Background Diet is an important risk factor contributing to the development of non-alcoholic fatty liver disease (NAFLD) and associated metabolic co-morbidities (obesity or metabolic syndrome). This study aimed to investigate the association between fruit and vegetable consumption and NAFLD risk according to sex among Korean adults.

Methods We included 52 280 participants from the Health Examinees study cohort. The cumulative average intake of fruits and vegetables was estimated using a validated semi-quantitative food frequency questionnaire. Cox proportional hazards regression analysis was performed to estimate relative risk (RR) and 95% CI of NAFLD according to the quintiles of fruit and vegetable consumption.

Results During 4.2 years of follow-up, 2130 cases of NAFLD were documented. In women, higher consumption of fruits (RR 0.77; 95% CI 0.62 to 0.96) and vegetables (RR 0.71; 95% CI 0.56 to 0.88) was associated with lower NAFLD risk (p for trend=0.0106 and 0.0071, respectively). Men showed a decreasing tendency of NAFLD risk according to vegetable consumption (p for trend =0.0374). Higher total intakes of fruits and vegetables were significantly associated with lower NAFLD risk in men (RR 0.75; 95% CI 0.62 to 0.92, p for trend =0.0047) and women (RR 0.74; 95% CI 0.59 to 0.93, p for trend =0.0021).

Conclusion Fruit intake, vegetable intake, and total fruit and vegetable intake were associated with reduced NAFLD risk. Fruit and vegetable consumption can protect against NAFLD and associated metabolic co-morbidities.