What is the Non-Alcoholic Steatohepatitis (NASH) diet?

NASH Diet: Evidence-Based Dietary Recommendations for Non-Alcoholic Steatohepatitis

The NASH diet is a Mediterranean-style eating pattern that emphasizes vegetables, fruits, whole grains, lean proteins, and healthy fats while limiting processed foods, added sugars, and saturated fats to reduce liver inflammation and fibrosis. 1, 2

Core Components of the NASH Diet

1. Mediterranean Dietary Pattern

• Follow a Mediterranean-style diet rich in:
  • Vegetables and leafy greens
  • Fruits
  • Whole grains
  • Legumes and pulses
  • Fish and seafood
  • Extra virgin olive oil
  • Nuts and seeds
  • Low-fat dairy in moderation 1, 2

2. Caloric Restriction

• Implement a hypocaloric diet with:
  • 500-1000 kcal daily reduction from baseline
  • Target of 1200-1500 kcal/day
  • Aim for gradual weight loss of up to 1 kg/week 1

3. Weight Loss Targets

• 3-5% weight loss: Improves steatosis (fat accumulation)
• 7-10% weight loss: Improves liver inflammation and biochemistry

• 10% weight loss: Improves fibrosis (scarring) 1, 2

4. Foods to Limit or Avoid

• Processed foods and fast food
• Added sugars and high-fructose corn syrup
• Sugar-sweetened beverages
• Refined carbohydrates
• Saturated fats
• Red and processed meats
• Alcohol (complete abstinence recommended) 1, 2

Exercise Recommendations

• 150-200 minutes/week of moderate-intensity aerobic activity
• 3-5 sessions per week
• Combination of aerobic exercise and resistance training
• Exercise alone can reduce hepatic steatosis, but combined with diet produces better results 1, 2

Specific Nutritional Considerations

Protein Intake

• Minimum of 1.2-1.5 g/kg body weight
• Focus on plant proteins and lean animal proteins 2

Fats

• Replace saturated fats with monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA)
• Emphasize omega-3 rich foods (fatty fish, walnuts, flaxseeds)
• Use extra virgin olive oil as primary fat source 1

Carbohydrates

• Choose complex carbohydrates with high fiber content
• Limit refined carbohydrates and added sugars
• Completely avoid or significantly limit beverages with added fructose 1

Clinical Pearls and Pitfalls

Key Success Factors

• Sustained adherence is more important than specific macronutrient composition
• Gradual weight loss is safer than rapid weight loss (which can worsen inflammation)
• Dietary changes should be maintained long-term for continued benefit 1

Common Pitfalls

• Focusing only on weight loss without addressing diet quality
• Excessive caloric restriction leading to poor compliance
• Neglecting physical activity component
• Continuing alcohol consumption, even in moderation 1, 2

Special Considerations

• Patients with diabetes may need additional dietary modifications
• Consultation with a specialized nutritionist is recommended
• Regular monitoring of liver enzymes every 3 months 1, 2

Effectiveness of the NASH Diet

When properly implemented, the NASH diet can:

• Reduce hepatic fat content
• Improve insulin sensitivity
• Decrease liver inflammation
• Slow or reverse fibrosis progression
• Improve overall metabolic health 1, 2

The combination of dietary changes and physical activity represents the cornerstone of NASH management, with pharmacological treatments generally reserved for those with biopsy-proven NASH and fibrosis who don't respond adequately to lifestyle modifications 1, 2.