{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:53:28Z","timestamp":1784307208884,"version":"3.55.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T00:00:00Z","timestamp":1699228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81802888"],"award-info":[{"award-number":["81802888"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014103","name":"Key Technology Research and Development Program of Shandong","doi-asserted-by":"publisher","award":["2018GSF118088"],"award-info":[{"award-number":["2018GSF118088"]}],"id":[{"id":"10.13039\/100014103","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Flavonoids are a class of plant chemicals known to have health-promoting properties, including six subclasses. Anthocyanin is one of the subclasses that have anti-inflammatory and antioxidant activities. However, the relationship between flavonoid subclass intake and the risk of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis has not been verified in representative samples of the United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a cross-sectional study based on the data from the National Health and Nutrition Examination Survey (NHANES) and the Food and Nutrient Database for Dietary Studies (FNDDS) in 2017\u20132018. The intake of flavonoid subclasses of the participants was obtained from two 24\u2009h dietary recalls. The NAFLD and liver fibrosis were defined based on the international consensus criteria. The relationship between flavonoid subclass intake and NAFLD and liver fibrosis was evaluated using a multivariate logistic regression model corrected for multiple confounding factors. Subgroup analysis, trend tests, interaction tests and restricted cubic spline were carried out to further explore this relationship. In addition, we also explored the relationship between anthocyanin and liver serum biomarkers, dietary total energy intake and healthy eating index (HEI)-2015 scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 2,288 participants were included in the analysis. The intake of anthocyanin was significantly negatively associated with the risk of NAFLD, but not other flavonoid subclasses. A higher anthocyanin intake was significantly associated with a lower risk of NAFLD (quartile 4, OR 0.470, 95% CI 0.275\u20130.803). The results of subgroup analysis showed that the protective effect of dietary anthocyanin intake on NAFLD was more pronounced in participants of non-Hispanic whites, with hypertension and without diabetes (<jats:italic>P<\/jats:italic> for interaction &amp;lt;0.05). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), dietary total energy intake was significantly negatively correlated with dietary anthocyanin intake. We did not find any protective effect of flavonoid subclass intake on liver fibrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Anthocyanin, but not other flavonoid subclasses, can significantly reduce the risk of NAFLD. The protective effect was more pronounced in non-Hispanic whites, participants without diabetes and those with hypertension. Our study provides new evidence that anthocyanin intake has a reverse significant association with the risk for NAFLD.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2023.1265507","type":"journal-article","created":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T10:02:32Z","timestamp":1699264952000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Higher anthocyanin intake is associated with a lower risk of non-alcoholic fatty liver disease in the United States adult population"],"prefix":"10.3389","volume":"10","author":[{"given":"Shuai","family":"Xiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjun","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqian","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanglong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1038\/s41591-018-0104-9","article-title":"Mechanisms of NAFLD development and therapeutic strategies","volume":"24","author":"Friedman","year":"2018","journal-title":"Nat Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1002\/hep.24376","article-title":"Endpoints and clinical trial design for nonalcoholic steatohepatitis","volume":"54","author":"Sanyal","year":"2011","journal-title":"Hepatology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1836","DOI":"10.1002\/hep.24001","article-title":"Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis","volume":"52","author":"Tilg","year":"2010","journal-title":"Hepatology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"230","DOI":"10.14218\/jcth.2015.00019","article-title":"Treatment of nonalcoholic fatty liver disease: the role of medical, surgical, and endoscopic weight loss","volume":"3","author":"Popov","year":"2015","journal-title":"J Clin Transl Hepatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"110620","DOI":"10.1016\/j.nut.2019.110620","article-title":"Influence of lifestyle factors and staple foods from the Mediterranean diet on non-alcoholic fatty liver disease among older individuals with metabolic syndrome features","volume":"71","author":"Bull\u00f3n-Vela","year":"2020","journal-title":"Nutrition"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1016\/j.jcmgh.2018.07.004","article-title":"Micronutrients in nonalcoholic fatty liver disease pathogenesis","volume":"6","author":"Pickett-Blakely","year":"2018","journal-title":"Cell Mol Gastroenterol Hepatol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.1111\/liv.14164","article-title":"Association between nut consumption and non-alcoholic fatty liver disease in adults","volume":"39","author":"Zhang","year":"2019","journal-title":"Liver Int"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"6069","DOI":"10.1021\/jf401171k","article-title":"Mulberry anthocyanins inhibit oleic acid induced lipid accumulation by reduction of lipogenesis and promotion of hepatic lipid clearance","volume":"61","author":"Chang","year":"2013","journal-title":"J Agric Food Chem"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2740","DOI":"10.1002\/jsfa.4489","article-title":"Mulberry extract inhibits oleic acid-induced lipid accumulation via reduction of lipogenesis and promotion of hepatic lipid clearance","volume":"91","author":"Ou","year":"2011","journal-title":"J Sci Food Agric"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"3252","DOI":"10.3390\/nu12113252","article-title":"Bilberry anthocyanins ameliorate NAFLD by improving dyslipidemia and gut microbiome Dysbiosis","volume":"12","author":"Nakano","year":"2020","journal-title":"Nutrients"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1039\/d1fo03108b","article-title":"Supplementation with cyanidin and delphinidin mitigates high fat diet-induced endotoxemia and associated liver inflammation in mice","volume":"13","author":"Cremonini","year":"2022","journal-title":"Food Funct"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"4663","DOI":"10.1021\/acs.jafc.0c06695","article-title":"Malvidin-3-O-glucoside from blueberry ameliorates nonalcoholic fatty liver disease by regulating transcription factor EB-mediated lysosomal function and activating the Nrf2\/ARE signaling pathway","volume":"69","author":"Xu","year":"2021","journal-title":"J Agric Food Chem"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/j.freeradbiomed.2020.08.006","article-title":"Cyanidin-3-O-\u03b2-glucoside inactivates NLRP3 inflammasome and alleviates alcoholic steatohepatitis via SirT1\/NF-\u03baB signaling pathway","volume":"160","author":"Zhou","year":"2020","journal-title":"Free Radic Biol Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.jnutbio.2018.10.001","article-title":"A higher flavonoid intake is associated with less likelihood of nonalcoholic fatty liver disease: results from a multiethnic study","volume":"65","author":"Mazidi","year":"2019","journal-title":"J Nutr Biochem"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1002\/hep.20466","article-title":"Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity","volume":"40","author":"Browning","year":"2004","journal-title":"Hepatology"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1111\/j.1478-3231.2012.02781.x","article-title":"Controlled attenuation parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography","volume":"32","author":"Myers","year":"2012","journal-title":"Liver Int"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.cgh.2018.04.043","article-title":"Vibration-controlled transient Elastography to assess fibrosis and steatosis in patients with nonalcoholic fatty liver disease","volume":"17","author":"Siddiqui","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref18","volume-title":"2017\u20132018 data documentation, codebook, and frequencies. Liver ultrasound transient Elastography","year":"2018"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.jfca.2004.02.013","article-title":"An overview of USDA\u2019s dietary intake data system","volume":"17","author":"Raper","year":"2014","journal-title":"J Food Compos Anal"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"i3857","DOI":"10.1136\/bmj.i3857","article-title":"Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the global burden of disease study 2013","volume":"354","author":"Kyu","year":"2016","journal-title":"BMJ"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1491","DOI":"10.1002\/hep.32207","article-title":"High-quality diet, physical activity, and college education are associated with low risk of NAFLD among the US population","volume":"75","author":"Vilar-Gomez","year":"2022","journal-title":"Hepatology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2249","DOI":"10.1111\/liv.15024","article-title":"Diet and exercise in NAFLD\/NASH: beyond the obvious","volume":"41","author":"Semmler","year":"2021","journal-title":"Liver Int"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1016\/s0016-5085(98)70599-2","article-title":"Steatohepatitis: a tale of two \"hits\"?","volume":"114","author":"Day","year":"1998","journal-title":"Gastroenterology"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"21833","DOI":"10.3390\/ijms141121833","article-title":"Rodent models of nonalcoholic fatty liver disease\/nonalcoholic steatohepatitis","volume":"14","author":"Imajo","year":"2013","journal-title":"Int J Mol Sci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.foodchem.2018.01.055","article-title":"Extraction techniques and analysis of anthocyanins from food sources by mass spectrometry: an update","volume":"250","author":"Ongkowijoyo","year":"2018","journal-title":"Food Chem"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1016\/j.jnutbio.2013.01.005","article-title":"Polyphenol-rich black chokeberry (Aronia melanocarpa) extract regulates the expression of genes critical for intestinal cholesterol flux in Caco-2 cells","volume":"24","author":"Kim","year":"2013","journal-title":"J Nutr Biochem"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"4825949","DOI":"10.1155\/2019\/4825949","article-title":"Cherry anthocyanins regulate NAFLD by promoting autophagy pathway","volume":"2019","author":"Chu","year":"2019","journal-title":"Oxidative Med Cell Longev"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2586","DOI":"10.3390\/nu11112586","article-title":"Efficacy and mechanism of polymerized anthocyanin from grape-skin extract on high-fat-diet-induced nonalcoholic fatty liver disease","volume":"11","author":"Fan","year":"2019","journal-title":"Nutrients"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"101843","DOI":"10.1016\/j.clinre.2021.101843","article-title":"Upregulated NLRP3 inflammasome activation is attenuated by anthocyanins in patients with nonalcoholic fatty liver disease: a case-control and an intervention study","volume":"46","author":"Zhu","year":"2022","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1053\/j.gastro.2020.01.052","article-title":"Nonalcoholic fatty liver disease 2020: the state of the disease","volume":"158","author":"Cotter","year":"2020","journal-title":"Gastroenterology"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1016\/j.jhep.2018.10.033","article-title":"Non-alcoholic fatty liver disease \u2013 a global public health perspective","volume":"70","author":"Younossi","year":"2019","journal-title":"J Hepatol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e758","DOI":"10.1097\/md.0000000000000758","article-title":"A CONSORT-compliant, randomized, double-blind, placebo-controlled pilot trial of purified anthocyanin in patients with nonalcoholic fatty liver disease","volume":"94","author":"Zhang","year":"2015","journal-title":"Medicine"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1136\/gutjnl-2023-329998","article-title":"Timing of energy intake and the therapeutic potential of intermittent fasting and time-restricted eating in NAFLD","volume":"72","author":"Marjot","year":"2023","journal-title":"Gut"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"4556","DOI":"10.3390\/nu14214556","article-title":"Race and ethnicity in non-alcoholic fatty liver disease (NAFLD): a narrative review","volume":"14","author":"Riazi","year":"2022","journal-title":"Nutrients"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1016\/j.jhep.2011.12.011","article-title":"Predictors for incidence and remission of NAFLD in the general population during a seven-year prospective follow-up","volume":"56","author":"Zelber-Sagi","year":"2012","journal-title":"J Hepatol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/s1262-3636(07)70098-8","article-title":"The ins and outs of mitochondrial dysfunction in NASH","volume":"30","author":"Fromenty","year":"2004","journal-title":"Diabetes Metab"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.3390\/nu11061431","article-title":"Potential factors influencing the effects of anthocyanins on blood pressure regulation in humans: a review","volume":"11","author":"Vendrame","year":"2019","journal-title":"Nutrients"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"949746","DOI":"10.3389\/fimmu.2022.949746","article-title":"Efficacy and safety of dietary polyphenol supplementation in the treatment of non-alcoholic fatty liver disease: a systematic review and meta-analysis","volume":"13","author":"Yang","year":"2022","journal-title":"Front Immunol"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2023.1265507\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T10:02:36Z","timestamp":1699264956000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2023.1265507\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,6]]},"references-count":38,"alternative-id":["10.3389\/fnut.2023.1265507"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2023.1265507","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,6]]},"article-number":"1265507"}}