27.9%, respectively. The majority in these groups did not have nafld, with non-nafld prevalence rates of 68.2% and 72.1%, respectively. The chi-square test yielded a significant p-value of 0.001 across all physical activity levels, indicating a statistically significant association between higher levels of physical activity and a reduced risk of nafld. These findings suggest that regular physical activity plays a protective role against the development of nafld (figure 4).

Figure 4: association between physical activity levels and nafld prevalence

Table 7: association between frequency of consuming sugary beverages and nafld prevalence

The association between the frequency of consuming sugary beverages and nafld prevalence shows a significant positive correlation (table 7), where higher consumption of sugary beverages is linked to an increased prevalence of nafld. Among participants who consumed sugary beverages daily, 83.8% (140 out of 167) were diagnosed with nafld, while only 16.2% were not affected. Those who consumed sugary beverages 2-3 times a week had a nafld prevalence of 60.2%, with 39.8% remaining unaffected. In contrast, participants who consumed sugary beverages once a week or less showed much lower nafld prevalence rates, with 30.3% of those consuming them once a week and 27% of those consuming them less than once a week being diagnosed with the condition. The chi-square test yielded a significant p-value of 0.001 across all consumption frequencies, indicating a strong and statistically significant association between the intake of sugary beverages and the prevalence of nafld. These findings suggest that frequent consumption of sugary beverages is a considerable risk factor for developing nafld.

Table 8: association between smoking status and nafld prevalence

The association between smoking status and nafld prevalence indicates a clear pattern where smoking is associated with higher nafld prevalence (table 8). Among participants who smoked daily, 89.2% (100 out of 112) were diagnosed with nafld, while only 10.8% were not affected. Those who smoked occasionally had a nafld prevalence of 58%, with 42% remaining unaffected. In contrast, non-smokers had a much lower nafld prevalence of 25.2%, with 74.8% not having the condition. The chi-square test revealed a significant p-value of 0.001 for all smoking statuses, highlighting a strong and statistically significant association between smoking and the prevalence of nafld. These results suggest that smoking is a significant risk factor for nafld, with daily smoking particularly associated with a high prevalence of the condition (figure 5).

Figure 5: association between smoking status and nafld prevalence

Table 9: prevalence of nafld in patients with diabetes, hypertension, and hyperlipidemia

The prevalence of nafld among patients with various medical conditions shows a significant association with each condition. Among patients with diabetes, 72.7% (40 out of 55) were diagnosed with nafld, while 27.3% were not affected. Similarly, 82.2% of those with hypertension (46 out of 56) had nafld, compared to 17.8% without the condition. For patients with hyperlipidemia, the prevalence of nafld was notably high at 88.3%, with only 11.7% remaining unaffected. In individuals with hepatitis, 74.5% (41 out of 55) had nafld, whereas 25.5% did not. In contrast, among participants with no other diseases, the prevalence of nafld was significantly lower at 33.7% (56 out of 166), with 66.3% being free of the condition. The chi-square test yielded a significant p-value of 0.001 for all conditions, indicating strong and statistically significant associations between these medical conditions and the prevalence of nafld. These findings suggest that diabetes, hypertension, hyperlipidemia, and hepatitis are substantial risk factors for nafld (table 9).

Discusion
A study was done showing that emerging evidence underscores the critical role of diet and specific nutrients in influencing the pathophysiology of nafld. High-calorie diets, rich in saturated fatty acids (sfa), cholesterol, and sugary beverages, are known to exacerbate hepatic lipid accumulation and advance the progression to non-alcoholic steatohepatitis (nash). Conversely, interventions that reduce caloric intake, enhance consumption of soy protein and whey, and incorporate supplements such as monounsaturated fatty acids (mufa), omega-3 fatty acids, and probiotics have demonstrated preventive and therapeutic benefits. Sustainable weight loss through lifestyle modifications, including caloric restriction (whether low in carbohydrates or fats), is identified as the most effective strategy for managing nafld. Moreover, a balanced dietary pattern, along with specific nutrients, offers additional advantages beyond mere weight reduction¹⁷. In comparison, our study highlights similar trends, showing that dietary habits like high consumption of fried foods and sugary beverages are strongly associated with nafld prevalence. Our findings align with the broader literature, suggesting that dietary choices and lifestyle interventions play a pivotal role in nafld management and prevention.

Another study was done showing that lifestyle changes, including adopting a healthy diet and engaging in regular physical activity, are crucial for managing nafld. Aiming for a 7-10% weight loss and maintaining it is a key goal for nafld patients. Reducing caloric intake, improving the balance of macronutrients, and increasing physical activity can independently contribute to halting disease progression. Adherence to dietary recommendations is vital for sustainable weight loss, necessitating high-quality, practical dietary interventions for nafld. High consumption of carbohydrates, simple sugars, saturated fats, trans fats, red meat, and processed foods, coupled with low fiber intake, is linked to the development of nafld¹⁸. In our study, the findings resonate with these principles. For instance, daily consumption of high-fat dairy products and sugary beverages was associated with a high prevalence of nafld, with prevalence rates reaching 76.2% and 83.8%, respectively. Conversely, a lower nafld prevalence was observed among participants with higher fruit and vegetable intake and increased physical activity. These results underscore the importance of dietary adherence and physical activity in managing nafld, aligning with broader recommendations for lifestyle modifications.

In the study, nafld patients were more likely to be smokers, have a lower physical activity level, and be married, with significantly higher bmi and socioeconomic status (ses) compared to healthy participants (p < 0.05). Their diets were characterized by higher intakes of energy, red and processed meat, sugar-sweetened beverages, and trans fats, while they had lower vegetable intake and scored lower on the alternative healthy eating index (ahei) and healthy lifestyle score (hls) (p < 0.05)¹⁹. In comparison, my study found that the prevalence of nafld was highest among individuals aged 18-24 (89.2%) and 45-54 (93.6%), with significant associations observed between nafld and frequent consumption of fried foods (daily: 89.6%), high-fat dairy products (daily: 76.2%), and sugary beverages (daily: 83.8%). Smoking, particularly daily smoking, was strongly associated with nafld (89.2%), as were lower levels of physical activity (none: 89.6%) and the presence of comorbid conditions such as hyperlipidemia (88.3%) and hypertension (82.2%). These findings are consistent with the referenced study, emphasizing the critical role of diet and lifestyle factors, including physical inactivity, poor diet quality, and smoking, in the prevalence of nafld across different populations.  This paragraph integrates the findings from the other study with your own, highlighting the similarities in dietary and lifestyle factors associated with nafld, while also drawing attention to the specific numerical values from your study that reinforce these associations.

In a comparative analysis of nafld risk factors, our results align with previous literature that identifies lifestyle and dietary patterns as significant contributors to nafld prevalence. Our findings showed a higher nafld prevalence in those with frequent consumption of fried foods, high-fat dairy products, and sugary beverages, along with lower physical activity levels. This mirrors prior studies, which also found that less vegetable and nut intake, higher sweet consumption, and reduced physical activity were linked to an increased probability of nafld²⁰. Furthermore, our data highlighted that lower physical activity levels were strongly associated with nafld presence, consistent with an earlier report where a higher physical activity level (measured in metabolic equivalents) correlated with a lower likelihood of nafld. Additionally, the inverse relationship between optimal sleep duration and nafld in our study echoes findings that suggest adequate sleep may offer a protective effect, although the association was marginal in previous research. Overall, our results reinforce the established understanding that diet, physical activity, and lifestyle choices are crucial in the development and management of nafld.

Limitations
One limitation of this study is the reliance on self-reported data, which may introduce recall bias or inaccuracies in participants' responses regarding their dietary habits and lifestyle behaviors. Additionally, the cross-sectional design of the study limits the ability to establish causality between the identified factors and nafld. The sample size, while adequate for preliminary findings, may not fully represent the broader population, thereby limiting the generalizability of the results. Future research should consider longitudinal designs and larger, more diverse populations to confirm these associations and better understand the long-term impact of diet and lifestyle on nafld.

Conclusion
this study provides valuable insights into the impact of diet and lifestyle factors on the prevalence of non-alcoholic fatty liver disease (nafld) in a specific population. Our findings underscore the significant role that unhealthy dietary habits, such as frequent consumption of fried foods, sugary beverages, and high-fat dairy products, play in increasing the risk of nafld. Additionally, lifestyle factors like physical inactivity and smoking further exacerbate this risk, particularly among individuals with pre-existing conditions such as diabetes, hypertension, hyperlipidemia, and hepatitis.

The strong associations observed between these modifiable factors and the prevalence of nafld emphasize the urgent need for public health initiatives aimed at promoting healthier eating patterns and more active lifestyles. Educating the population about the risks associated with poor dietary choices and sedentary behavior, along with providing accessible resources for making healthier lifestyle changes, could significantly reduce the burden of nafld.

Moreover, the findings suggest that targeted interventions in populations with a high prevalence of comorbid conditions could be particularly effective in mitigating the risk of nafld. These results not only add to the growing body of evidence linking diet and lifestyle to liver health but also highlight the importance of early detection and prevention strategies.

In conclusion, addressing the modifiable risk factors identified in this study could play a crucial role in reducing the prevalence of nafld, thereby improving overall public health outcomes. Future research should continue to explore these associations in more diverse populations and consider longitudinal studies to better understand the causal relationships between diet, lifestyle, and nafld.

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