A Case-Control Study of the Link Between Quantity and Quality of Dietary Carbs Scores and Non-Alcoholic Fatty Liver Disease Publisher



Moradi F ; Yaxshimuratov M ; Shateri Z ; Nouri M ; Moosavian SP ; Teimori A ; Faghih Imani Z ; Alavi Naeini A
Source: BMC Nutrition Published:2026

Abstract

Background: More studies are needed to show the significance of carbohydrate quantity and quality, given the rising global incidence of fatty liver disease and its effects on health. Consequently, in a case-control investigation, we evaluated the relationship between non-alcoholic fatty liver disease (NAFLD), the low-carbohydrate diet score (LCDS), and the carbohydrate quality index (CQI). Methods: In the case-control study (121 participants with NAFLD and 119 participants without NAFLD), we employed a validated quantitative 168-item food frequency questionnaire. We evaluated CQI and LCDS at baseline. The ultimate scores were utilized to categorize the participants into tertiles. Blood tests were performed to measure selected blood markers. Demographic, anthropometric, and socioeconomic status data were recorded. Results: Patients with NAFLD had a higher mean age (38.0 vs. 35.6 years, p = 0.037), body mass index (BMI) (28.6 vs. 23.2 kg/m², p < 0.001), and fasting blood sugar (FBS) (114.2 vs. 97.8 mg/dL, p < 0.001), as well as elevated liver enzymes (alanine aminotransferase (ALT) and aspartate aminotransferase (AST), both p < 0.001) compared with controls. In the crude model, participants in the highest tertile of CQI had significantly lower odds of NAFLD (odds ratio [OR] = 0.24; 95% confidence interval [CI]: 0.12–0.50; p-trend < 0.001), and those in the highest tertile of LCDS also showed reduced odds (OR = 0.30; 95% CI: 0.15–0.59). In the fully adjusted model, the likelihood of NAFLD remained lower among participants in the upper tertile of CQI (OR = 0.22; 95% CI: 0.08–0.54). Moreover, each one-unit increment in CQI score was associated with higher total antioxidant capacity (TAC) and lower ALT, FBS, and malondialdehyde (MDA) (all p < 0.05). Each one-unit increment in LCDS was also linked to a significant reduction in FBS (p < 0.05). Conclusions: Our results demonstrate a strong inverse association between higher quality dietary carbohydrate consumption and the development of NAFLD, as well as lower ALT, FBS, and MDA levels. This indicates that preventive strategies for NAFLD should prioritize the quality of this macronutrient. © The Author(s) 2026.