Nutrition and Physical Activity in Nonalcoholic Fatty Liver Disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and it is associated with other medical conditions such as diabetes mellitus, metabolic syndrome, and obesity. The mechanisms of the underlying disease development and progression are not completely established and there is no consensus concerning the pharmacological treatment. In the gold standard treatment for NAFLD weight loss, dietary therapy, and physical activity are included. However, little scientific evidence is available on diet and/or physical activity and NAFLD specifically. Many dietary approaches such as Mediterranean and DASH diet are used for treatment of other cardiometabolic risk factors such as insulin resistance and type-2 diabetes mellitus (T2DM), but on the basis of its components their role in NAFLD has been discussed. In this review, the implications of current dietary and exercise approaches, including Brazilian and other guidelines, are discussed, with a focus on determining the optimal nonpharmacological treatment to prescribe for NAFLD.

A Khorasan Wheat-Based Replacement Diet Improves Risk Profile of Patients With Nonalcoholic Fatty Liver Disease (NAFLD): A Randomized Clinical Trial

“…NAFLD encompasses a wide spectrum of conditions, ranging from the asymptomatic accumulation of triglyceride deposits (hepatic steatosis) to the potentially progressive nonalcoholic steatohepatitis (NASH), also characterized by inflammation, ballooning, and moderate fibrosis, to more advanced forms including cirrhosis, liver failure, and hepatocellular carcinoma (1,2). The estimated prevalence of NAFLD in the adult population ranges from 20 to 30% (15-20% in women and 30-40% in men), increasing up to 70% and 90% in type 2 diabetes mellitus (T2DM) and obese populations, respectively (1¡3).…”

“…NAFLD in the hepatic steatosis phase can be reversed by lifestyle modifications, with the "gold standard" treatment including weight loss, dietary therapy, and physical activity (2). Although a relatively smaller proportion of patients with NAFLD have NASH, the latter is more difficult to treat, and preventing the progression of hepatic steatosis to NASH is of primary importance in the treatment of NAFLD (2,5).…”

“…Although a relatively smaller proportion of patients with NAFLD have NASH, the latter is more difficult to treat, and preventing the progression of hepatic steatosis to NASH is of primary importance in the treatment of NAFLD (2,5). In general, dietetic recommendations for NAFLD are the same as those for obesity, T2DM, and dyslipidemia; however, clinical dietary trials on patients with NAFLD are scarce (2). In a single study, the Mediterranean diet was shown to reduce hepatic steatosis and reduce insulin resistance in patients with nondiabetic NAFLD (6).…”

Non-invasive quantification of liver fibrosis regression following successful treatment of chronic hepatitis C with direct acting antivirals

“…In our study, 27.3% of patients did not present steatosis, and 50% of them presented minimal steatosis. These findings suggest that in our cohort of patients, timely lifestyle and nutritional intervention may be used to try and prevent the progression of steatosis (21,22).…”

NAFLD therapy and monitoring disease progression

“…Proteins should comprise 20% of TCI. 54 Foods which should be excluded from the diet include processed food, and foods and beverages high in added fructose. 46 There is currently no universal consensus on the type of diet that NAFLD patients should follow.…”