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Impact of healthy plant-based diet on abdominal visceral and liver fat contents.

HepatoBiliary Surg Nutr 2021;10(1):136-138 | http://dx.doi.org/10.21037/hbsn-20-760 Diet is an important modifiable risk factor for obesity and obesity-related complications, and there has been growing interest in plant-based diets, mainly defined as “vegetarian” diets, which have been associated with a lower prevalence rate of overweight/obesity as well as a lower risk of coronary heart disease, type 2 diabetes, other cardiometabolic diseases, and all-cause mortality (1). Such dietary patterns are also a major determinant of environmental sustainability (1). Of note, however, vegetarian diets can include less healthy plant foods, such as refined grains and sugar-sweetened beverages which have detrimental effects on health (2). In this regard, the recent development of three different plant-based diet indices has allowed an appraisal of the quality of plant-based diets: an overall plant-based diet index, reflecting a general plant-based diet; a healthy plantbased diet index, specifically based on whole grains, fruits, vegetables, legumes, nuts, tea/coffee; and an unhealthy plant-based diet index, emphasizing high intakes of refined grains, sweets, potatoes, fruit juices, and sugar-sweetened beverages (3). Against this background, the recent article by Ratjen et al. (4) is the first to investigate the relation between consumption of different plant-based diet indices and magnetic resonance imaging (MRI)—quantified volumes of abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) as well as of liver fat content. The study was performed in a population-based sample of 578 individuals (median age, 62 years) from Northern Germany, whose adherence to the three plant-based diet indices over the past 12 months was assessed by a validated, semiquantitative, web-based, 112-item food frequency questionnaire. Findings from Ratjen et al. showed that adherence to a healthy plant-based diet remained associated with lower VAT, even after adjusting for several potential confounders including body mass index (BMI) (4). These cross-sectional results are somehow in line with other longitudinal studies reporting in middle-aged and elderly populations inverse associations over time between adherence to overall or specifically healthy plant-based diet and measures of adiposity such as BMI, waist circumference, fat mass index, and body fat percentage (3,5). Such associations may be partly explained by the abundant intake of certain components of plant-based foods. For instance, wholegrains products and vegetables in general have low glycemic index values; vegetables are a major source of fiber, antioxidants, and chlorogenic acids; fruits are rich in fiber, antioxidants, phytochemicals, and minerals; whole grains and nuts are rich in monoor poly-unsaturated fatty acids; and coffee and tea are rich in antioxidants and phenol chlorogenic acid. These components have been suggested to influence adiposity through their satiating effects, antiinflammatory and antioxidant properties as well as their impact on gut microbiome composition. Considerable evidence has demonstrated that a healthy eating pattern diet across the lifespan can help reduce the risk of chronic diseases (6). Among these, nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide. Prior to the Commentary