The key drivers of NAFLD, including insulin resistance and obesity, are all linked to poor diet and lifestyle. Adopting a healthy lifestyle is the most important way to manage non-alcoholic fatty liver disease by treating the problem at its root cause.
Approximately 100 million individuals in the United States have nonalcoholic fatty liver disease.
24% of US adults 1.
If the disease progresses it can lead to cirrhosis, liver cancer, and liver failure.
Jennifer Wetherington, MD has seen the power of lifestyle medicine address the key drivers of NAFLD.
A Healthful Plant-Based Diet Is Associated with Lower Odds of Nonalcoholic Fatty Liver Disease
This study looked at 3900 participants and their dietary patterns. The researchers found that people following a plant-based diet rich in healthy plant foods had half the odds of developing NAFLD compared to those who didn’t follow this diet 2.
Long-term lifestyle interventions in middle-aged and elderly men with nonalcoholic fatty liver disease: a randomized controlled trial
This trial included 280 participants with NAFLD, split into a test group that received counseling on diet and exercise from 2 physicians every 3 months, and a control group without regular intervention. After the 2-year intervention, fatty liver index (FLI) and NAFLD-fibrosis score (NAFLD-FS) reduced markedly in the test group alongside body weight, abdominal circumference, alanine aminotransferase (ALT - blood test that checks for liver damage), LDL-cholesterol and HDL-cholesterol. No improvements in fatty liver index or NAFLD-fibrosis score (NAFLD-FS) were seen in the control group 3.
Community-based lifestyle modification programme for non-alcoholic fatty liver disease: A randomized controlled trial
154 adults with NAFLD were randomized into two groups: one received a dietitian-led lifestyle modification programme at 2 community centers and the other received usual care, both for 12 months. The results were heavily in favor of diet and lifestyle changes, with 64% of the patients in the intervention group compared to just 20% in the control group achieving remission of NAFLD, a difference between groups of 44% 4.
Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial
Researchers at randomised 244 overweight or obese adults to a low-fat plant-based diet or no dietary change for 16 weeks. The plant-based group achieved a weight loss of 6.4 kg and reduced the fat inside their liver cells by 34%. There were no significant changes in these outcomes in the control group 5.
NAFLD is the buildup of fat deposits in the liver that is not caused by alcohol.
The two types of NAFLD are non-alcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). The more severe form of NAFLD is NASH, where the liver is inflamed, swollen and damaged. NAFL has little to no inflammation or damage, but can be painful due to the enlargement of the liver.
When progressive, NAFLD can lead to liver fibrosis, and scarring of the liver into a state of cirrhosis, resulting in liver cancer, liver failure, and even death6.
The key drivers of NAFLD are obesity, dyslipidemia, insulin resistance and metabolic syndrome which are all closely linked to our diet and lifestyle. Specific dietary components that increase the risk of NAFLD include saturated fat, red and processed meat, refined carbohydrates, and fructose (from sugar and high fructose corn syrup) 6.
Both forms of NAFLD are silent diseases and most people experience no or few symptoms. Even the more serious, progressive forms of disease such as cirrhosis have very few symptoms. Some people may experience fatigue or pain in the upper right side of their abdomen 7.
First your doctor may ask about your lifestyle and medical history to determine how likely you are to have NAFLD, these risk factors include:
Your doctor may then conduct a physical exam to look for signs of NAFLD, and perform tests including blood tests, imaging tests, and a liver biopsy.
Remission of NAFLD is achievable with diet and lifestyle interventions, and this is the line first treatment option for patients with fatty liver disease. Intervention trials prove how successful this can be, especially with the support of a physician.
Plant-based diets and lifestyle changes also reduce the risk of, and can treat, the key drivers of developing NAFLD including obesity, dyslipidemia, insulin resistance and metabolic syndrome.
Support from a dedicated team of lifestyle-medicine medical experts inspire the changes that allow our patients to live a life free of chronic disease and medications.
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1. Younossi, Z. M. et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes: HEPATOLOGY, Vol. XX, No. X 2016. Hepatology 64, 73–84 (2016).
2. Li, X. et al. A Healthful Plant-Based Diet Is Associated with Lower Odds of Nonalcoholic Fatty Liver Disease. Nutrients 14, 4099 (2022).
3. Dong, F. et al. Long-term lifestyle interventions in middle-aged and elderly men with nonalcoholic fatty liver disease: a randomized controlled trial. Sci. Rep. 6, 36783 (2016).
4. Wong, V. W.-S. et al. Community-based lifestyle modification programme for non-alcoholic fatty liver disease: A randomized controlled trial. J. Hepatol. 59, 536–542 (2013).
5. Kahleova, H. et al. Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial. JAMA Netw. Open 3, e2025454 (2020).
6. Byrne, C. D. & Targher, G. NAFLD: A multisystem disease. J. Hepatol. 62, S47–S64 (2015).
7. Symptoms & Causes of NAFLD & NASH | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/symptoms-causes.
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