What dietary recommendations are suitable for patients with hepatic steatosis (fatty liver disease)?

From the Guidelines

For patients with fatty liver disease, I strongly recommend a Mediterranean-style diet that emphasizes plant-based foods, lean proteins, and healthy fats while limiting processed foods and added sugars, as it has been shown to reduce the risk of and progression of NAFLD through its antioxidant and anti-inflammatory effects 1. This diet should include plenty of fruits, vegetables, whole grains, nuts, seeds, and olive oil as the primary fat source. Patients should consume lean proteins like fish (especially fatty fish rich in omega-3 fatty acids) twice weekly, poultry, and plant proteins such as legumes. They should strictly limit refined carbohydrates, sugary beverages, and alcohol, which can worsen fat accumulation in the liver. Some key points to consider when implementing this diet include:

• Limiting saturated fatty acid intake, specifically from red and processed meat, as these have been associated with NAFLD 1
• Avoiding commercially produced fructose, which can contribute to fat accumulation in the liver, although fructose contained in fruits is not associated with NAFLD and should not be restricted 1
• Portion control is essential, as weight loss of 7-10% of body weight can significantly improve liver health in overweight patients 1 Regular physical activity (at least 150 minutes of moderate exercise weekly) should complement this dietary approach, as it can enhance the positive effect of a hypocaloric diet on NAFLD 1. This diet works by reducing insulin resistance, decreasing inflammation, and promoting gradual weight loss, which helps reduce fat deposits in the liver and can potentially reverse early-stage fatty liver disease. It is also important to note that patients with NAFLD should be evaluated for coexisting metabolic conditions, such as obesity, diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease, and these comorbidities should be managed aggressively 1.

From the Research

Dietary Recommendations for Fatty Liver Disease

To manage fatty liver disease, a well-structured diet is essential. The following dietary recommendations can be suggested:

• Calorie restriction and increased physical activity to enable weight loss 2
• High consumption of foods such as fish, olive oil, and polyphenols, which are beneficial for metabolic disorders 2, 3
• Limited intake of red and processed meat, saturated fat, added sugar, and sweetened beverages, which are associated with an increased risk of developing NAFLD and hepatocellular carcinoma 2
• Increased consumption of complex carbohydrates rich in dietary fiber 4
• Fat intake should comprise less than 30% of daily calories, with an emphasis on mono- and polyunsaturated fatty acids 4
• Ingestion of protein should constitute 15-20% of total energy 4

Benefits of Specific Diets

Certain diets have shown promise in managing fatty liver disease:

• The Mediterranean diet has been found to improve hepatic steatosis and insulin resistance in patients with NAFLD 3, 5
• Omega-3 fatty acid treatment may have beneficial effects in regulating hepatic lipid metabolism, adipose tissue function, and inflammation 6
• A low carbohydrate/low-fat diet, time-restricted eating diet, and calorie restriction have also been studied as potential dietary interventions for NAFLD 2

Key Nutrients and Foods

The following nutrients and foods may be beneficial for patients with fatty liver disease:

• Omega-3 fatty acids, which can help regulate hepatic lipid metabolism and inflammation 6
• Polyphenols, which can ameliorate inflammation and improve metabolic disorders 3
• Whole-grain and low glycemic index cereal-based items, which can interact with glucose and insulin metabolism 3
• Unsaturated fatty acids, which are associated with better hepatic lipid metabolism 3