Overview and prospect of NAFLD: Significant roles of nutrients and dietary patterns in its progression or prevention

Abstract

NAFLD is the most common chronic liver disease worldwide, characterized by lipid accumulation in the liver, and usually evolves from steatohepatitis to fibrosis, cirrhosis, or even HCC. Its incidence is rapidly rising in parallel with the increasing prevalence of obesity and metabolic syndrome. Current therapies are limited to lifestyle changes including dietary intervention and exercise, in which dietary modification exerts an important part in losing weight and preventing NAFLD. In this review, we briefly discuss the roles and mechanisms of dietary components including fructose, non-nutritive sweeteners, fat, proteins, and vitamins in the progression or prevention of NAFLD. We also summarize several popular dietary patterns such as calorie-restricted diets, intermittent fasting, ketogenic diets, Mediterranean diets, and dietary approach to stop hypertension diets and compare the effects of low-fat and low-carbohydrate diets in preventing the development of NAFLD. Moreover, we summarize the potential drugs targeting metabolic-related targets in NAFLD.

Food Insecurity is Increasing and is More Common Among Persons with Chronic Liver Disease

“…Common recommendations include eliminating excess carbohydrates in favor of whole foods. 6,16,17 This strategy is challenged in the context of increasingly prevalent food insecurity. In this nationally representative study, we showed that food insecurity was prevalent among those with liver disease, and their levels increased signi cantly over time.…”

Fruit and vegetable intake and the risk of non-alcoholic fatty liver disease: a meta-analysis of observational studies

“…While vegetables are generally considered low-carbohydrate foods and those with high dietary fiber levels may reduce the risk of NAFLD (33), excessive intake of starchy vegetables might increase blood glucose and insulin resistance, which is detrimental to NAFLD patients (53). Similarly, fruits contain natural fructose, and high fructose intake increases hepatic de novo lipogenesis (DNL), reduces fatty acid β-oxidation (FAO), and leads to fatty acid deposition (54). Excessive fructose intake can also promote the development of NAFLD.…”

Distinct Gut Microbial Signature and Host Genetic Variants in Association with Liver Fibrosis Severity in Patients with MASLD

“…It is well documented that dietary patterns and nutrient compositions have significant impacts in promoting or counteracting the development and progression of MASLD [ 52 ]. Moreover, the heterogeneity of gut microbial composition can be modulated positively or negatively by different dietary patterns [ 13 ].…”

“…Regarding the impact of high protein consumption on MASLD, little is known, as most reports focus on carbohydrates and fats. Moreover, the role of a meat-based diet in MASLD development remains controversial, depending on the type and amount of protein intake [ 52 ]. Despite this inconclusive data, an unhealthy Western diet with a high protein intake is thought to be related to the increased prevalence and severity of MASLD [ 53 ].…”