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NONALCOHOLIC FATTY LIVER DISEASE

Nonalcoholic fatty liver disease is having excessive 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 & enzymes levels but not in fibrosis
  • Lifestyle modification overall goals are to reduce excess body weight through diet & 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 & restricting lipids in terms of the proportions of nutrient intake

Diet

  • It was found that moderate calorie-restricted diet with modified macronutrient composition produces better results in comparison with a very low-caloric diet
  • Avoid beverages & foods that contain fructose & 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 men & 20 g for women
  • Heavy alcohol intake is a risk factor for chronic liver disease & should be avoided by patients with NAFL & NASH

Coffee drinking

  • Found to have protective element in NAFLD & reduces histological severity & 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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