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Lifestyle and Dietary Interventions in the Management of Nonalcoholic Fatty Liver Disease

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Abstract

NAFLD is the leading cause of chronic liver disease in the Western world with an estimated prevalence of 20–30 %. Lifestyle interventions targeted at weight loss through dietary interventions and exercise are the most effective treatment, but only a minority of patients are able to achieve and sustain the necessary intervention targets. Weight loss of 3–5 % has been associated with a reduction of hepatic steatosis while weight loss of ≥5–7 % has correlated with resolution of NASH in some studies. Greater reductions in weight loss (≥10 %) may improve hepatic fibrosis. In the absence of weight loss, no specific diet has demonstrated superiority. Physical activity can improve hepatic steatosis and metabolic indices even without weight loss. Diet coupled with exercise can produce significant weight loss and may improve histologic components of the NAFLD activity score. While formal guidelines for diet and exercise in NAFLD are lacking, adherence to diet and exercise recommendations similar to those from the American Diabetes Association for diabetic care seems reasonable. Dietary supplementation with vitamin E in non-diabetics with biopsy-proven NASH has been shown to improve NAFLD activity score. The role for other macronutrients, micronutrients, antioxidants, and probiotics in the treatment of NAFLD remains limited.

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Abbreviations

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

AASLD:

American Association for the Study of Liver Diseases

NAS:

Nonalcoholic fatty liver disease activity score

OR:

Odds ratio

ADA:

American Diabetes Association

MRS:

Magnetic resonance spectroscopy

HOMA:

Homeostasis model assessment

BMI:

Body mass index

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

MUFA:

Monounsaturated fatty acid

MET:

Metabolic equivalent

LDL:

Low-density lipoprotein

PUFA:

Polyunsaturated fatty acid

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Authors and Affiliations

  1. Department of Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA - Fort Sam Houston, San Antonio, TX, 78234-4504, USA

    William N. Hannah Jr.

  2. Division of Gastroenterology, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA - Fort Sam Houston, San Antonio, TX, 78234-4504, USA

    Stephen A. Harrison

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Correspondence to Stephen A. Harrison.

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Dr. Hannah has no financial disclosures to report. Dr. Harrison is an advisor for Fibrogen, Chronic Liver Disease Foundation, NGM Biopharmaceuticals, Merck, Pfizer, Nimbus Discovery, Zafgen, and Intercept. He is a speaker for Gilead, Merck, and Abbvie.

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Disclaimer The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of San Antonio Military Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, Department of Defense or the U.S. Government.

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Hannah, W.N., Harrison, S.A. Lifestyle and Dietary Interventions in the Management of Nonalcoholic Fatty Liver Disease. Dig Dis Sci 61, 1365–1374 (2016). https://doi.org/10.1007/s10620-016-4153-y

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