# Diet Quality as an Associated Factor for Liver Function Enzyme Abnormalities Among Women of Reproductive Age

## TL;DR

Poor diet quality is linked to abnormal liver enzymes in Bangladeshi women of reproductive age, suggesting dietary improvements could help prevent liver issues.

## Contribution

The study identifies low Food Consumption Score as a novel risk factor for elevated liver enzymes in this population.

## Key findings

- 28.7% of participants had elevated ALT and/or AST levels.
- Low Food Consumption Score significantly increased the odds of elevated liver enzymes.
- Higher saturated fat and cholesterol intake were associated with abnormal liver enzymes.

## Abstract

Background

Elevated liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are early indicators of liver dysfunction in non-alcoholic fatty liver disease (NAFLD). The prevalence of NAFLD is increasing in Bangladesh, with studies indicating a higher prevalence among women. Additionally, rapid dietary transitions toward energy-dense foods rich in fat and sugar have contributed to the rising burden of non-communicable diseases. This study aimed to investigate the association between dietary intake, diet quality indicators, and elevated liver enzymes (ALT and AST) among women of reproductive age in Bangladesh.

Methods

A cross-sectional study was conducted among 240 women of reproductive age (15-49 years) randomly selected from community households in three selected districts of Bangladesh. Anthropometric and socioeconomic data were collected using standardized tools. Dietary intake was assessed using a single 24-hour dietary recall method and a Food Frequency Questionnaire (FFQ). Three complementary indices were applied to evaluate diet quality: Dietary Diversity (DD), Food Consumption Score (FCS), and the Bangladesh Healthy Eating Index (BD_HEI). The participant's blood was collected after overnight fasting. Serum ALT and AST levels were measured using a biochemical analyzer, and elevations in liver enzymes were defined according to standard clinical cut-off values. Descriptive and inferential statistics were performed using STATA version 15.1 (Stata Corp LLC, College Station, TX, USA).

Results

Among the 240 participants, 69 (28.7%) exhibited elevated ALT and/or AST levels, while 171 (71.3%) had normal values. Participants with elevated liver enzymes had higher intake of saturated fat (5.89 vs. 4.41 g, IQR: (3.84-9.63 vs. 2.98-7.15), p =0.010), cholesterol (55.21 vs. 30.41 mg, IQR: (15.21-137.92 vs. 0-106.61), p = 0.015). Participants with elevated liver enzymes had significantly lower FCS scores (23.2% vs. 9.4%, p = 0.014) but higher DD (27.5% vs. 15.8%, p = 0.036) as compared to normal liver enzymes. Multivariable logistic regression revealed that low FCS significantly increased the odds of elevated liver enzymes (AOR = 3.64, 95% CI: 1.53-8.62, p = 0.003).

Conclusion

This study highlights a significant association between poor FCS and liver enzyme abnormalities among Bangladeshi women of reproductive age. Integrating dietary quality interventions into reproductive health and noncommunicable disease (NCD) prevention programs could play a vital role in maintaining liver health and metabolic well-being in this vulnerable population.