A large study of over 12,000 Chinese adults found that eating lots of rice may increase the risk of fatty liver disease, while choosing wheat, whole grains, and yams instead appears protective. Over 4 years, people who ate the most refined carbs (especially rice) were 51% more likely to develop fatty liver disease. However, those who ate more wheat, coarse grains, and yams had lower risk. The effects were stronger in women than men. Simply swapping one serving of rice daily for wheat or whole grains reduced disease risk by 6-8%.

The Quick Take

  • What they studied: How different types of grains and starches affect the risk of developing fatty liver disease in Chinese adults
  • Who participated: 12,134 healthy Chinese adults from Shanghai, followed for about 4 years to see who developed fatty liver disease
  • Key finding: People eating 11+ servings of refined carbs daily had 51% higher risk of fatty liver disease compared to those eating less than 4 servings, with rice being the main culprit
  • What it means for you: Consider replacing some rice with wheat products, whole grains, or yams in your diet, especially if you’re a woman or at risk for liver problems

The Research Details

Researchers followed over 12,000 healthy adults in Shanghai for more than 4 years, tracking their eating habits through detailed food questionnaires and checking for fatty liver disease using ultrasound scans. They measured how much refined carbs, rice, wheat, whole grains, and yams people ate, then watched to see who developed liver problems. The study used advanced statistical methods to account for other factors that might influence results, like age, weight, exercise habits, and overall health.

This prospective design is considered the gold standard for nutrition research because it follows people over time rather than just taking a snapshot. By starting with healthy people and watching what happens, researchers can better establish whether certain foods actually cause health problems rather than just being associated with them.

The large sample size and long follow-up period make the results more reliable. The study used validated questionnaires and objective ultrasound measurements rather than relying on self-reported health problems. However, it only included Chinese adults, so results may not apply equally to other populations.

What the Results Show

The study found a clear dose-response relationship with refined carbohydrates - the more people ate, the higher their risk of fatty liver disease. Those consuming 11 or more servings daily had 51% higher risk compared to those eating fewer than 4 servings. Rice showed the strongest harmful association, with people eating 10+ servings daily having 43% higher risk. In contrast, wheat consumption was protective, reducing risk by 22% in the highest intake group. Coarse grains and yams also showed protective effects, reducing risk by 14% and 22% respectively. The researchers calculated that replacing just one daily serving of rice with wheat reduced risk by 8%, while substituting coarse grains reduced it by 6%.

The protective effects were much stronger in women than men, suggesting hormonal or metabolic differences may influence how different grains affect liver health. A ‘Low Rice Pattern’ dietary score, representing overall lower rice consumption, was associated with 22% lower disease risk. The study also found that the timing and preparation methods of grains didn’t significantly change the associations.

This study provides some of the first specific evidence about different grain types and fatty liver disease risk. Previous research has suggested refined carbohydrates may contribute to liver problems, but most studies lumped all refined carbs together. This research breaks new ground by showing that not all grains affect liver health equally, with rice appearing more harmful than wheat or whole grains.

The study only included Chinese adults, so results may not apply to other ethnic groups with different genetic backgrounds or eating patterns. The follow-up period of 4 years, while substantial, may not capture very long-term effects. Food questionnaires, though validated, rely on people accurately remembering and reporting what they eat, which can introduce errors.

The Bottom Line

Consider moderating rice intake and incorporating more wheat products, whole grains, and yams into your diet. The evidence is strongest for women, who should particularly consider these grain swaps. Start with small changes like replacing one serving of rice daily with whole grain bread, oats, or sweet potatoes. These findings suggest moderate confidence for dietary changes, but shouldn’t override medical advice for existing liver conditions.

Women appear to benefit most from these dietary changes. People with risk factors for fatty liver disease (obesity, diabetes, high cholesterol) should pay particular attention. However, those with existing liver disease should consult healthcare providers before making major dietary changes. The findings may be less applicable to non-Asian populations.

Fatty liver disease develops gradually over months to years, so benefits from dietary changes would likely take several months to become apparent. The study suggests that consistent, long-term dietary patterns matter more than short-term changes.

Want to Apply This Research?

Use the Gram app to:

  • Track daily servings of rice versus wheat/whole grains, aiming to keep total refined carbs under 7 servings daily while gradually increasing wheat and whole grain portions
  • Set a goal to replace one rice serving daily with wheat bread, oats, quinoa, or sweet potato, tracking this substitution weekly to build a sustainable habit
  • Monitor grain ratios monthly, tracking the percentage of total grain intake from rice versus protective options like wheat and whole grains, aiming for rice to comprise less than 60% of total grain consumption

This information is for educational purposes only and should not replace professional medical advice. Individuals with existing liver disease, diabetes, or other health conditions should consult their healthcare provider before making significant dietary changes.