Non-Alcoholic Fatty Liver Disease (NAFLD) is becoming increasingly common but yet remains underdiagnosed, and is the most common liver disease in Canada. It is diagnosed in women who consume less than 20g/day of alcohol and in men who consume less than 30g/day of alcohol, and other causes for liver disease are ruled out. NAFLD is on a spectrum from mild fat (triglyceride) accumulation to inflammation and scarring (non-alcoholic steatohepatitis or NASH), and eventually liver cirrhosis or even cancer (hepatocellular carcinoma)[1].
NAFLD is commonly an incidental finding on ultrasound or suspected when an elevated ALT is noted on routine lab work.
There is a strong relationship between cardiovascular diseases (CVD), particularly coronary artery disease (CAD, disease of the arteries of the heart) and NAFLD. CVD is the most common cause of death in those with this disease. Insulin resistance, diabetes, endothelial dysfunction, hypertension and hyperlipidemia are commonly found in those with NAFLD[2]. Excess caloric intake, obesity, and sedentary lifestyle create the perfect storm to develop NAFLD.
First line treatment for NAFLD includes lifestyle interventions with an emphasis on exercise and weight loss. The following are key strategies to reduce liver fat and prevent the progression of NAFLD1 [1,3]:
- Weight loss. 5-10% weight loss goal depending on severity, achieved by a loss of 0.5-1kg/week. Severe caloric restriction and rapid weight loss can have a detrimental impact on liver health. An activity goal of 150 minutes/week of moderate intensity aerobic activity should be achieved.
- Mediterranean diet. A plant-based dietary pattern provides antioxidants and helps to reduce oxidative stress and inflammation. It also helps to manage insulin resistance, and elevated cholesterol reducing risk of NAFLD as well as cvd and diabetes. Choose plant-based proteins such as beans, lentils, a variety of vegetables, healthy fats found in nuts, flax seed, and olive oil and choose more poultry and fish.
- Low saturated fat, no trans fats with an emphasis on polyunsaturated and monounsaturated fats. Diets high in saturated fats and trans fats increase oxidative stress, inflammation and accumulation of fat in the liver, also increasing risk for cardiovascular diseases. While healthy fats, such as those found in fish and extra-virgin olive oil, can help to reduce triglycerides, LDL, and cholesterol, reduce inflammation and fat accumulation in the liver.
- High fibre, whole grains. Choosing more whole grains instead of starchy and high glycemic foods will help to balance blood sugar, keep you feeling full longer and helps to reduce cholesterol. Not only that, it also helps to maintain healthy gut bacteria which is important for liver health
- Avoid processed foods, and foods high in fructose. Process foods are often high in saturated and trans-fat and excess sugar contributing to excess calories and accumulation of liver fat. By eliminating highly processed and sweetened foods and beverages can help you achieve your weight loss goals.
- Reduction/elimination of alcohol.
[1] Jeznach-Steinhagen, A., Ostrowska, J., Czerwonogrodzka-Senczyna, A., Boniecka, I., Shahnazaryan, U., & Kuryłowicz, A. (2019). Dietary and Pharmacological Treatment of Nonalcoholic Fatty Liver Disease. Medicina (Kaunas, Lithuania), 55(5). https://doi.org/10.3390/medicina55050166
[2] Arslan, U., & Yenerçağ, M. (2020). Relationship between non-alcoholic fatty liver disease and coronary heart disease. World journal of clinical cases, 8(20), 4688–4699. https://doi.org/10.12998/wjcc.v8.i20.4688
[3] Elena S George, Adrienne Forsyth, Catherine Itsiopoulos, Amanda J Nicoll, Marno Ryan, Siddharth Sood, Stuart K Roberts, Audrey C Tierney, Practical Dietary Recommendations for the Prevention and Management of Nonalcoholic Fatty Liver Disease in Adults, Advances in Nutrition, Volume 9, Issue 1, January 2018, Pages 30–40, https://doi.org/10.1093/advances/nmx007
Disclaimer: The information presented on this site does not constitute medical advice and does not replace the advice from your doctor. Always consult a qualified health care professional when changing or beginning a new health plan.
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