Dietary niacin supplementation may reduce mortality risk in patients with non-alcoholic fatty liver disease

1. Among participants with non-alcoholic fatty liver disease, greater consumption of dietary niacin was associated with a reduction in the risk of all-cause mortality. 

Evidence Rating Level: 1 (Excellent)

Study Rundown: Non-alcoholic fatty liver disease (NAFLD) has an estimated prevalence worldwide of 32.4%. The global mortality among these patients has doubled in the last 3 decades, with cardiovascular disease (CVD) accounting for the majority of deaths. Niacin has become a focus of research for the prevention and treatment of liver disease, though no previous studies have examined the association between niacin intake and mortality risk in patients with NAFLD. Researchers aimed to assess the association between dietary niacin consumption and both all-cause and CVD mortality among patients with NAFLD. Using self-reported data on dietary intake, researchers estimated daily niacin consumption among 4315 adults in the United States with NAFLD. It was found that those in the highest tertile for dietary niacin intake had lower all-cause mortality risk. No association was found between niacin intake and CVD mortality. Overall, this study demonstrates that individuals with NAFLD may benefit from greater dietary niacin intake to reduce all-cause mortality risk. Further research is needed to guide recommendations for niacin intake among populations with liver disease.

Click to read the full study in JAMA Network Open

In-Depth [prospective cohort study]: 4315 adult participants with NAFLD were included in this prospective cohort study, (mean [SD] age, 52.5 [16.2] years). Data were collected from the National Health and Nutrition Examination Survey (NHANES), which was designed to assess the nutritional status of non-institutionalized populations in the United States between 2003 and 2018. The survey utilized the standardized Automated Multiple Pass Method (AMPM) to collect data on nutritional intake. Via this method, participants were asked to recall their previous 24 hours of food intake on two separate occasions to assess the types and quantities of food they consumed and estimate their typical dietary niacin consumption. Over the median (IQR) follow-up period of 8.8 (4.6-11.8) years, 566 deaths occurred. 197 of these deaths occurred due to cardiovascular disease. Compared to participants with a niacin intake of 18.4 mg or lower, the lowest tertile, those who consumed 26.7 mg or greater, the highest tertile, had a lower all-cause mortality risk (HR, 0.70; 95% CI, 0.50-0.96) P = 0.03. There was no significant association found between niacin intake and deaths due to cardiovascular disease. Several confounding variables were adjusted for during the analysis of this data. One of the greatest limitations of this study is its observational nature, which limits the ability to make causal interpretations of the data. 

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