Nonalcoholic fatty liver disease: the potential role of nutritional management

To review available data pertaining to dietary imbalances and metabolic alterations leading to the development of fatty liver disease and nutritional managements.

The importance of treating fatty liver disease is now firmly recognized not only because of the risk of progression toward a more aggressive liver disease but also because the fatty liver is an important provider of cardiovascular risks. The ideal diet for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis patients should reduce fat mass and inflammation in the adipose tissue, restore insulin sensitivity, and provide low amounts of substrates for de-novo lipogenesis, but scientific evidence to recommend specific diets is currently lacking. Moderate weight loss, low-calorie diets, reduction in saturated fatty acids intake, together with an increase in monosaturated and n-3 polyunsaturated fatty acids appear to be beneficial. Excessive consumption of high glycemic index carbohydrates appears deleterious, as it favors hyperglycemia and hyperinsulinemia and stimulates de-novo lipogenesis. Physical exercise is an important component of the approach, as it improves insulin sensitivity. Behavioral therapy promotes long-term compliance to lifestyle modifications.

One panacea is unlikely to be found, the more useful approach is probably multimodal and includes tailored lifestyle modifications. Randomized controlled trials are needed to establish dietary recommendations. While awaiting such trials, reduced consumption of simple sugar, especially sweetened beverages, and incremental increase in physical activity must be encouraged.