From the Guidelines
For fatty liver disease, I strongly recommend focusing on weight loss through a combination of diet and exercise as the primary lifestyle modification, aiming to lose 7-10% of body weight gradually, as this can significantly reduce liver fat and inflammation, as supported by the most recent and highest quality study 1. To achieve this, it's essential to adopt a Mediterranean-style diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats like olive oil, while limiting processed foods, added sugars, and saturated fats, as recommended by 1 and further emphasized by 1.
- Key dietary recommendations include:
- Following traditional dietary patterns, such as the Mediterranean diet
- Limiting excess fructose consumption and avoiding processed foods and beverages with added fructose
- Replacing saturated fatty acids (SFAs) with polyunsaturated fatty acids (PUFAs) and monounsaturated fatty acids (MUFAs) in the diet
- Consuming unprocessed foods high in fiber, including whole grains, vegetables, fruits, legumes, nuts, and seeds
- Avoiding excess alcohol consumption, as it directly damages liver cells, as highlighted in 1 and 1. Regular physical activity should also be considered, with a target of 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic exercise per week, complemented by resistance training exercise, as suggested by 1.
- Additionally, managing underlying conditions like diabetes and high cholesterol through proper medication adherence and regular medical follow-ups, avoiding unnecessary medications that may stress the liver, and ensuring adequate sleep of 7-8 hours nightly are crucial, as these modifications work by reducing fat accumulation in liver cells, decreasing inflammation, improving insulin sensitivity, and enhancing the liver's ability to process fats, with most patients seeing improvements in liver function tests within 3-6 months of consistent lifestyle changes, as noted in 1 and supported by the principles outlined in 1 and 1.
From the Research
Lifestyle Modifications for Fatty Liver
Lifestyle modifications are essential for managing fatty liver disease, as there are no approved pharmacological treatments. The following modifications can be recommended:
- Weight loss: A 7-10% reduction in body weight can improve steatosis, inflammation, hepatocyte ballooning, and fibrosis 2
- Daily exercise: Combined with diet, exercise can lead to greater reductions in liver enzymes and improve quality of life, cardiorespiratory fitness, and weight 2
- Diet: A healthy diet is crucial in managing fatty liver disease, and combined with exercise, it can lead to better outcomes than diet or exercise alone 2, 3
- Other lifestyle modifications: Light alcohol consumption, coffee, circadian misalignments, and sleep can also play a role in managing fatty liver disease 4
Barriers to Lifestyle Modification
Several barriers can hinder lifestyle modifications in patients with fatty liver disease, including:
- Lack of time 5
- Lack of information on diagnosis and management 5
- Negative perceptions of prescribed exercise and diet 5
- Physical symptoms interfering with behavior 5
- Presence of comorbidities 5
- Lack of family cooperation 5
Intensive Dietary and Lifestyle Interventions
Intensive dietary and lifestyle interventions can be effective in treating lean nonalcoholic fatty liver disease patients, with significant weight loss and improvement in liver enzymes and hepatic steatosis 6