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associations of the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI) with the odds of nonalcoholic fatty liver disease (NAFLD). We present a nationwide cross-sectional study among US adults aged 18 years or older. Diet was assessed by 24-h recalls. Overall PDI, hPDI, and uPDI were constructed based on 18 food groups. NAFLD was defined based on controlled attenuation parameter derived via transient elastography (TE) in the absence of other causes of chronic liver disease. Among 3900 participants with eligible TE examination, 1686 were diagnosed with NAFLD. The overall PDI was not associated with NAFLD prevalence (comparing extreme tertiles of PDI score OR = 1.03, 95% CI 0.76, 1.38, ptrend = 0.609). However, hPDI was inversely (OR = 0.50, 95% CI 0.35, 0.72, ptrend &lt; 0.001), while uPDI was positively associated with odds of NAFLD (OR = 1.37, 95% CI 0.93, 2.02, ptrend = 0.009) in the multivariable-adjusted models without body mass index (BMI). After further adjustment for BMI, only the association of hPDI with NAFLD remained statistically significant (OR = 0.64, 95% CI 0.46, 0.87, ptrend = 0.006). Such inverse association appeared stronger in non-Hispanic whites, but not in other racial\/ethnic groups (pinteraction = 0.009). Our findings suggest that a plant-based diet rich in healthy plant foods might be associated with lower odds of NAFLD, particularly among US non-Hispanic whites. Clinical trials and cohort studies to validate our findings are needed.<\/jats:p>","DOI":"10.3390\/nu14194099","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T01:21:07Z","timestamp":1665364867000},"page":"4099","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["A Healthful Plant-Based Diet Is Associated with Lower Odds of Nonalcoholic Fatty Liver Disease"],"prefix":"10.3390","volume":"14","author":[{"given":"Xiude","family":"Li","sequence":"first","affiliation":[{"name":"Department of Nutrition, School of Public Health, Anhui Medical University, Hefei 230032, China"},{"name":"Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People\u2019s Republic of China, Hefei 230032, China"},{"name":"NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China"},{"name":"Anhui Provincial Key Laboratory of Population Health and Aristogenics\/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei 230032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaohong","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meiling","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Public Health, Anhui Medical University, Hefei 230032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueke","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Public Health, Anhui Medical University, Hefei 230032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haowei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Public Health, Anhui Medical University, Hefei 230032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Public Health, Anhui Medical University, Hefei 230032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Big Data and Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anla","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Public Health, Anhui Medical University, Hefei 230032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7894-5691","authenticated-orcid":false,"given":"Qihong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Public Health, Anhui Medical University, Hefei 230032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Public Health, Anhui Medical University, Hefei 230032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2605-5697","authenticated-orcid":false,"given":"Hua","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Oncology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changzheng","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Big Data and Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7365-2689","authenticated-orcid":false,"given":"Wanshui","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Public Health, Anhui Medical University, Hefei 230032, China"},{"name":"Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People\u2019s Republic of China, Hefei 230032, China"},{"name":"NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China"},{"name":"Anhui Provincial Key Laboratory of Population Health and Aristogenics\/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei 230032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"ref_2","first-page":"1491","article-title":"High-quality diet, physical activity, and college education are associated with low risk of NAFLD among the US population","volume":"75","author":"Nephew","year":"2021","journal-title":"Hepatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1053\/j.gastro.2020.11.051","article-title":"AGA Clinical Practice Update on lifestyle modification using diet and exercise to achieve weight loss in the 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