CONTEXT: Chronic liver disease is a major global health burden, and preventive strategies are crucial, given its insidious progression. Although individual nutrients and foods' associations with chronic liver disease are studied, dietary patterns' holistic effects matter more. OBJECTIVE: This study systematically evaluated the links between 2 healthy dietary indices-the Alternative Healthy Eating Index (AHEI) and the Healthy Eating Index (HEI)-and chronic liver disease, namely, metabolic dysfunction-associated steatotic liver disease, liver fibrosis, cirrhosis, fatty liver, and liver cancer. DATA SOURCES: A systematic literature search was conducted in the PubMed, Web of Science, Cochrane Library, and Embase databases for relevant observational studies published up to February 2025. DATA EXTRACTION: Data extraction and quality assessment were performed independently by the authors. A total of 28 articles comprising 50 studies (n = 18 prospective cohort, 25 cross-sectional, and 7 case-control studies) involving 624 914 participants were included. DATA ANALYSIS: A random-effects model was used for the meta-analysis. Results showed the AHEI (OR = 0.71; 95% CI, 0.62-0.80) and HEI (OR = 0.68; 95% CI, 0.61-0.77) were significantly negatively associated with chronic liver disease. Subgroup analysis found the AHEI protected against MASLD, liver cancer, and overall chronic liver disease, notably in Asia and North America. The HEI protected against MASLD, fibrosis, liver cancer, and chronic liver disease, with marked effects in North America. This study's strengths lie in its large sample size, integration of multiple study designs, and rigorous methodological framework, which collectively enhance the generalizability of its results. CONCLUSIONS: The findings suggest the AHEI and HEI are associated with a lower risk of chronic liver disease, providing valuable guidance for clinical practice, such as advocating for these dietary patterns among high-risk populations. However, limitations exist, including potential heterogeneity in dietary assessment methods and unaccounted confounders. Future research should address these issues to further optimize chronic liver disease management strategies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42025065410.
Zhang et al. (2026) studied this question.