Anthocyanins and liver health -
Detailed dietary intake information of NHANES participants was obtained through dietary recalls. Body Mass Index BMI was calculated as weight in kilograms divided by height in meters squared, and then rounded to one decimal place.
Family income-to-poverty ratio PIR was calculated by dividing family or individual income by the poverty guidelines specific to the survey year. Smoking status was divided into former smokers smoked more than cigarettes in life and do not smoke at all now , never smokers smoked less than cigarettes in life , and current smokers smoked more than cigarettes in life and smoke regularly.
Participants were diagnosed with diabetes if they met one of the following criteria: 1. doctor diagnosed diabetes; 2. use of diabetes medications or insulin. All blood pressure measurements systolic and diastolic were taken in the MEC and were taken in the right arm unless specific conditions prohibited the use of the right arm.
The mean systolic or diastolic blood pressure was calculated as the average of three measurements. Physical activity PA information was self-reported by participants using the Global Physical Activity Questionnaire, which assesses the time spent doing different types of physical activity in a typical week, including vigorous and moderate intensity activities during work, transportation, and recreation.
Then, we calculated the metabolic equivalent of task MET minutes using the conversion formula recommended by NHANES. Using the latest version of healthy eating index HEI to evaluate diet quality, HEI scores ranged from 0 to , and the higher the score, the better the diet quality HEI consists of 13 components, including total fruits, whole fruits, total vegetables, greens and beans, whole grains, dairy, total protein foods, seafood and plant proteins, fatty acids, refined grains, sodium, added sugars and saturated fats.
Alanine aminotransferase ALT , aspartate transferase AST , alkaline phosphatase ALP , high-sensitivity C-reactive protein HS-CRP , high-density lipoprotein HDL , fasting plasma glucose FPG , triglyceride TG , and total cholesterol TC levels were measured using a Roche Cobas 6, c module analyzer.
Classification variables are expressed as weighted percentages, and continuous variables are expressed as weighted averages standard error. Differences in mean or percentage of baseline characteristics between NAFLD were tested by unadjusted binary logistic regression analysis.
A weighted multivariate logistic regression analysis model was used to analyze the relationship between flavonoid subclass intake and NAFLD and liver fibrosis risk.
Model 1 did not adjust for any covariates. Model 2 adjusted for age, sex, race, education level, PIR, BMI, smoking status, and alcohol use.
Model 3 additionally adjusted for diabetes mellitus, hypertension, hyperlipidemia, HEI scores, total energy, dietary intakes of protein, saturated fat, fiber, carbohydrates, polyunsaturated fat and physical activity, based on Model 2.
After adjusting for all covariates, weighted Restricted Cubic Spline RCS was used to fit the relationship between anthocyanin intake and NAFLD risk. To further explore the heterogeneity of the effect of anthocyanin on NAFLD risk, subgroup analysis was performed using age, race, BMI, sex, physical activity, DM, hypertension, hyperlipidemia, PIR, education level, smoking status, and alcohol use.
The interaction between subgroups and anthocyanin intake was tested by incorporating the interaction item into the model using the likelihood ratio test. Moreover, a weighted multivariate linear regression analysis was used to explore the relationship between daily anthocyanidin intake and liver serum biomarkers, dietary total energy intake and HEI scores.
All statistical analyses were performed in R Version 4. NAFLD patients were older and more likely to be male and Mexican-American than non-NAFLD participants. Further, NAFLD patients were more likely to have a history of smoking, diabetes, hypertension, hyperlipidemia, less physical activity, and a high daily total energy intake, dietary protein intake and dietary carbohydrate intake.
In addition, NAFLD patients also had increased BMI, ALT, AST, HS-CRP, FPG, TG, and TC and decreased HDL. Compared with the non-NAFLD population, NAFLD patients had a statistically lower intake of isoflavones and anthocyanin Table 1.
Table 1. Characteristics of participants by the non-alcoholic fatty liver disease NAFLD status, weighted. We established a multivariate logistic regression model to explore the correlation between flavonoid subclasses and NAFLD and liver fibrosis. The results showed that five flavonoids flavanols, flavanones, flavones, flavonols, and isoflavones had no significant correlation with NAFLD risk Supplementary Table S1.
Anthocyanin showed a significant correlation after correcting for various covariates. None of the flavonoid subclasses were significantly associated with the risk of liver fibrosis.
However, anthocyanin intake was negatively correlated with NAFLD risk Table 2. When RCS was used to fit the smooth curve, the results further revealed a negative correlation between anthocyanin intake and NAFLD risk Figure 2. Table 2. The univariate and multivariate logistic regression analysis results of association between anthocyanidins intake with the risk of non-alcoholic fatty liver disease NAFLD prevalence, weighted.
Figure 2. RCS plot between anthocyanin intake and the risk of NAFLD. Age, sex, race, education level, PIR, BMI, smoking status, alcohol use, diabetes mellitus, hypertension, hyperlipidemia, HEI scores, total energy, dietary intakes of protein, saturated fat, fiber, carbohydrates, polyunsaturated fat, and physical activity were adjusted.
We also performed a subgroup analysis based on age, sex, race, BMI, physical activity, DM, hypertension, hyperlipidemia, PIR, education level, smoking status, and alcohol use Table 3.
Table 3. Subgroup analyses of the association between anthocyanidins intake and NAFLD diagnosed by vibration controlled transient elastography, weighted. We performed multivariate linear regression analysis of daily anthocyanin intake and liver serum biomarkers, dietary total energy intake and HEI scores Table 4.
The results showed that participants with a higher anthocyanin intake had lower plasma concentrations of ALT, AST, ALP, and dietary total energy intake. Table 4. Multivariate linear regression analysis of daily anthocyanidins intake and liver serum biomarkers, dietary total energy intake and HEI scores.
The increasing incidence of NAFLD has had a negative effect on public health and has increased social burden. Therefore, increasing attention has been paid to the primary prevention of NAFLD through improvements in diet and living habits Our study found that higher levels of anthocyanin intake were significantly associated with lower NAFLD risk, while other flavonoid subtypes were not.
In addition, no significant correlation was observed between all flavonoid subtypes and the risk of liver fibrosis. The protective effect of higher levels of anthocyanin was more significant in patients who were non-Hispanic whites, without diabetes mellitus and with hypertension.
We also found that ALT, AST, and total energy intake decreased significantly in individuals with a high anthocyanin intake. The first blow is steatosis caused by insulin resistance, which leads to the accumulation of fatty acids in the liver.
Subsequently, liver lipid metabolism disorder leads to the activation of oxidative stress, the release of pro-inflammatory factors, and finally liver injury and fibrosis Anthocyanin belongs to a subset of polyphenols called flavonoids.
They are soluble in water and widely exist in fruits, grains, and vegetables, making them appear red-orange to blue-purple In vivo and in vitro studies have found that anthocyanin can reduce the risk of NAFLD through various mechanisms.
Kim et al. found that anthocyanin extracted from black chokeberry enhanced the expression of LDL-R mRNA and protein in Caco-2 cells and stimulated cholesterol transport Chu et al. found that cherry anthocyanin prevented oxidative stress induced by oleic acid OA- and decreased the accumulation of lipid droplets by activating autophagy in a NAFLD cell model Fan et al.
found that polymeric anthocyanin extracted from grape skins inhibited oxidative stress by increasing antioxidant levels and increased β-oxidation to inhibit mitochondrial dysfunction on a NAFLD model in mice However, focused studies on the role of anthocyanin in the human body remain limited.
This cross-sectional study found that dietary anthocyanin intake was significantly negatively correlated with ALT, AST, ALP and total energy intake using linear regression models adjusted for multiple confounders.
Elevated levels of ALT, AST, and ALP are the most common abnormal findings in liver function tests, indicating increased permeability and damage of hepatocytes, and are usually considered as markers of NAFLD 30 , This is similar to the results of some previous studies.
found that the higher the flavonoid intake, the more favorable the liver marker characteristics manifested as significant reductions in AST and ALT Moreover, higher total energy intake, along with excessive intake of ultra-processed foods and saturated fats, has long been considered as the main driving factor for NAFLD development This study showed that participants with higher dietary anthocyanin intake had lower total energy intake, which may also be a reason for the reduced risk of NAFLD.
In the subgroup analysis, we found that some groups were more likely to benefit from anthocyanin intake. The United States is a multi-ethnic country, and our research found that anthocyanin only play a significant role in non-Hispanic whites.
This may be due to differences in lifestyle, eating habits, and genetic background among races It is well known that diabetes mellitus is independent risk factor for the occurrence and development of NAFLD Patients with diabetes have higher levels of metabolic dysfunction and oxidative stress, which lead to more severe hepatic steatosis, inflammation and fibrosis, and impair their response to anthocyanin Patients with diabetes may require higher doses or longer duration of anthocyanin treatment to achieve effective results.
Moreover, anthocyanins have more pronounced effects in NAFLD patients with hypertension. Some preclinical studies have shown that anthocyanin have potential antihypertensive activity, which may be mediated by modulating endothelial nitric oxide synthase eNOS expression, antioxidant activity, inhibiting angiotensin-converting enzyme ACE activity and other pathways in endothelial cells Anthocyanin may reduce liver damage by improving vascular tone and hemodynamics, lowering blood pressure and portal pressure, and may have special benefits for NAFLD patients with hypertension.
These conclusions need more clinical trials to verify and support. The results showed that except for anthocyanin, the other five flavonoid subclasses had no significant correlation with NAFLD risk. Yang et al. However, due to only one randomized clinical trial RCT study on anthocyanin, the efficacy of anthocyanin could not be assessed.
Therefore, this cross-sectional study partially filled this knowledge gap. In addition, all six flavonoids were not related to the risk of liver fibrosis. Since liver fibrosis is a manifestation of NAFLD progression, flavonoids may not be able to significantly improve the condition of patients at this stage.
Using representative, national sample data and after correcting for confounding factors, we explored the relationship between anthocyanin intake and NAFLD risk. Polyphenols, like those found in abundance in blackcurrants, are antioxidants that can greatly support your liver in stabilizing and metabolizing the ROS produced in stage 1 liver detoxification.
Blackcurrants have been found to be effective at scavenging ROS, compared to nine other types of berries. This makes blackcurrants a uniquely powerful berry in supporting your liver function. The skin of the blackcurrant, specifically, has been found to upregulate liver antioxidant enzymes and support liver health by increasing its ability to detoxify.
Anthocyanins are a type of polyphenol that are effective at reducing inflammation in the liver. Many studies have demonstrated that anthocyanins reduce inflammation systemically, including in adipose fat tissue.
This fact is particularly insightful for cases of Non-alcoholic fatty liver disease NAFLD , where inflammation can be damaging to the liver. Inflamed tissue often contains a type of white blood cell that perpetuates the inflammation. NAFLD is on the rise due to contemporary diet, exercise, and lifestyle factors.
Inflammation often predisposes cancerous development in cells. Liver cancer is a leading cause of cancer related deaths worldwide.
fruit extract on the liver function, tumor necrosis factor α, malondealdehyde, and adiponectin in patients with non-alcoholic fatty liver. In the next stage, the fruits will be cleaned and their cores will be removed.
Extraction will be performed by percolation for one week. After filtration of the obtained extract, it will be concentrated by evaporation. The total anthocyanin content of the achieved extract will be determined using the pH differential method [ 52 , 53 ]. Furthermore, the necessary microbiology measurements will be performed for the prepared extract.
The placebo will be prepared using diluted water, caramel color, allura red color, and natural flavorings with a color, appearance, taste, and texture similar to the cornelian cherry extract, but without any anthocyanins. Patients with NAFLD will be selected based on the inclusion and exclusion criteria from gastroenterology clinics affiliated to Diabetes Research Center and Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Furthermore, patients should be residents of Yazd city and will be required to sign the written consent forms to participate in the research.
In the current research, nonalcoholic steatohepatitis NASH will be defined based on the guidelines of American Gastroenterological Association and American Association for the Study of Liver Diseases [ 54 ].
According to this guideline, NASH is defined as the presence of hepatic steatosis proved by ultrasonography or inflammation with hepatocyte injury ballooning with or without fibrosis [ 54 ]. Moreover, NAFLD will be diagnosed by ultrasonography based on following criteria: an increase in hepatic echogenicity via renal echogenicity as a reference, presence of enhancement and lack of differentiation of periportal, and bile duct walls reinforcement due to great hyperechogenicity of the parenchyma [ 55 ].
Exclusion criteria will include: having any history of diseases such as cirrhosis, viral hepatitis, cardiovascular disease, diabetes, Wilson, and cancer; taking medications including corticosteroids, non-steroidal anti-inflammatory drugs, hypoglycemic agents, or any medicines that affect the blood glucose, tamoxifen, sodium valproate, methotrexate, amiodarone, anti-retroviral agents for HIV, probiotics; consuming any medicine or supplement that affect liver function as well as supplements with antioxidant and anti-inflammatory properties such as vitamin D, vitamin E, omega-3, resveratrol one month before the study; following a special diet one month before the study; being pregnant and breastfeeding; and consuming alcohol.
We will also ask the patients to not consume the medicines in exclusion criteria list during the study. This survey was approved by Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, Iran approval number: IR.
The research was also registered on Iranian Registry of Clinical Trials IRCT registration code: IRCTN1. After informing the participants about the study protocol, they will be asked to sign the informed consent forms. The participants will be also stratified based on age, gender, BMI, and severity of fatty liver fatty liver grade 1, 2, 3.
If it is required, we will adjust the amount of consumed extract based on its total anthocyanin content. The participants will be asked to keep the intervention and placebo, which are presented as liquid in the refrigerator to ensure food safety.
In the current double-blind randomized clinical trial, the cornelian cherry extract and the placebo will be packed in containers with the same color, shape, and size, so that they cannot be identifiable by the patients or administrators.
A person out of research, who does not know about the details of study, will be asked to label the bottles containing the extract or placebo as A or B, the contents of these bottles should be consumed in one month by participants. We will also ask the participants to give back their bottles empty or not at the end of each month and receive the next bottles until the end of study.
At the end of intervention, the remaining contents of bottles will be recorded for each participant. Moreover, regular consumption of the extract or placebo will be checked by contacting the patients during the survey.
At the end of the trial, the consumed amounts of extract or placebo will be estimated considering the remaining contents of the bottles for each participant. Meanwhile, anthropometric parameters e. Height will be measured in a relaxed position with the accuracy of 0.
Then, BMI will be calculated after dividing the body weight kg by the square of height m. Waist circumference will be also measured at the midway between the lowest ribs and the iliac crest.
Moreover, hip circumference will be measured over the largest part of the buttocks. At the baseline and at the end of trial, serum concentrations of Alanine aminotransferase ALT and Aspartate aminotransferase AST will be measured with an auto-analyzer.
Furthermore, hepatic steatosis and liver fibrosis will be examined using transient elastography by a gastroenterologist at the baseline and at the end of the survey.
Evaluation will be conducted while patients are lying in a dorsal decubitus position with their right arm in maximum abduction [ 57 ]. At the baseline and at the end of the study, serum concentrations of glucose, total cholesterol TC , high density lipoprotein HDL-C , low density lipoprotein LDL-C , and triglyceride TG will be determined by an auto-analyzer.
Serum levels of insulin will be also measured by ELISA. Moreover, insulin resistance will be evaluated at the baseline and at the end of trial by the following two methods:. Data analysis will be conducted using SPSS version 24 SPSS Inc. The normality of variables will be evaluated using Kolmogorov- Smirnov test.
Then, the Chi-Squared test will be used to compare the qualitative variables between two groups. In addition, the variables with normal distribution will be compared between and within the groups using the independent sample t-test and the paired sample t-test, respectively. However, in order to compare the variables with non-normal distribution between and within the groups, Mann-Whitney test and Wilcoxon test will be applied, respectively.
To control the confounding variables, analysis of covariance ANCOVA will be used to examine the differences in post-intervention values between the two groups while adjusting for the baseline values and covariates. Nonalcoholic fatty liver disease is one of the most common chronic liver diseases with an increasing prevalence throughout the world.
Since no certain therapy has been found for NAFLD yet, determination of new and effective treatments is one of the substantial challenges of the current researchers. Recently, studies indicated that anthocyanins had some impacts on NAFLD. In addition, the protective effects of cornelian cherry fruit extract, as an anthocyanins-rich source, on liver were reported in animal studies.
However, very few clinical trials investigated the impact of anthocyanins on NAFLD and we are faced with paucity of information on the disease and its main limitations. Therefore, further clinical trials with a more comprehensive assessment of important variables related to NAFLD are needed to evaluate the impact of anthocyanins on patients with NAFLD.
Therefore, we will examine the effect of supplementation with total anthocyanin-base standardized cornelian cherry fruit extract on liver function, TNF-α, MDA, and adiponectin in NAFLD patients.
The findings of this study can provide new information over the impact of total anthocyanin-base standardized cornelian cherry fruit extract, as an anthocyanins-rich source, on NAFLD.
It also paves the way to discover new approaches for treatment of the disease. Ong JP, Younossi ZM. Epidemiology and natural history of NAFLD and NASH.
Clinics in liver disease. Article Google Scholar. Feldstein AE, editor Novel insights into the pathophysiology of nonalcoholic fatty liver disease. Seminars in liver disease; © Thieme Medical Publishers. Adams LA, Waters OR, Knuiman MW, Elliott RR, Olynyk JK.
NAFLD as a risk factor for the development of diabetes and the metabolic syndrome: an eleven-year follow-up study. Am J Gastroenterol. Petta S, Muratore C, Craxi A. Non-alcoholic fatty liver disease pathogenesis: the present and the future.
Dig Liver Dis. Article CAS Google Scholar. Lazo M, Clark JM, editors. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Clark JM. The epidemiology of nonalcoholic fatty liver disease in adults. J Clin Gastroenterol. PubMed Google Scholar. Moghaddasifar I, Lankarani K, Moosazadeh M, Afshari M, Ghaemi A, Aliramezany M, et al.
Prevalence of non-alcoholic fatty liver disease and its related factors in Iran. Int J Organ Transplant Med. CAS PubMed PubMed Central Google Scholar. Polyzos SA, Kountouras J, Zavos C, Deretzi G.
Nonalcoholic fatty liver disease: multimodal treatment options for a pathogenetically multiple-hit disease. Tilg H, Moschen AR. Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis.
Van De Wier B, Koek GH, Bast A, Haenen GR. The potential of flavonoids in the treatment of non-alcoholic fatty liver disease. Crit Rev Food Sci Nutr. Utzschneider KM, Kahn SE. The role of insulin resistance in nonalcoholic fatty liver disease.
J Clin Endocrinol Metab. Wei Y, Rector RS, Thyfault JP, Ibdah JA. Nonalcoholic fatty liver disease and mitochondrial dysfunction. World J Gastroenterol: WJG.
Polyzos SA, Kountouras J, Zavos C, Tsiaousi E. The role of adiponectin in the pathogenesis and treatment of non-alcoholic fatty liver disease. Diabetes Obes Metab. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association.
Nascimbeni F, Pais R, Bellentani S, Day CP, Ratziu V, Loria P, et al. From NAFLD in clinical practice to answers from guidelines.
J Hepatol. Bueno JM, Sáez-Plaza P, Ramos-Escudero F, Jiménez AM, Fett R, Asuero AG. Analysis and antioxidant capacity of anthocyanin pigments. Part II: chemical structure, color, and intake of anthocyanins.
Crit Rev Anal Chem. Valenti L, Riso P, Mazzocchi A, Porrini M, Fargion S, Agostoni C. Dietary anthocyanins as nutritional therapy for nonalcoholic fatty liver disease.
Oxidative Med Cell Longev ; Guo H, Li D, Ling W, Feng X, Xia M. Anthocyanin inhibits high glucose-induced hepatic mtGPAT1 activation and prevents fatty acid synthesis through PKCζ.
J Lipid Res. Guo H, Liu G, Zhong R, Wang Y, Wang D, Xia M. CyanidinO-β-glucoside regulates fatty acid metabolism via an AMP-activated protein kinase-dependent signaling pathway in human HepG2 cells.
Lipids Health Dis. Jia Y, Kim J-Y, Jun H-j, Kim S-J, Lee J-H, Hoang MH, et al. Cyanidin is an agonistic ligand for peroxisome proliferator-activated receptor-alpha reducing hepatic lipid. Biochimica et Biophysica Acta BBA -Molecular and Cell Biology of Lipids.
CAS Google Scholar. Chang J-J, Hsu M-J, Huang H-P, Chung D-J, Chang Y-C, Wang C-J. Mulberry anthocyanins inhibit oleic acid induced lipid accumulation by reduction of lipogenesis and promotion of hepatic lipid clearance. J Agric Food Chem. Hwang YP, Choi JH, Han EH, Kim HG, Wee J-H, Jung KO, et al.
Purple sweet potato anthocyanins attenuate hepatic lipid accumulation through activating adenosine monophosphate—activated protein kinase in human HepG2 cells and obese mice. Nutr Res.
Anthocyanins and liver health ageing helath a significant risk factor for chronic liver diseases. Anthocyanin is a food Anthocyanins and liver health that healh previously shown efficacy in increasing longevity. Here, we helath whether anthocyanins could lier young mice from Citrus aurantium for energy ageing of Anthocyanins and liver health liver. After eight weeks, whole liver function and structure were evaluated, and the expression levels of genes involved in the DNA damage signalling pathway were assessed by Western blot analysis. Moreover, the expression levels of sensors ATM and ATRmediators H2AX and γ-H2AX and effectors Chk1, Chk2, p53 and p-p53 in the DNA damage signalling pathway were all reduced. Anthocyanins could be widely used in the field of health products to slow ageing-related deterioration of liver function and structure by inhibiting DNA damage.Anthocyanins and liver health -
This fact is particularly insightful for cases of Non-alcoholic fatty liver disease NAFLD , where inflammation can be damaging to the liver. Inflamed tissue often contains a type of white blood cell that perpetuates the inflammation. NAFLD is on the rise due to contemporary diet, exercise, and lifestyle factors.
Inflammation often predisposes cancerous development in cells. Liver cancer is a leading cause of cancer related deaths worldwide. The cancer starts -like all cancers- with the proliferation of local cells, which in the liver, are called hepatocytes.
Blackcurrant skin extract has been shown to directly reduce the proliferation of cancer cells in the liver. Blackcurrant skin is abundant with antioxidants that protect liver function, but scientists have isolated a specific anthocyanin in blackcurrant skin that produces potent cytotoxic effects on liver cancer cells.
Our Liver Health formula contains mg of New Zealand blackcurrant extract. Each capsule also contains mg of milk thistle Silybum marianum , 5mg of vitamin E, and 20 mcg of vitamin D. Milk thistle is another powerful antioxidant, and it contains the compound silymarin, which has been shown to be an active flavonoid in repairing liver damage.
Subgroup analyses of the association between anthocyanidins intake and NAFLD diagnosed by vibration controlled transient elastography, weighted. We performed multivariate linear regression analysis of daily anthocyanin intake and liver serum biomarkers, dietary total energy intake and HEI scores Table 4.
The results showed that participants with a higher anthocyanin intake had lower plasma concentrations of ALT, AST, ALP, and dietary total energy intake.
Table 4. Multivariate linear regression analysis of daily anthocyanidins intake and liver serum biomarkers, dietary total energy intake and HEI scores. The increasing incidence of NAFLD has had a negative effect on public health and has increased social burden.
Therefore, increasing attention has been paid to the primary prevention of NAFLD through improvements in diet and living habits Our study found that higher levels of anthocyanin intake were significantly associated with lower NAFLD risk, while other flavonoid subtypes were not.
In addition, no significant correlation was observed between all flavonoid subtypes and the risk of liver fibrosis. The protective effect of higher levels of anthocyanin was more significant in patients who were non-Hispanic whites, without diabetes mellitus and with hypertension.
We also found that ALT, AST, and total energy intake decreased significantly in individuals with a high anthocyanin intake. The first blow is steatosis caused by insulin resistance, which leads to the accumulation of fatty acids in the liver. Subsequently, liver lipid metabolism disorder leads to the activation of oxidative stress, the release of pro-inflammatory factors, and finally liver injury and fibrosis Anthocyanin belongs to a subset of polyphenols called flavonoids.
They are soluble in water and widely exist in fruits, grains, and vegetables, making them appear red-orange to blue-purple In vivo and in vitro studies have found that anthocyanin can reduce the risk of NAFLD through various mechanisms.
Kim et al. found that anthocyanin extracted from black chokeberry enhanced the expression of LDL-R mRNA and protein in Caco-2 cells and stimulated cholesterol transport Chu et al.
found that cherry anthocyanin prevented oxidative stress induced by oleic acid OA- and decreased the accumulation of lipid droplets by activating autophagy in a NAFLD cell model Fan et al.
found that polymeric anthocyanin extracted from grape skins inhibited oxidative stress by increasing antioxidant levels and increased β-oxidation to inhibit mitochondrial dysfunction on a NAFLD model in mice However, focused studies on the role of anthocyanin in the human body remain limited.
This cross-sectional study found that dietary anthocyanin intake was significantly negatively correlated with ALT, AST, ALP and total energy intake using linear regression models adjusted for multiple confounders.
Elevated levels of ALT, AST, and ALP are the most common abnormal findings in liver function tests, indicating increased permeability and damage of hepatocytes, and are usually considered as markers of NAFLD 30 , This is similar to the results of some previous studies.
found that the higher the flavonoid intake, the more favorable the liver marker characteristics manifested as significant reductions in AST and ALT Moreover, higher total energy intake, along with excessive intake of ultra-processed foods and saturated fats, has long been considered as the main driving factor for NAFLD development This study showed that participants with higher dietary anthocyanin intake had lower total energy intake, which may also be a reason for the reduced risk of NAFLD.
In the subgroup analysis, we found that some groups were more likely to benefit from anthocyanin intake. The United States is a multi-ethnic country, and our research found that anthocyanin only play a significant role in non-Hispanic whites.
This may be due to differences in lifestyle, eating habits, and genetic background among races It is well known that diabetes mellitus is independent risk factor for the occurrence and development of NAFLD Patients with diabetes have higher levels of metabolic dysfunction and oxidative stress, which lead to more severe hepatic steatosis, inflammation and fibrosis, and impair their response to anthocyanin Patients with diabetes may require higher doses or longer duration of anthocyanin treatment to achieve effective results.
Moreover, anthocyanins have more pronounced effects in NAFLD patients with hypertension. Some preclinical studies have shown that anthocyanin have potential antihypertensive activity, which may be mediated by modulating endothelial nitric oxide synthase eNOS expression, antioxidant activity, inhibiting angiotensin-converting enzyme ACE activity and other pathways in endothelial cells Anthocyanin may reduce liver damage by improving vascular tone and hemodynamics, lowering blood pressure and portal pressure, and may have special benefits for NAFLD patients with hypertension.
These conclusions need more clinical trials to verify and support. The results showed that except for anthocyanin, the other five flavonoid subclasses had no significant correlation with NAFLD risk.
Yang et al. However, due to only one randomized clinical trial RCT study on anthocyanin, the efficacy of anthocyanin could not be assessed.
Therefore, this cross-sectional study partially filled this knowledge gap. In addition, all six flavonoids were not related to the risk of liver fibrosis. Since liver fibrosis is a manifestation of NAFLD progression, flavonoids may not be able to significantly improve the condition of patients at this stage.
Using representative, national sample data and after correcting for confounding factors, we explored the relationship between anthocyanin intake and NAFLD risk. We also conducted subgroup analyses, trend tests, and interaction tests to analyze the effects of anthocyanin in different individual groups.
However, this study also has some limitations. First, the diet and physical activity data were reported by participants independently, which may have resulted in measurement errors. Second, although we corrected for many confounding factors, unidentified confounding factors may remain that could affect our conclusions.
Third, more in vivo studies are needed to explore the specific mechanisms of anthocyanin in reducing the risk of NAFLD. Finally, because this was a cross-sectional study, we could identify a significant negative correlation between anthocyanin intake and NAFLD risk but could not determine a causal relationship.
Overall, this study provides new evidence that anthocyanin may significantly reduce the risk of NAFLD in the United States. The negative correlation was more significant among participants belonging to the following categories: non-Hispanic whites, without diabetes and with hypertension.
In the future, a more elaborate experimental design is needed to clarify the minimum intake required to achieve health benefits.
The studies involving humans were approved by the NCHS Research Ethics Review Board approved the NHANES research program, and informed consent was obtained from all participants.
The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. SX: Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Writing — original draft.
YujL: Data curation, Methodology, Writing — original draft. WP: Data curation, Formal analysis, Writing — original draft. The study was supported by the National Natural Science Foundation of China Grant No.
We thank LetPub www. com for its linguistic assistance during the preparation of this manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.
Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Friedman, SL , Neuschwander-Tetri, BA , Rinella, M , and Sanyal, AJ.
Mechanisms of NAFLD development and therapeutic strategies. Nat Med. doi: PubMed Abstract CrossRef Full Text Google Scholar.
Sanyal, AJ , Brunt, EM , Kleiner, DE , Kowdley, KV , Chalasani, N , Lavine, JE, et al. Endpoints and clinical trial design for nonalcoholic steatohepatitis. Tilg, H , and Moschen, AR.
Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis. Popov, VB , and Lim, JK. Treatment of nonalcoholic fatty liver disease: the role of medical, surgical, and endoscopic weight loss. J Clin Transl Hepatol. Bullón-Vela, V , Abete, I , Tur, JA , Pintó, X , Corbella, E , Martínez-González, MA, et al.
Influence of lifestyle factors and staple foods from the Mediterranean diet on non-alcoholic fatty liver disease among older individuals with metabolic syndrome features. Pickett-Blakely, O , Young, K , and Carr, RM. Micronutrients in nonalcoholic fatty liver disease pathogenesis.
Cell Mol Gastroenterol Hepatol. Zhang, S , Fu, J , Zhang, Q , Liu, L , Meng, G , Yao, Z, et al. Association between nut consumption and non-alcoholic fatty liver disease in adults.
Liver Int. Chang, JJ , Hsu, MJ , Huang, HP , Chung, DJ , Chang, YC , and Wang, CJ. Mulberry anthocyanins inhibit oleic acid induced lipid accumulation by reduction of lipogenesis and promotion of hepatic lipid clearance.
J Agric Food Chem. According to forecasts for —, the global omega-3 market is expected Content provided by Verdure Sciences Feb White Paper.
Cognitive health, mental acuity and brain support categories have seen tremendous growth. With an aging population and increased interest from formulators Content provided by Kaneka Nutrients — Manufacturer and Supplier of Kaneka Ubiquinol® Feb White Paper.
An ally in the fight against oxidative stress, Kaneka Ubiquinol® offers antioxidant support for men and women concerned about reproductive health. Content provided by Natural Remedies Private Limited Jan White Paper. More than ever, stress is extremely common among adults today.
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Background: Flavonoids are a class of plant Anthocyanins and liver health known to have health-promoting properties, Anthocyanins and liver health six subclasses. Anthocyanin is one heslth Anthocyanins and liver health subclasses Anthocyaniins have helth and antioxidant activities. However, Maca root and fertility relationship between flavonoid subclass intake abd the risk of non-alcoholic fatty wnd disease NAFLD and liver fibrosis has not been verified in representative samples of the United States. Methods: 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 — 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.
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