Nutrition's Role in Non-Alcoholic Fatty Liver Disease
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The liver is a vital organ, performing more than 500 life-supporting functions within the body including:
- Produces bile, aiding in digestion
- Makes proteins for the body
- Stores iron
- Converts nutrients into energy
- Creates substances that help your blood clot
- Helps with resisting infections, removing bacteria and toxins from the blood
When fat deposits build up in the liver, non-alcoholic fatty liver disease (NAFLD) can occur. Unrelated to alcohol consumption, medications or other disease, NAFLD is the world’s leading cause of adult chronic liver disease in the United States and other industrialized nations. Its increase in prevalence and severity correlates with the rise in obesity and metabolic syndrome affecting 30-40% of the global population. NAFLD is one of three types of fatty liver disease.
- Simple Fatty Liver (NAFLD): Fat in the liver without inflammation or damage.
- Nonalcoholic Steatohepatitis (NASH): Advanced fatty liver, unrelated to alcohol, that can lead to inflammation or irreversible liver damage such as scarring, cirrhosis and cancer.
- Alcohol-Related Fatty Liver Disease (ARLD): Excess alcohol consumption leading to the same irreversible damage as NASH that may improve with eliminating alcohol if damage is not already excessive.
Approximately 20% of NAFLD cases advance to NASH and, if left untreated, can result in the need for a kidney transplant.
The cause of NAFLD is not fully understood but genetics, excess weight gain, insulin resistance and inflammation are involved. Risk factors include obesity, prediabetes, type 2 diabetes and metabolic syndrome. Metabolic syndrome is diagnosed when someone experiences three or more of the following conditions:
- High blood glucose: 100 mg/dL or more
- Low HDL (“good”) cholesterol levels: men < 40 mg/dL; women < 50 mg/dL
- High triglyceride levels: 150 mg/dL or higher
- Large waist circumference: men > 40 inches; women > 35 inches
- High blood pressure: 130/80 mmHg or higher
Currently, there are no approved medical treatments or medications to treat NAFLD but practicing healthy lifestyle choices including eating a healthy diet, exercising regularly and managing pre-existing diseases can improve and prevent conditions.
Weight Loss is advised for those with a body mass index of 25 or higher. Losing 5-7% of your weight goal is the first target to hit. Weight loss should be gradual, no more than 1-2 pounds per week. Overly restrictive or very low-calorie diets should be avoided as they can worsen the condition and increase inflammation of the liver.
Exercise can also decrease the risk of common co-morbidities of NAFLD. Exercise even without weight loss is beneficial.1 Research suggests combining aerobic exercise and resistance training is more effective than aerobic exercise alone for improving inflammation and decreasing cardiovascular risk factors.
Following the Mediterranean diet has been shown to reverse metabolic syndrome.2 This plant-based eating plan does not necessarily mean vegan or vegetarian but instead focuses on:
- 100% whole grains
- Fruits and vegetables
- Healthy fats and carbohydrates
- Seafood and lean meats
- Low-fat dairy
Saturated fats are known to cause inflammation which has been linked to metabolic syndrome. Try to avoid saturated fats such as coconut and palm oil, high-fat meats and high fat-dairy. Instead, consume monounsaturated fats which can include olive oil, avocados and avocado oil, nut butters and nuts. Omega-3 fats are not a specific treatment for NAFLD but are recommended for their anti-inflammatory properties and can be found in fatty fish such as salmon, tuna and herring.
Soluble fiber is helpful in the treatment of NAFLD and can be found in foods such as oats, barley, berries, artichokes, legumes, chia seeds and sugar-free Metamucil®.
Lean proteins with the primary focus on plant-based sources such as whole soy (tofu, edamame, tempeh, soy nuts), legumes, seeds and nuts can aid in preventing NAFLD. Eggs, poultry and low-fat dairy are also encouraged. Red meat and processed meats should be limited (<12-18 oz. per week) to reduce health risks. Try Soy Vay Tofu with Lentils as a healthy, plant-based meal option.
Drinking 2-3 cups of black coffee per day could play a role in fighting inflammation.1 Fermented foods such as kimchi, tempeh, sauerkraut and kefir may also prove beneficial.
Vitamin D deficiency has been linked with the worsening of various liver diseases. Have your blood levels checked to determine if you are deficient and need additional supplementation. Try to consume antioxidants, vitamins and minerals through your diet first before turning to supplements. Your doctor will be able to determine which supplements may be right for you. Liver “cleansers” and all other supplements to treat NAFLD have not been proven to treat or prevent liver disease at this time.
Avoid alcohol and limit added sugar to less than 10% of your daily calories. For example, an 1,800-calorie diet should include no more than 180 calories from added sugar but less is better. Ongoing research investigates the risk of high fructose corn syrup, but the current research suggests it is no worse for liver health than simple sugar.3
Research to determine the best course of action in the treatment of NAFLD continues. For now, the importance of weight management and exercise is the key to prevention and the treatment of this disease.
To schedule a one-on-one consultation with a Registered Dietitian Nutritionist to build a healthy eating program or learn more about Cooper Clinic Nutrition, visit cooperclinicnutrition.com or call 972.560.2655.
Article provided by Kathy Duran-Thal, RDN, LD, and Cooper Clinic Nutrition.
- Kirkpatrick, K., & Hanouneh, I. (2017). Skinny Liver: A Proven Program to Prevent and Reverse the New Silent Epidemic—Fatty Liver Disease. Da Capo Lifelong Books.
- Suárez M., Et. al. (2017). Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease.
- Katz, D., Et al. (2021). Nutrition in Clinical Practice. Wolters Kluwer.