Prospective study of perceived dietary salt intake and the risk of non-alcoholic fatty liver disease

Background: A high sodium intake is associated with obesity and metabolic syndrome. However, little is known regarding whether greater salt intake is a potential risk factor for non-alcoholic fatty liver disease (NAFLD). We thus prospectively investigated whether individuals with higher perceived dietary salt intake had a higher risk of developing NAFLD. Methods: The present study included 35 023 participants (22 629 men and 12 394 women) from the Kailuan study who were free of NAFLD at baseline (2006) and who did not drink alcohol at baseline and during follow-up (2006–2014; follow-rate 95.2%). NAFLD was defined as a participant who had been diagnosed with fatty liver at least twice by ultrasound tests conducted every 2 years during follow-up. Dietary salt intake was determined by a self-report question and was classified into three categories: low (<6 g day⁻¹), medium (6–9 g day⁻¹) or high (≥10 g day⁻¹). Cox proportional models were used to estimate the risk of NAFLD, adjusting for potential confounders, such as age, sex, education, physical activity, smoking, income, occupation, marriage, body mass index, waist circumference and blood pressure, as well as serum concentrations of glutamic-pyruvic transaminase, glucose, total cholesterol and triglyceride. Results: During 8 years of follow-up, we identified 5102 incident NAFLD cases. After adjusting for potential confounders, the hazard ratio (95% conference interval) for NAFLD was 1.12 (1.00, 1.26) for medium salt intake and 1.19 (1.02,1.39) for high salt consumption (P trend = 0.03) relative to the low salt consumption group. Conclusions: A perceived high salt intake was associated with a higher future risk of NAFLD.