Dietary Treatment Of Nafld And Nash
Because of the strong association of obesity and the metabolic syndrome across the entire spectrum of NAFLD, current recommendations for the treatment of fatty liver disease are aimed at weight loss and dietary modification . For unknown reasons, sudden or quick weight loss achieved through dietary modification may lead to the progression of liver failure in some NAFLD patients . On the other hand, weight reduction through surgical methods, even with quick weight-loss after surgery, has been successful in reducing disease progression . Despite the fact that weight loss and dietary and lifestyle changes are recommended as primary treatment for fatty liver, no specific guidelines exist pertaining to diet. Very few studies of the effects of different diets on NAFLD have been performed. The premises, effects, barriers, and issues related to current dietary guidelines and specific popular weight-loss diets as they relate to NAFLD are discussed below.
Coffee To Help Lower Abnormal Liver Enzymes
Your daily cup of coffee could help protect your liver against NAFLD.
A found that regular coffee consumption is associated with a lowered risk of developing NAFLD, as well as a decreased risk of the advancement of liver fibrosis in those already diagnosed with NAFLD.
Caffeine also appears to lower the in people at risk for liver diseases.
Assessment Of Other Variables
All participants were asked to answer demographic and socioeconomic questions including age, educational status, job, smoking status, home status, home type, foreign travel, income, and disease history. Many factors, including income, profession, housing, and education can determine socioeconomic status . SES was defined based on educational level , family size , acquisition , and foreign travel . For each variable of the SES score, participants were given a score of 1 if they had4 family members, were academically educated, owned a house, or travelled internationally. Instead, they were given a score of 0 if they had> 4 family members, had non-academic education, had leasehold house or had not foreign travel. Then, total SES score was calculated by summing up the assigned scores . Individuals with the score of 4 were considered as having high SES.
Data on physical activity was obtained via a short form of validated international physical activity questionnaire , which was presented as metabolic equivalent-minutes per week . All questionnaires were completed by a trained dietitian through a personal interview in a relaxed atmosphere.
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I Realized Just How Much Hidden Dairy There Is
Before cutting out dairy, I naively never really looked into what I was putting into my body. Sure, Id glance over the calorie count, just to check it wasnt hugely excessive, but Id never give a second look to the ingredients. Now, I have to keep a close eye on the ingredients list. Youd be very surprised at how often dairy sneaks into the everyday foods we love, and how much we really eat. All too often, people hear of my allergy and say, Oh yes, well, I dont eat too much dairy myself either. But you probably eat far more than you think you do. Rosé wine? Often it has skim milk powder in. Salt and vinegar Pringles? You guessed it, milk!
Types Of Fatty Liver Disease
Health care providers divide fatty liver disease into two types. If you just have fat but no damage to your liver, the disease is called nonalcoholic fatty liver disease . If you have fat in your liver plus signs of inflammation and liver cell damage, the disease is called nonalcoholic steatohepatitis .
About 10% to 20% of Americans have NAFLD. About 2% to 5% have NASH.
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Exercise For Nonalcoholic Fatty Liver Disease
While diet is essential for treating NAFLD, exercise can also help especially when combined with a Mediterranean-style diet .
A review of 20 studies involving more than 1,000 people with NAFLD found that exercise decreased the amount of fat within the liver, even in the absence of significant weight loss .
The same review found no significant difference between aerobic exercise like brisk walking, running, or cycling and resistance training or weight lifting.
The Physical Activity Guidelines for Americans recommend doing at least 150 minutes per week of moderate-intensity exercise, 75 150 minutes a week of high-intensity exercise, or a combination of both .
Here are examples of moderate- and high-intensity activities :
- walking briskly
- weight training
- climbing briskly up a hill
- circuit weight training
- competitive sports like football, basketball, and soccer
The same guidelines also recommend performing muscle-strengthening exercises that involve all major muscle groups at least twice per week.
What Foods Help Prevent And Reverse Fatty Liver Disease
Medical providers preach about the importance of a healthy diet, but nutrition isnt always one-size-fits-all. For patients with fatty liver disease, the countrys most common chronic liver condition that affects about 100 million Americans and can lead to cirrhosis and cancer, it’s important to focus on diet and lifestyle changes.
As a registered dietitian and nutritionist at the University of Chicago Medicine’s Metabolic and Fatty Liver Disease Clinic, I recommend a diet full of healthy fats and plant-based foods as well as up to three cups of coffee per day to help keep your liver healthy.
The Impact Of Nutrients On The Development Of Nonalcoholic Fatty Liver Disease
The impact of nutrients on the development of NAFLD can be observed from as early as foetal life. A study conducted on rats revealed that an unbalanced diet during pregnancy and lactation contributes to the development of NAFLD in offspring. Maternal diet during pregnancy rich in energy, fat, sugar and salt increases the risk of NAFLD development and stimulates oxidative stress in offspring. Metabolic disturbances fixed during pregnancy and lactation cannot be turned back after introduction of a sensible diet in weaning time. A crucial role in the prevention of metabolic disturbances in offspring is played by nutritional education of pregnant women .
Foods That Help Fatty Liver Disease
Give the Mediterranean diet a try. Although it wasn’t created for people with fatty liver disease, this style of eating combines the kinds of foods that help reduce fat in your liver: healthy fats, antioxidants, and complex carbohydrates.
Things youâll see on the table that you should reach for include:
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How Long Does It Take To Reverse A Fatty Liver
Healthcare providers recommend losing at least 3% to 5% of your body weight to begin to see results in your liver. They also recommend that you aim to lose no more than 1 to 2 pounds per week. Rapid weight loss can make NAFLD worse. Take your time with a conservative diet and exercise program. Aim for 30 minutes of exercise a day.
I Lost 33 Pounds Without Even Trying
My main motivation for cutting out dairy was to feel better, not to lose weight but I must admit, it was a nice bonus. Rather scarily though, it showed me just how much dairy I must have been eating before, and how much it was affecting my body. For someone to just drop 33 pounds over a period of a year, without even really trying, is quite intriguing. All that dairy clearly isnt good for our waistlines!
I Realized How Much Of Our Social Lives Revolve Around Food
It was only when I started looking in-depth at our behavior around food that I understood how much of our lives revolve around it. I adore food as much as the next person, but I couldnt believe I was basing my daily life around my meal plans. Theres so much more to life than food. Planning active dates and activities is much better for the mind and bringing your friends along can add a whole other dimension to your relationships!
Progression Of Fatty Liver
Chronic liver cell injury and inflammation can stimulate stellate cells to increase collagen production, leading to fibrosis and eventually cirrhosis .2 In addition, the conditions that contribute to the progression of NAFLD to NASH and fibrosis also increase the risk of hepatocellular carcinoma .10
Cirrhosis and liver failure. Inflammation and increased oxidative stress related to NASH accelerate liver cell damage and trigger fibrotic processes that can progress to cirrhosis and liver failure, a terminal condition treatable only with liver transplant.12 Nearly 68% of NASH patients will develop advanced fibrosis and 20% will develop cirrhosis.11,14 NAFLD patients who also have type 2 diabetes mellitus have the highest risk of cirrhosis and liver failure.12
Hepatocellular carcinoma. As liver cells undergo increasing rates of injury and death, production of new hepatocytes is up-regulated. This, combined with heightened inflammation and fibrosis, is believed to contribute to an increased risk of hepatocellular carcinoma.10 The likelihood of hepatocellular carcinoma over a 10-year period is estimated to be greater than 5% in patients with NASH, but is about 0.4% in those in the overall NAFLD-affected population.11 It is important to note that even NASH patients without cirrhosis may be at an elevated risk of hepatocellular carcinoma.10
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Nonalcoholic Fatty Liver Disease
Nonalcoholic fatty liver disease is the build up of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% 10% percent of the livers weight is fat, then it is called a fatty liver . The more severe form of NAFLD is called nonalcoholic steatohepatitis . NASH causes the liver to swell and become damaged.
My Stomach Stopped Bloating
My main reason for cutting out dairy was to improve my digestive systems health. But I think the most surprising thing for me was the lack of bloating. Previously, I just expected to have to unbutton my jeans after a big meal, rather than questioning whether it was normal that my stomach ballooned. It used to be so bad that Id have two or three different dress sizes in my wardrobe at any one time, because I never knew if Id be able to squeeze myself into something with all the bloating going on. Thats now a thing of the past, and I can stick to one dress size.
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How Is It Treated
There are no medical treatments yet for non-alcoholic fatty liver disease. Eating a healthy diet and exercising regularly may help prevent liver damage from starting or reverse it in the early stages.
- See a doctor who specializes in the liver regularly
- Talk to your doctor about ways to improve your liver health
- Lose weight, if you are overweight or obese
- Lower your cholesterol and triglycerides
- Control your diabetes
Get Your Vitamins And Minerals
Make room in your diet for:
- Vitamin D. Low levels may play a role in more severe fatty liver disease. Your body makes vitamin D when you’re in the sun. You can also get it in some dairy products. Choose low-fat dairy items because they have less saturated fat.
- Potassium. Low levels may be linked to non-alcoholic fatty liver disease . Fish like cod, salmon, and sardines are good sources. It’s also in veggies including broccoli, peas, and sweet potatoes, and fruits such as bananas, kiwi, and apricots. Dairy foods, like milk and yogurt, are also high in potassium. Choose low-fat options.
- Betaine. It might protect your liver from fatty deposits, but research results are mixed. You can find it in wheat germ and shrimp.
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Identified Major Dietary Patterns
Factor analysis revealed three major dietary patterns from 36 food groups. The first one was labeled as western pattern which reflected the intakes of foods such as processed meats, organ meats, high fat dairy, soft drinks, refined grains, fast foods, mayonnaise, salty snacks, sugar-sweets-desserts and hydrogenated fats. The second pattern, was labeled healthy pattern, which displayed relatively high consumption of fish, skinless poultry, low fat dairy, fresh fruits, natural juices, canned fruits, dried fruits, vegetables, nuts, olive and garlic. The third pattern labeled traditional pattern and showed relatively high consumption of red meat organ meats, skinless poultry, eggs, yogurt drink, tea, legumes, tomato sauce, sugar-sweets-desserts, potato, condiments, salt, pickles and broth. Altogether, these three dietary patterns explained 50% of variance in primary variable. The factor loadings for each dietary pattern are presented in Table .
Table 2 Factor-loading matrix for major dietary patterns
Quinoa Tabbouleh Salad Recipe
This plant-based salad serves a family of four and is packed with liver-friendly ingredients.
Quinoa is technically a seed but considered a whole grain and complex carb, making for a healthier diet, Bonkowski says. This recipe also has fiber, protein, unsaturated fat from the olive oil and fresh ingredients like cucumbers, carrots and tomatoes.
What youll need
1 cup of quinoa, rinsed and dried
2 cups of water
1 bunch of fresh parsley, finely chopped
12 bunch of fresh mint, finely chopped
2 carrots, shredded
1 pint of cherry tomatoes
12 cucumber, diced
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Surprise No Calorie Counting
You won’t need a calculator for this meal plan. Instead of adding up numbers, you swap out bad fats for heart-healthy ones. Go for olive oil instead of butter. Try fish or poultry rather than red meat. Enjoy fresh fruit and skip sugary, fancy desserts.
Eat your fill of flavorful veggies and beans. Nuts are good, but stick to a handful a day. You can have whole-grain bread and wine, but in moderate amounts.
The Spices Are Delicious
Bay leaves, cilantro, coriander, rosemary, garlic, pepper, and cinnamon add so much flavor you won’t need to reach for the salt shaker. Some have health benefits, too. Coriander and rosemary, for example, have disease-fighting antioxidants and nutrients. This recipe for Greek-Style Mushrooms uses cilantro and coriander and has a lemony kick.
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National Cholesterol Education Program
The National Cholesterol Education Program has been developing guidelines for reducing the incidence of coronary heart disease since 1985. The Step I and Step II diets were created by the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults through 2 guideline reports, the Adult Treatment Panel I and II, respectively . The Step I diet is a strategy for the prevention of CHD in individuals with LDL concentrations 160 mg/dL or in those with a borderline high LDL concentration and 2 risk factors, including cigarette smoking, hypertension, low HDL, family history of premature CHD, and age . This diet restricts total fat intake to 30% of total daily calories, SFA intake to < 10% of total daily calories, and cholesterol to < 300 mg/d.
The Step II diet was created to address the need for further risk reduction in persons with established CHD and in those who are already at Step I goals and with a high-risk TC concentration of 240 mg/dL. This diet restricts SFA intake further to < 7% of total calories and cholesterol to < 200 mg/d. The terms Step I and Step II are no longer used in the new literature however, the Step I diet is still recommended for the general public, whereas the Step II diet has been updated and renamed the TLC diet.
Greens To Prevent Fat Buildup
Compounds found in spinach and other leafy greens may help fight fatty liver disease.
A 2021 study found that eating spinach specifically lowered the risk of NAFLD, possibly due to the nitrate and distinct polyphenols found in the leafy green. Interestingly enough, the study focused on raw spinach, as cooked spinach did not have the same strong results. This could be because cooking spinach may result in lowered polyphenolic content and antioxidant activity.
Things You Can Do If You Have Non
Adopting a healthy lifestyle is the main way of managing NAFLD.
For example, it can help to:
- lose weight you should aim for a BMI of 18.5 to 24.9 losing more than 10% of your weight can remove some fat from the liver and improve NASH if you have it
- eat a healthy diet try to have a balanced diet high in fruits, vegetables, protein and carbohydrates, but low in fat, sugar and salt eating smaller portions of food can help, too
- have water instead of sweet drinks
- exercise regularly aim to do at least 150 minutes of moderate-intensity activity, such as walking or cycling, a week all types of exercise can help improve NAFLD, even if you do not lose weight
- stop smoking if you smoke, stopping can help reduce your risk of problems such as heart attacks and strokes
NAFLD is not caused by alcohol, but drinking may make it worse. It’s therefore advisable to cut down or stop drinking alcohol.
Page last reviewed: 13 January 2022 Next review due: 13 January 2025
Specific Recommendations And Future Directions
Taking into account the evidence discussed in this article, the authors recommend a highly individualized approach for the dietary treatment of NAFLD and NASH based on a thorough assessment of individual metabolic, physiologic, and nutritional status and personal goals and preferences. The effects of each diet discussed in this article on specific health indexes, such as blood triacylglycerol concentration and insulin sensitivity, are shown in and are based on a review of the references included in this article. The composition and the relative macronutrient content of each diet are shown in . Most NAFLD patients would benefit from the guidelines given below.
Moderate calorie restriction of 100500 kcal/d through a decrease in portion sizes is recommended by the American Dietetic Association and the America on the Move program . Evidence of beneficial effects from weight loss through surgical methods in obese patients with NAFLD suggests that weight reduction through dietary means would also have positive effects. Specifically, weight loss resulted in a significant decrease in the prevalence of the metabolic syndrome and marked improvements in liver steatosis, inflammation, and fibrosis . However, very few studies examining the effects of different dietary and lifestyle approaches in achieving weight loss in NAFLD have been done, and further studies are urgently needed .
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