Nutritional Approaches to Achieve Weight Loss in Nonalcoholic Fatty Liver Disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) can range in spectrum from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH), which is characterized by lipotoxicity, hepatocellular ballooning, and inflammation and can progress to cirrhosis. Weight loss is the cornerstone treatment for NAFLD and NASH. Various randomized controlled trials have shown that weight loss of ≥5-10% leads to significant improvements in hepatic steatosis. Diets high in sodium and fructose have been implicated in the pathogenesis of NAFLD. Although some clinical studies suggest that an isocaloric high-fructose diet does not worsen NAFLD, these clinical studies are often short in duration. More recently, the Dietary Approaches to Stop Hypertension diet, a sodium-restricted diet, has been associated with less prevalence of NAFLD and has been shown to improve NAFLD. In addition, the Mediterranean diet has been promising in improving hepatic steatosis, and a larger randomized controlled trial is currently enrolling subjects. For those who are unable to pursue weight loss through dietary approaches, bariatric surgery has been shown to improve hepatic steatosis and steatohepatitis. This method has been variable in improving hepatic fibrosis. In conclusion, weight loss is crucial to the improvement of NAFLD and NASH, and patients should attempt various diets in an attempt to achieve weight loss.

Keywords: DASH diet; bariatric surgery; liver disease; metabolic syndrome; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis; obesity; type 2 diabetes.

FIGURE 1

NAFLD patients (n = 154) randomly assigned to a dietitian-led lifestyle modification compared with standard of care for 12 mo. The figure represents the percentage of patients who had NAFLD resolution according to the percentage of weight loss when compared with their baseline. P-trend < 0.001. NAFLD, nonalcoholic fatty liver disease. Adapted from reference with permission.

FIGURE 2

NASH patients (n = 293) who underwent 52 wk of lifestyle changes. This figure represents hepatic fibrosis stabilization, regression, or worsening according to the percentage of weight loss from baseline to 52 wk. P = 0.04. NASH, nonalcoholic steatohepatitis. Adapted from reference 48 with permission.