Dietary Composition Independent of Weight Loss in the Management of Non-Alcoholic Fatty Liver Disease

Abstract

Poor dietary composition is an important factor in the progression of non-alcoholic fatty liver disease (NAFLD). The majority of NAFLD patients follow diets with overconsumption of simple carbohydrates, total and saturated fat, with reduced intake of dietary fiber and omega-3 rich foods. Although lifestyle modifications including weight loss and exercise remain the keystone of NAFLD management, modifying dietary composition with or without a calorie-restricted diet may also be a feasible and sustainable strategy for NAFLD treatment. In the present review article, we highlight the potential therapeutic role of a “high quality healthy diet” to improve hepatic steatosis and metabolic dysfunction in patients with NAFLD, independent of caloric restriction and weight loss. We provide a literature review evaluating the evidence behind dietary components including fiber-, meat- and omega-3-rich diets and, pending further evidence, we concur with the EASL-EASD-EASO Clinical Guidelines recommendation of the Mediterranean diet as the diet of choice in these patients.

Dietary Factors in Relation to Liver Fat Content: A Cross-sectional Study

“…The main goals in NAFLD management are moderate body weight reduction (7%-10%) and increased physical activity [6], while, despite first promising clinical studies with anti-diabetic and anti-inflammatory drugs [4], no specific medical treatment for NAFLD is approved so far [7]. Several studies have analyzed the relationships between dietary factors and NAFLD in recent years [7][8][9]. Epidemiological studies suggest that coffee consumption may decrease liver fat content [8], but little is known about associations between food consumption and NAFLD so far.…”

“…Epidemiological studies suggest that coffee consumption may decrease liver fat content [8], but little is known about associations between food consumption and NAFLD so far. As a dietary pattern, the Mediterranean (MED) diet has been recommended as a diet of choice for individuals with NAFLD [6], and observational studies [9], as well as smaller intervention studies [10,11], suggest potential benefits from following the MED diet. These effects could be related to dietary and nutrient composition (especially higher consumption of whole grains products, fruit, vegetables, extra virgin olive oil and fish, with an overall higher content of anti-oxidants) and go beyond those of calorie restriction and weight loss [12,13].…”

Development and relative validation of a short food frequency questionnaire for assessing dietary intakes of non-alcoholic fatty liver disease patients

“…Consistently, a 'Western style' diet, with high intakes of meat, saturated fat and sugar, and low intakes of fruits, vegetables, fibre and omega 3 polyunsaturated fats has been associated with NAFLD disease severity [7]. Given the challenge of sustaining weight loss for most people [8], altering dietary composition in the absence of caloric restriction may be more feasible and may improve steatosis and metabolic dysfunction in NAFLD [9]. Notably, in a recent trial examining the effects of isocaloric, ad libitum Mediterranean and low-fat diets on steatosis and cardiometabolic risk factors, both diets reduced liver fat significantly after 12-weeks to a similar degree, 25-32%, measured by magnetic resonance spectroscopy.…”

From sugar to liver fat and public health: systems biology driven studies in understanding non-alcoholic fatty liver disease pathogenesis

“…In general, combining dietary and physical activity interventions appears most effective, as are interventions of longer duration and greater intensity (multicomponent; more contact time, ≥14 times in 6 months); although trial heterogeneity can confound systematic review (68,69,71) . Because achieving and maintaining 5-10 % weight loss is a significant challenge for many (69,72) , a pertinent question is whether or not improving the nutritional quality of the diet and/ or increasing physical activity may improve NAFLD in the absence of weight loss (73) . While the focus of this review is the role of nutrition and dietary modification, increasing physical activity is an important component of lifestyle change aimed at weight loss and clinical improvement of NAFLD.…”