Publication on the connection of non-alcoholic fatty-liver disease, dietary behavior and food literacy of working adults in nutrients

Non-alcoholic fatty-liver disease (NAFLD) is the fatty degeneration of the liver with more than 5% hepatocytes without other identifiable causes, such as excessive alcohol consumption. This places NAFLD as the leading risk factor for cirrhosis and hepatocellular carcinoma in adults. In addition, NAFLD is the hepatic manifestation of metabolic syndrome, being closely linked to other non-communicable diseases, such as diabetes mellitus, and increased cardiovascular and overall morbidity and mortality. German working adults might be particularly at risk of NAFLD as current studies indicate an increased risk for NAFLD in this population due to unhealthy dietary behavior, occupational stress, and long working hours. Dietary behavior (DB) and health knowledge are crucial factors in the conceptual NAFLD model, which can directly influence this disease. These two factors largely align with the concept of food literacy (FL), which deals with proficiency in food-related skills and knowledge to promote healthy DB and prevent NAFLD. However, the potential of FL for NAFLD prevention remains unknown, because FL has not been tested in connection with DB and NAFLD. Therefore, the current study examined the direct and indirect connections between FL, DB, and NAFLD in a mediation model.

A total of 372 working adults (38% female) participated in a cross-sectional study by completing self-report questionnaires on FL and DB. In addition, an independent physician assessed the fatty-liver index (FLI) as an indicator of NAFLD in an occupational health checkup. The mediation model revealed that FL had a direct moderate connection with DB (β = 0.25, p < 0.01), but no direct connection with FLI (β = −0.05, p = 0.36). However, DB showed a small to moderate connection with FLI (β = −0.14, p = 0.01), which could indicate the indirect-only mediation of the relationship between FL and NAFLD via DB.

These results confirm the value of DB for the prevention of NAFLD. Furthermore, FL might be able to increase the effectiveness of dietary interventions to prevent NAFLD, because it could enable working adults to understand dietary advice and increase the overall adherence to dietary programs by improving food-related knowledge and skills and navigating barriers in the food environment. Consequently, FL might be a vital component for improving DB and thereby function as a resource in the prevention of NAFLD. However, future longitudinal research is needed to substantiate the value of FL with respect to NAFLD.


Blaschke, S., Schad, N., Schnitzius, M., Pelster, K. & Mess, F. (2023). The Connection between Non-Alcoholic Fatty-Liver Disease, Dietary Behavior, and Food Literacy in German Working Adults. Nutrients. 15(3):648.