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NONALCOHOLIC FATTY LIVER DISEASE

Nonalcoholic fatty liver disease is having excessive hepatic fat (in the form of triglycerides) accumulation not due to excessive alcohol consumption or other secondary causes.

It is considered as a hepatic manifestation of metabolic syndrome.

Progression of nonalcoholic fatty liver disease is variable.

Lifestyle Modification

  • The only effective treatment for nonalcoholic fatty liver (NAFL) is weight loss
    • It was found that a gradual weight loss of 5-10% has shown improvement in hepatic insulin resistance, liver histology (eg portal inflammation and fibrosis) and enzyme levels
  • Lifestyle modification overall goals are to reduce excess body weight through diet and exercise therapies for a period of 3-12 months
  • To improve NAFL/nonalcoholic steatohepatitis (NASH), it is recommended to prioritize the optimization of energy intake and restricting lipids in terms of the proportions of nutrient intake

Diet

  • It was found that moderate calorie-restricted diet (500-1000 kcal reduction/day) with modified macronutrient composition produces better results in comparison with a very low-caloric diet
  • Avoid beverages and foods that contain fructose and trans-fat
  • Increasing intake of omega-3/omega-6 polyunsaturated fatty acids in diet is suggested

Alcohol Intake

  • Keep alcohol intake below the risk threshold of 30 g for males and 20 g for females
  • Heavy alcohol intake is a risk factor for chronic liver disease and should be avoided by patients with NAFL and NASH

Coffee Drinking

  • Found to have protective element in NAFLD and reduces histological severity and liver-related outcomes

Exercise/Physical Activity

  • Moderate intensity aerobic physical activities 150-200 minutes/week in 3-5 sessions is recommended
    • Has been shown to improve fatty changes in the liver even without accompanying reduced body weight
  • It was also found that resistance training is also effective as it promotes musculoskeletal fitness with effects on metabolic risk factors
  • Any increase on previous levels of physical activity is better than continuing inactivity
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