Factors were named descriptively according to the food items that showed high loading (absolute value >0.3) with respect to each dietary pattern as follows: sweet foods pattern, vegetable pattern and animal foods pattern (Additionalfile1: Table S1). Learn more The datasets generated and/or analysed during the current study are not publicly available due to that it is an ongoing cohort study but are available from the corresponding author on reasonable request. Green tea group showed significant reductions in ALT and AST levels after 12 weeks period (P < 0.001). [5] They have been found to decrease oxidative stress[6] and to exert anti-virus,[7] anti-allergenic,[8] anti-hypertensive,[9] and anti-hyperglycemic effects. Mechanisms underlying beneficial health effects of tea catechins to improve insulin resistance and endothelial dysfunction. Wang Y, Ho CT. Polyphenolic chemistry of tea and coffee: A century of progress. Cookies policy. Targher G, Bertolini L, Padovani R, Rodella S, Zoppini G, Pichiri I, et al. The Koo SI, Noh SK. Total alcohol intake in the preceding week was assessed using the FFQ. 2011;12:4550. All subjects were randomly assigned to one of the two above-mentioned groups. NAFLD develops without alcohol abuse and represents a spectrum of liver disease encompassing simple fatty infiltration, fat and inflammation, and cirrhosis [2]. [13] Experimental evidence supports a role of green tea extract (GTE) or its catechins in protecting against NAFLD by regulating energy homeostasis and decreasing oxidative stress and inflammatory responses. To the best of our knowledge, no study has explored the associations between daily tea consumption and the prevalence of NAFLD. Yang Xia and Xuena Wang contributed equally to this work. 2006;50:21828. Sumida Y, Kanemasa K, Fukumoto K, Yoshida N, Sakai K, Nakashima T, et al. Maeda-Yamamoto M, Inagaki N, Kitaura J, Chikumoto T, Kawahara H, Kawakami Y, et al. The scores of dietary patterns were used for further analyses as confounding factors. about navigating our updated article layout. Fatty acids that are not metabolized by mitochondria undergo or oxidation by microsomes or peroxisomes. Diabetes Care. Metabolic equivalents (METs; hours per week) were calculated using corresponding MET coefficients (3.3, 4.0, and 8.0, respectively) according to the following formula: MET coefficient of activity duration (hours)frequency (days). Total PA levels were assessed by combining separate scores for different activities. However, the amounts of catechins in most commercially available green teas is about 60mg per 200ml [28], which is equal to one cup in the present study. 36, San Hao Street, Shenyang, 110004, Liaoning, China, Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, Tianjin, China, Xuena Wang,Shunmin Zhang,Ge Meng,Hongmei Wu,Xue Bao,Yeqing Gu&Kaijun Niu, Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China, Qing Zhang,Li Liu,Shaomei Sun,Xing Wang,Ming Zhou,Qiyu Jia,Kun Song&Kaijun Niu, You can also search for this author in
Green tea extract protects leptin-deficient, spontaneously obese mice from hepatic steatosis and injury. Lifestyle-related factors such as poor diet, obesity, excessive alcohol intake, diabetes, and hyperlipidemia have all been proposed to contribute to NAFLD. Beneficial effects of fermented green tea extract in a rat model of non-alcoholic steatohepatitis. At baseline and at the end of the intervention weight, serum ALT, AST, and alkaline phosphatase (ALP) were measured in fasting state, and dietary data were collected at baseline and end of the study. Lee MS, Kim CT, Kim Y. Type 2 diabetes was defined as having fasting blood glucose 7.0mmol/, or 2-h postprandial blood glucose 11.1mmol/l, or HbA1c6.5% (48mmol/mol), or a history of diabetes based on the 2014 American Diabetes Association criteria [17]. This cross-sectional study aimed to evaluate the associations between tea consumption and the prevalence of newly diagnosed NAFLD among Chinese adults. First, due to the nature of the self-reporting questionnaire, recall bias existed and the amount of tea consumed may not have been precisely reported. If a large quantity of fatty acids continues to be deposited in the liver, accumulation of acylglycerol in the hepatocytes induces oxidative stress that may progress to NAFLD. PubMedGoogle Scholar. Beijing, China: Peking University Medical Press; 2009. The aim of the study was carefully explained to the patients, and their written informed consent was obtained. Associations between tea drinking and the prevalence of newly diagnosed NAFLD were assessed via conditional logistic regression analysis. The utility of radiological imaging in nonalcoholic fatty liver disease. Murase T, Haramizu S, Shimotoyodome A, Tokimitsu I, Hase T. Green tea extract improves running endurance in mice by stimulating lipid utilization during exercise. Received 2014 Nov 20; Accepted 2015 Jul 25. Effect of iron reduction by phlebotomy in Japanese patients with nonalcoholic steatohepatitis: A pilot study. Hakim IA, Harris RB, Brown S, Chow HH, Wiseman S, Agarwal S, et al. The FFQ included seven frequency categories ranging from almost never eat to twice or more per day for foods and eight frequency categories ranging from almost never drink to four or more times per day for beverages. 2018M641753). Daily tea drinking is not associated with newly diagnosed non-alcoholic fatty liver disease in Chinese adults: the Tianjin chronic low-grade systemic inflammation and health cohort study. We thank all the participants and Colleague of Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran. 2014;9:e88701. NAFLD was identified for the first time in people without alcohol usage experience in 1980. The site is secure. A total of 32,165 participants without acute inflammatory disease completed a comprehensive health examination and the study questionnaire. Free fatty acids are absorbed by the liver through the intestinal tract after a meal and are oxidized by mitochondria and peroxisomes. How big a problem is non-alcoholic fatty liver disease? A previous meta-analysis of four clinical trials suggested that green tea extract supplementation yield benefits on NAFLD related risk factors [11]. Weight control and prevention of metabolic syndrome by green tea. Non-alcoholic fatty liver disease - a global public health perspective. Daily tea consumption yields a lower content of catechins than in tea extract. Categorical variables have been presented as percentages and examined using chi-square test. Despite the limitations, the results of the present study demonstrate that consumption of tea ( 1 cup/day) is not associated with the prevalence of newly diagnosed NAFLD among general Chinese adults. Information on smoking (never, former, and current smoking) and drinking (never, former, current drinking everyday, and current drinking sometimes) status of the participants was obtained via a questionnaire survey. The associations between tea consumption and the prevalence of newly diagnosed NAFLD are shown in Table2. HbA1c separation and quantification were conducted by a high-performance liquid chromatography analyzer (HLC-723G8; Tosoh, Tokyo, Japan). Ann Nutr Metab. 2014;2:90110. Second, we excluded participants with health conditions; thus, the final sample may not be representative of the population. Liver ultrasonography was performed by trained sonographers using a TOSHIBA SSA-660A ultrasound machine (Toshiba, Tokyo, Japan) with a 25MHz curved array probe. [26,27,28] There have been no certain treatment for NAFLD so far, but losing weight, controlling metabolic syndromes such as diabetes and hyperlipidemia, taking antioxidant drugs like Vitamin D and those which are sensitive to insulin are recommended. Shrestha S, Ehlers SJ, Lee JY, Fernandez ML, Koo SI. Logistic regression analysis was used to estimate the associations between tea consumption and the prevalence of NAFLD. Epigallocatechin gallate, a green tea polyphenol, mediates NO-dependent vasodilation using signaling pathways in vascular endothelium requiring reactive oxygen species and Fyn. 2015;7:29627. Among the 19,350 participants, 19.4% were classified as newly diagnosed NAFLD. [17] The subjects were randomly allocated into two groups Green tea extract and placebo groups. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Model 2 was additionally adjusted for energy intake (kJ/d), type 2 diabetes, hypertension, hyperlipidemia, physical activity, educational level, household income, smoking status, drinking status, employment status, family history of cardiovascular disease, cancer, and diabetes, intake of sweet foods pattern, vegetable pattern and animal foods pattern, and consumption of two other kinds of tea. statement and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. Food Chem Toxicol. 2008;8:828. IFCC method for aspartate aminotransferase (L-aspartate: 2-oxoglutarate aminotransferase, EC 2.6.1.1). 2008;47:74654. Tea (Camellia sinensis Theaceae) was discovered in China in 3000BC or earlier [8]. Also Lifestyles, modifications, particularly weight reduction may more improve the condition of this disease. Increased mRNA expression of acyl-CoA oxidase, one of the peroxisomal -oxidizing enzymes and medium-chain acyl-CoA dehydrogenase, a mitochondrial -oxidizing enzyme, was observed in the liver of the catechin administration group. The Chinese food composition tables [13] were used as the nutrient database. All the studies pooled in that meta-analysis explored the effect of tea consumption on the risk factors of NAFLD by using green tea extract supplementation as treatment [11]. Dietary data were collected using a 3-day dietary record and averages of 3-day energy and macro-nutrients intakes were analyzed using Nutritionist Software (Version 4.1, First Databank Division, The Hearst Corporation, San Bruno, CA). Most recently, a meta-analysis that included four randomized controlled trials suggested that there are potential benefits of green tea supplementation on the risk factors of NAFLD [11]. American DA. All analyses were performed using the Statistical Analysis System 9.3 edition for Windows (SAS Institute Inc., Cary, NC, USA) and STATA (version 12.1; Stata Corp LP, College Station, TX, USA). 2008;46:12718. volume18, Articlenumber:71 (2019) Maturitas. If fatty acid uptake by hepatocytes increases, fatty acid pools in the liver increase and accumulate in the hepatocytes as acylglycerol, increasing the load on hepatic mitochondria. Before The subjects were asked to take one capsule containing 500 mg of either GTE or cellulose each day for 12 weeks. Lee SA, Dai Q, Zheng W, Gao YT, Blair A, Tessari JD, et al. 2011;25:178995. 2018;15:129. Nutr J 18, 71 (2019). 2002;123:74550. Kim JA, Formoso G, Li Y, Potenza MA, Marasciulo FL, Montagnani M, et al. Z., L. L., G. M., H. W., X. The https:// ensures that you are connecting to the Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus. Weight decreased significantly in both groups (P < 0.001). Mutat Res. The new PMC design is here! Guidelines for the diagnosis and management of nonalcoholic fatty liver disease: update 2010. The study protocol was approved by the Ethics Committee of Isfahan University of Medical Sciences and was registered in the Iranian Registry of Clinical Trials website (IRCT2013092611763N12). Careers. The components of NAFLD have not yet been fully elucidated, but the following steps are considered to be the main mechanism. and transmitted securely. Non-alcoholic fatty liver disease: an emerging driving force in chronic kidney disease. Correspondence to This number was increased to 40 per group to accommodate the anticipated dropout rate. Sakata R, Nakamura T, Torimura T, Ueno T, Sata M. Green tea with high-density catechins improves liver function and fat infiltration in non-alcoholic fatty liver disease (NAFLD) patients: a double-blind placebo-controlled study. Green tea as inhibitor of the intestinal absorption of lipids: Potential mechanism for its lipid-lowering effect. Part 3. According to the revised definition and treatment guidelines for NAFLD published by the Chinese Association for the Study of Liver Disease in 2010 [14], we defined heavy drinking as an intake of >140g of alcohol per week among men and>70g per week among women. 2010;270:7784. government site. However, no study has reported on the beneficial effect of daily tea consumption and the prevalence of NAFLD. Further studies are warranted to directly assess pesticide levels in tea and confirm the findings of the present study. [23,24,25] The prevalence of this is 3446% in adults, although the prevalence of it is 21.531.5% in Iran. [22] In fact, when NAFLD appears that fat comprises 510% of liver's weight. The placebo group showed a reduction in ALT and AST levels at the end of the study, but it was no significant. In addition to the development of a fatty liver, NAFLD patients may also exhibit inflammation, necrosis and fibrosis of the liver, which are known as nonalcoholic steatohepatitis (NASH). The results indicated green tea extract supplementation significantly altered the blood levels of alanine and aspartate aminotransferases [11]. Nutrients. All participants underwent ultrasonography for determining fatty liver by a single sonographist. This article was extracted from MSc. Green tea group showed significant reductions in ALT and AST levels after 12 weeks period (P < 0.001). Phytother Res. B., Y. G., S. S., X. W., M. Z., Q. J. and K. S., conducted research; Y. X. analyzed data; Y. X. and Q. W. wrote the paper. A random number between 0.0 and 0.99 was generated by the computer for each subject. Tea in its various processed forms (i.e., non-fermented green tea, partly-fermented oolong tea, and fermented black tea) represents the most widely consumed beverage worldwide [9]. Green tea ()-epigallocatechin-3-gallate reduces body weight with regulation of multiple genes expression in adipose tissue of diet-induced obese mice. 2014;37(Suppl 1):S8190. GTE samples were extracted from dried leaves of green tea according to the present standard procedures with a certificate of analysis given. All authors read and approved the final manuscript. It contains high levels of flavonoids, which have antioxidant properties. Our GTE samples were prepared by Giah Essence Phytopharm Corporation (Gorgan, Iran). This dynamic cohort study was launched in 2007. Finally, liver biopsy, the gold standard for the diagnosis of liver disease, was not performed in the present study, due to the apparently healthy study population. Fasting blood sugar level was measured via the glucose oxidase method, triglyceride level was measured via enzymatic methods, and high-density lipoprotein cholesterol level was measured via the chemical precipitation method using reagents obtained from Roche Diagnostics on an automatic biochemistry analyser (Roche Cobas 8000 modular analyser; Roche, Mannheim, Germany). Diraison F, Moulin P, Beylot M. Contribution of hepatic de novo lipogenesis and reesterification of plasma non esterified fatty acids to plasma triglyceride synthesis during non-alcoholic fatty liver disease. Model 1 was adjusted for age, BMI, and sex. This study was supported by grants from the National Natural Science Foundation of China (No. Murase T, Nagasawa A, Suzuki J, Hase T, Tokimitsu I. Association of serum concentration of organochlorine pesticides with dietary intake and other lifestyle factors among urban Chinese women. The mean daily intake of nutrients was calculated using an ad hoc computer program developed to analyse the questionnaire. Serum samples were transferred into microtubes and were stored at 70C until analysis. Bassett DR Jr. International physical activity questionnaire: 12-country reliability and validity. Jablonski KL, Jovanovich A, Holmen J, Targher G, McFann K, Kendrick J, et al. EGCG, the main catechin in green tea is believed to reduce liver oxidation stress. NAFLD is defined by elevated liver enzymes (alanine aminotransferase [ALT] >31 mg/dl and 41 mg/dl and aspartate aminotransferase [AST] >31 mg/dl and 47 g/dl in women and men, respectively) and echogenicity grading of the liver was based on Saverymuttu et al.,[16] that is, mild steatosis as a slight increase in liver echogenicity and exaggeration of liver and kidney echo discrepancy, and relative preservation of echoes from the walls of the portal vein, moderate steatosis as a loss of echoes from the walls of the portal veins, particularly from the peripheral branches, resulting in a featureless appearance of the liver as well as a greater posterior beam attenuation and a greater discrepancy between hepatic and renal echoes, and severe steatosis as a greater reduction in beam penetration, loss of echoes from most of the portal vein wall. Saadeh S, Younossi ZM, Remer EM, Gramlich T, Ong JP, Hurley M, et al. [1] This disease may progress to cirrhosis of the liver and hepatocellular carcinoma. Employment status was classified as either senior officials and managers or professionals. Takato U, Ryuichiro S, Toru N, Takuji T, Michio S. Green tea with high-density catechins improves liver function and fat infiltration in non-alcoholic fatty liver disease (NAFLD) patients. The role of BMI and weight in the fatty liver has been the topic of many studies. Spearmans rank correlation coefficient for energy intake as assessed via the WDRs and FFQ was 0.49. Chang Y, Jung HS, Yun KE, Cho J, Cho YK, Ryu S. Cohort study of non-alcoholic fatty liver disease, NAFLD fibrosis score, and the risk of incident diabetes in a Korean population. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The placebo group showed a reduction in ALT and AST levels at the end of the study, but it was no significant. According to these results, it can be claimed that GTE 500 mg prescribed can be considered as an absolute treatment to improve serum levels of liver enzymes in NAFLD patients. CAS World J Hepatol. Wolfram S. Effects of green tea and EGCG on cardiovascular and metabolic health. Papavagelis C, Avgeraki E, Augoulea A, Stamatelopoulos K, Lambrinoudaki I, Yannakoulia M. Dietary patterns, Mediterranean diet and obesity in postmenopausal women. Powell EE, Cooksley WG, Hanson R, Searle J, Halliday JW, Powell LW. Low 25-hydroxyvitamin D level is independently associated with non-alcoholic fatty liver disease. will also be available for a limited time. Bethesda, MD 20894, Web Policies [34,35] So according to the significant reduction in BMI and weight effected by taking GTE daily in the intervention group, this drug can be considered as an effective drug and can be prescribed for NAFLD patients. California Privacy Statement, Green tea as inhibitor of the intestinal absorption of lipids: potential mechanism for its lipid-lowering effect. [32,33] In the past, BMI was the more important independent predictor agent of accumulated fat in the liver. Third, although we considered as many covariates as possible, we cannot rule out the possibility that unmeasured factors might contribute to the associations observed. 81903302, 91746205, and 81673166), China; China Postdoctoral Science Foundation (No. Components of caffeine and polyphenols (500 mg each capsule). Significant increases in serum biochemical indices, including the levels of alanine aminotransferases, aspartate aminotransferase, alkaline phosphatase, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and lipid peroxidation by-products have been observed experimentally after subchronic or chronic exposure to organophosphates [31, 32]. Suzuki Y, Miyoshi N, Isemura M. Health-promoting effects of green tea. Leite NC, Salles GF, Araujo AL, Villela-Nogueira CA, Cardoso CR. 2017;13:297310. Dietary green tea extract lowers plasma and hepatic triglycerides and decreases the expression of sterol regulatory element-binding protein-1c mRNA and its responsive genes in fructose-fed, ovariectomized rats. Hepatology. 1999;436:6997. 2008;331:65562. Stangl V, Lorenz M, Stangl K. The role of tea and tea flavonoids in cardiovascular health. NAFLD was diagnosed via liver ultrasonography and no history of heavy alcohol intake. Joint committee for guideline r. 2016 Chinese guidelines for the management of dyslipidemia in adults. J Geriatr Cardiol. By using this website, you agree to our 2007;33:15763. Participants were recruited during their annual health examinations at the Tianjin Medical University General Hospital-Health Management Center and community management centres in Tianjin. Cite this article. Proc Jpn Acad Ser B Phys Biol Sci. Although the underlying mechanism remains unclear, the present study extended the evidence in this regard, and found no association between daily tea consumption and the prevalence of newly diagnosed NAFLD among Chinese adults. Consumption of green tea, oolong tea, and black tea were positively associated with the prevalence of newly diagnosed NAFLD before adjustments. Thus, reverse causation was corrected as much as possible. All participants were asked to maintain their usual lifestyle. Y. X., K. N., and Y, Z., designed research; Y. X., X. W., S. Z., Q. There were no significant differences at baseline between the two groups in terms of age, gender, marital status, education level, physical activity, and the severity of fatty liver. 2003;35:1396. Liu X, Xu W, Cai H, Gao YT, Li H, Ji BT, et al. We excluded participants who changed their lifestyles (including dietary intake, drinking, smoking, physical activity, and sleeping habits) (assessed via a question in the questionnaire) in the last five years (n=7364), or those had a history of cardiovascular disease (n=1057), cancer (n=173), NAFLD (n=3344), alcoholic fatty liver disease (n=775), and other live diseases (including chronic hepatitis B or C, autoimmune liver disease, and liver surgery, n=102). A controlled study looking at the effects of EGCG on nonheme iron absorption showed that it was decreased by 27% in patients consuming 300 mg EGCG compared with controls consuming placebo. Johansson G, Westerterp KR. Recommendations of the German Society for Clinical Chemistry. ALP levels showed significant reductions in both groups after 12 weeks period (P < 0.001). It is believed to have beneficial effects in the prevention and treatment of many diseases, one of which is nonalcoholic fatty liver disease (NAFLD). Gastroenterology. The evidence from in vitro and in vivo studies indicates that green tea inhibits dietary lipid absorption [23], decreases lipid accumulation in the liver and adipose tissue [24], improves insulin sensitivity [25], and exerts antioxidant properties [26].
The present study has some limitations. The natural history of nonalcoholic steatohepatitis: A follow-up study of forty-two patients for up to 21 years. Binukumar BK, Bal A, Kandimalla R, Sunkaria A, Gill KD. Phytother Res. 2007;18:17983. JAMA. The chemistry of tea flavonoids. Am J Gastroenterol. [37] It has been shown that catechins promote lipid metabolism in the liver. Google Scholar. Xia, Y., Wang, X., Zhang, S. et al. Bruno RS, Dugan CE, Smyth JA, DiNatale DA, Koo SI. Disease progression of non-alcoholic fatty liver disease: A prospective study with paired liver biopsies at 3 years. Differences in the mean of the continuous variables between the two groups were tested using analysis of covariance for adjusting for baseline measurements and covariates. Catechin, one of the main flavonoids in green tea has recently attracted attention for its anti-tumor[2] and anti-arteriosclerotic[3] effects. Correlation coefficients for nutrients (vitamin C, vitamin E, polyunsaturated fats, saturated fats, carbohydrates and calcium) as assessed via the WDRs and FFQ ranged from 0.35 to 0.54. Green tea consumption and risk of type 2 diabetes in Chinese adults: the Shanghai Women's health study and the Shanghai Men's health study. Stangl V, Lorenz M, Stangl K. The role of tea and tea flavonoids in cardiovascular health. Compared with the participants who never drink tea, the odds ratios (95% confidence interval) of newly diagnosed NAFLD in the highest categories ( 1 cup/day) of green tea, oolong tea, black tea, and jasmine tea were 1.48 (1.33, 1.65), 1.50 (1.33, 1.68), and 1.28 (1.13, 1.46), and 1.36 (1.20, 1.54) before adjustments, respectively. There is no significant association between daily tea drinking and newly-diagnosed NAFLD in general Chinese adults. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Environ Int. Angulo P. Nonalcoholic fatty liver disease. [21] In fact, this disease includes a wide range of disorders from accumulated lipid in the big vesicular form to accumulated lipid with inflammation, cirrhosis, and hepatic damage. Body mass index (BMI) was calculated by dividing the weight in kilograms by the square of the height in meters (kg/m2). Kaijun Niu or Yuhong Zhao. high consumption of red meat [19], fruits [20], sweet products, desserts, and sugar [21]). All P values for linear trend were calculated according to the categories of tea consumption (almost never: 1, <1 cup/week: 2, 16 cups/week: 3, 1 cup/day: 4) based on logistic regression. Previous studies have reported that tea extract supplementation has potential benefits on the risk factors of non-alcoholic fatty liver disease (NAFLD); however, no study has investigated the direct effect of daily tea consumption on the prevalence of NAFLD in the general population. Yang CQ, Shu L, Wang S, Wang JJ, Zhou Y, Xuan YJ, et al. Liu et al.
Sociodemographic, behavioural, metabolic, and health status confounding factors were adjusted in logistic regression to explore the associations between daily tea consumption and the prevalence of NAFLD. However, it is reasonable to exclude participants with cardiovascular disease and cancer when estimating the associations between tea consumption and NAFLD. Hypertension was defined as average systolic BP140mmHg or average diastolic BP 90mmHg or use of antihypertension medications [16]. Balentine DA, Wiseman SA, Bouwens LC. 8600 Rockville Pike Beneficial effects of tea catechins on diet-induced obesity: Stimulation of lipid catabolism in the liver. Malhotra N, Beaton MD. We found a positive association between consumption of tea and the prevalence of newly-diagnosed NAFLD before adjustments. Thus, the low amount of catechins consumed daily in tea may not be enough to have a beneficial effect on NAFLD. The present study, to the best of our knowledge, is the first to explore the associations between daily tea consumption and the prevalence of newly-diagnosed NAFLD in a general population with a large sample size. Assessment of the physical activity level with two questions: Validation with doubly labeled water. After adjustments for age and sex where appropriate, participants with NAFLD tended to be men, older, of lower education level, less likely to be employed as managers (P<0.0001), and current or ex-smokers, who drank sometimes, had lower daily energy intake and lower intake of vegetable pattern (P<0.0001), had a higher prevalence of type 2 diabetes, hypertension, hyperlipidaemia, and family history of diabetes, and higher BMI and alanine aminotransferase level (P<0.0001). 
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