Association between dietary patterns and lipid profile in patients with non-alcoholic fatty liver disease: a retrospective cross-sectional study

Background Dietary composition significantly influences metabolic health, particularly lipid metabolism and liver function. Objective This study aimed to examine the associations between ketogenic, low-fat, and balanced dietary patterns with lipid parameters, liver enzymes, and renal function in the Chinese adult population. Methods This retrospective cross-sectional study analyzed data from 650 adults categorized into 3 dietary groups based on recorded dietary intake: ketogenic ( n = 210), low-fat ( n = 220), and balanced ( n = 220). Demographic, socioeconomic, anthropometric, clinical, and biochemical variables were assessed. Group comparisons were performed using a one-way analysis of variance (ANOVA) and chi-square tests, while a multivariable linear regression analysis was used to evaluate associations between dietary patterns and metabolic outcomes. Results Baseline demographic and socioeconomic characteristics were comparable across the groups. The ketogenic diet was associated with higher levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) compared with the low-fat and balanced diets ( p < 0.01). Higher alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were also observed in association with the ketogenic diet. In adjusted analyses, the ketogenic diet remained significantly associated with increases in total cholesterol ( β = +62.9 mg/dL), triglycerides ( β = +36.5 mg/dL), LDL-C ( β = +34.2 mg/dL), HDL-C ( β = +5.6 mg/dL), ALT ( β = +8.7 U/L), and AST ( β = +5.9 U/L) (all p ≤ 0.001). No significant associations were observed between dietary patterns and renal function markers, including serum creatinine and estimated glomerular filtration rate (eGFR). Conclusion The ketogenic diet was associated with higher HDL-C and increased atherogenic lipids and liver enzymes; however, no significant association was observed with renal function. These findings highlight the importance of individualized dietary guidance and metabolic monitoring.