Ultra-Processed Foods Consumption and the Risk of nonalcoholic Fatty Liver Disease in Korean Adults

Objectives Despite the global burden of nonalcoholic fatty liver disease (NAFLD), its associations with ultra-processed food (UPF) consumption in Asian populations remain limited. We aimed to evaluate the association between total and subgroup-specific UPF consumption and NAFLD risk and its related biomarkers among Korean adults.Methods We analyzed data from 11,168 participants in the 2016–2019 Korea National Health and Nutrition Examination Survey. Diet was assessed using 24-h recall, and UPF was defined by NOVA classification. NAFLD was defined by a comprehensive NAFLD score ≥ 40. Multivariable-adjusted logistic regression and linear regression models were used to examine associations with NAFLD risk and cardiometabolic and liver-related biomarkers, respectively.Results There was a positive trend in the association between UPF intake and odds of NAFLD (Multivariable-adjusted Odds Ratio [MVOR]quintile 5 vs 1 = 1.28, 95% confidence interval [CI]: 1.06–1.56; p-trend <0.001). Higher UPF intake was also significantly associated with greater adiposity (all p-trend ≤0.03), dysregulated cardiometabolic profiles, including higher LDL-c, hemoglobin, and non-HDL-c (all p-trend ≤0.04), and elevated hepatic injury markers, including ALT or ALT/AST ratio (all p-trend ≤0.03). Among UPF subgroups, processed meat and fish showed a significant positive association with NAFLD (MVOR = 1.04, 95% CI: 1.01–1.07). Similarly, lower odds of NAFLD were observed in association with a 100 g/day substitution of processed meat and fish with unprocessed or minimally processed alternatives (MVOR: 0.89, 95% CI: 0.80–0.98).Conclusion In our study, higher UPF intake was associated with greater odds of NAFLD. Larger cohort studies are warranted to replicate our findings.