Non-Alcoholic Fatty Liver Disease is the most common liver disease in the USA, affecting roughly 30-40% of adult Americans 1. NAFLD defined by the presence of hepatic macrovesicular steatosis, with less than 20 gm of alcohol ingestion per day 2. The the liver, there is decreased mitochondrial fatty acid beta-oxidation, along with increased endogenous fatty acid synthesis or enhanced delivery of fatty acids to the liver 2,4, 8,14,. There is also a deficiency of the export of triglycerides as very low-density lipoprotein (VLDL) 2,4. Ultrasounds and serum enzymes are both used to detect NAFLD. People with T2DM or obesity are at a higher risk of developing NAFLD 1-4. In a study, Obese patients who are being treated with bariatric surgery were more than 90% likely to have NAFLD 13.
Studies have found that patients with NAFLD are more likely to develop other diseases, such as NASH or cardiovascular disease 1-4.One the best treatments for NAFLD is weight loss through dietary changes and exercise, which improves liver chemistries, steatosis, necroinflammatory changes and fibrosis 2,3,8,9,10,11,14,15.It has also been shown that gradual weight reduction has been shown to lower insulin levels and improve quality of life 1-4,8, 9,10,11,15. Weight loss may be achieved through dietary changes and increasing exercise frequency.
One suggested diet is that of the Mediterranean diet (ie, high consumption of complex carbohydrates and monounsaturated fat, low amounts of red meat, and low/moderate amounts of wine) 2,15. It has been shown that a low glycemic, low calorie diet with a weight loss of 1–2 kg/wk, which is a recommended goal for weight loss. Reducing the risk of obesity and T2DM also greatly lowers the risk for NAFLD, which are both decreased when subjects choose better diets and exercise more frequently 2,3,4,8,9,10,15.
There is a growing epidemiological and clinical evidence which stipulates that coffee consumption reduces the severity of NAFLD. Coffee, and particular components other than caffeine, reduce NAFLD prevalence and inflammation of nonalcoholic steatohepatitis 5-7. Coffee's hepatoprotective effects in NAFLD include antioxidative, anti-inflammatory, and antifibrotic effects, while a chemopreventive effect against hepatocarcinogenesis seems likely 5-7. “Coffee consumption reduces fat accumulation and collagen deposition in the liver and promotes antioxidant capacity through an increase in glutathione as well as modulation of the gene and protein expression of several inflammatory mediators.5” Coffee consumption also have been to shown to be inversely related to liver enzymes, even including that of heavy drinkers 5-,7.
Ursodeoxycholic acid, a metabolic byproduct of intestinal bacteria, is an anti-apoptotic, cyto-protective, immune-modulating, anti-inflammatory agent that has been used in treating liver disease 2. Some studies have showed some promising results, such as improving ALT 2. In one of the studies, Ursodiol did show improvements in steatosis, but little to no improvement in inflammation or fibrosis 2. With this knowledge, there are studies being done to use Ursodiol as an add-on therapy to treat liver disease.
Antioxidants have had a varied amount of studies, with some studies dealing with liver health. Antioxidants reduce the Oxidative stress, which is important in the pathogenesis of NASH, and antioxidants, such as vitamin E, may decrease levels of profibrinogenic TGF-β, improve histology, and inhibit hepatic stellate cell activation 2, 8, 14. Studies with vitamin E as the main antioxidant have been conducted with promising results in reducing aminotransferases and when paired with vitamin C, improvement in hepatic inflammation and fibrosis was detected 2, 4, 8,14.
Probiotics may also help with liver health, not just intestinal health. A study has shown probiotics may reduce hepatic injury, as is shown in animal models where intestinal derived bacterial endotoxin sensitizes fatty livers to the effects of TNF-α 2. A 3-month treatment period of a commercially available probiotic, VSL #3, given to 22 patients with NAFLD did improve ALT levels and markers of lipid oxidation 2.
Betaine, a component of the metabolic cycle of thionine, may increase S-adenosylmethionine levels which may protect against steatosis in alcoholic liver disease animal models 2,3. A trial study has showed that betaine significantly improved aminotransferase levels versus baseline 2,3. A marked improvement in of steatosis, necroinflammatory grade, and stage of fibrosis was also observed .2,3
Grape seed extract is another studied substance that has shown to help improve fatty liver. GSE significantly decreased the serum level of ALT, when compared to the control groups 14. GSE also significantly improved the grade of steatosis 14. It appears that GSE has an antioxidant effect on the body, which might be why it has shown to be a significant difference in the serum levels of ALT. .
NAFLD is a problematic issue, that has only risen in recent times, as people continue to trending to choose poor diets, lack of exercise and poor lifestyle decisions. As a result, more of the population are becoming diagnosed with NAFLD, especially shocking are the children. Best way to deal with disease is preventative care. As research has shown above, some of the best the results for NAFLD comes from weight loss. While diet alone may have good results, there are other dietary options to help boost prevention of this disease, along with helping the hepatocytes heal. Exercise may have improved histology of the liver, even without weight loss.11
Definition & Facts of NAFLD & NASH. NIDDK National Institute of Diabetes and Digestive and Kidney Diseases https://www.niddk.nih.gov/ Updated November 2016. Accessed October 12, 2017.
Tolman KG, Dalpiaz AS. Treatment of non-alcoholic fatty liver disease. Therapeutics and Clinical Risk Management. 2007;3(6):1153-1163.
Abdelmalek MF, Angulo P, Jorgensen RA, Sylvestre PB, Lindor KD. Betaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot study. Am J Gastroenterol. 2001 Sep;96(9):2711-7.
Xiao J, Fai So K, Liong EC, Tipoe GL. Recent Advances in the Herbal Treatment of Non-Alcoholic Fatty Liver Disease. Journal of Traditional and Complementary Medicine. 2013;3(2):88-94. doi:10.4103/2225-4110.110411.
Saab S, Mallam D, Cox GA 2nd, Tong MJ. Impact of coffee on liver diseases: a systematic review. Liver Int. 2014 Apr;34(4):495-504. doi: 10.1111/liv.12304.
Morisco F, Lembo V, Mazzone G, Camera S, Caporaso N. Coffee and liver health. J Clin Gastroenterol. 2014 Nov-Dec;48 Suppl 1:S87-90. doi: 10.1097
Chen S, Teoh NC, Chitturi S, Farrell GC. Coffee and non-alcoholic fatty liver disease: brewing evidence for hepatoprotection? J Gastroenterol Hepatol. 2014 Mar;29(3):435-41. doi: 10.1111/jgh.12422
Vos MB. Nutrition, nonalcoholic fatty liver disease and the microbiome: recent progress in the field. Current opinion in lipidology. 2014;25(1):61-66. doi:10.1097/MOL.0000000000000043.
Kargulewicz A, Stankowiak-Kulpa H, Grzymisławski M. Dietary recommendations for patients with nonalcoholic fatty liver disease. Przegla̜d Gastroenterologiczny. 2014;9(1):18-23. doi:10.5114/pg.2014.40845.
Rusu E, Enache G, Jinga M, et al. Medical nutrition therapy in non-alcoholic fatty liver disease – a review of literature . Journal of Medicine and Life. 2015;8(3):258-262.
Spengler EK, Loomba R. Recommendations for diagnosis, referral for liver biopsy, and treatment of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Mayo Clinic Proceedings. 2015;90(9):1233–1246.
Brunt EM, Wong VW, Nobili V, et al. Nonalcoholic fatty liver disease. Nature Reviews Disease Primers. 2015;1:15080
Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005–2023.
Khoshbaten M, Aliasgarzadeh A, Masnadi K, et al. Grape Seed Extract to Improve Liver Function in Patients with Nonalcoholic Fatty Liver Change. Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association. 2010;16(3):194-197. doi:10.4103/1319-3767.65197.
Sullivan S. Implications of Diet on Nonalcoholic Fatty Liver Disease. Current opinion in gastroenterology. 2010;26(2):160-164. doi:10.1097/MOG.0b013e3283358a58.