Impact of Nutritional Changes on Nonalcoholic Fatty Liver Disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) is a major global health threat due to its growing incidence and prevalence. It is becoming the leading cause of liver disease in addition to its strong association with cardio-metabolic disease. Therefore, its prevention and treatment are of strong public interest. Therapeutic approaches emphasize lifestyle modifications including physical activity and the adoption of healthy eating habits that intend to mainly control body weight and cardio-metabolic risk factors associated with the metabolic syndrome. Lifestyle interventions may be reinforced by pharmacological treatment in advanced stages, though there is still no registered drug for the specific treatment of NAFLD. The purpose of this review is to assess the evidence available regarding the impact of dietary recommendations against NAFLD, highlighting the effect of macronutrient diet composition and dietary patterns in the management of NAFLD.

Keywords: NAFLD; NASH; diet; macronutrients.

Figure 1

The effects of diverse macronutrients on non-alcoholic fatty liver disease pathophysiology. An unhealthy dietary pattern including saturated fats, trans fats, simple sugars and animal protein (red and processed meat) results in an increased total and visceral fat mass, insulin resistance, increased hepatic de novo lipogenesis and gut dysbiosis. Under these conditions and acting parallel, fat accumulates in the liver causing lipotoxicity, increased oxidative stress and mitochondrial dysfunction adding genetic or environmental predisposition for hepatic lipid accumulation (‘multiple hit hypothesis´). Red arrow: unfavorable/harmful effect; Green arrow: favorable/beneficial effect. NAFLD: non-alcoholic fatty liver disease; PPAR: peroxisome proliferator-activated receptors.