NAFLD is the leading cause of chronic
liver disease in the Western world with an estimated prevalence of 20-30 %. Lifestyle interventions targeted at
weight loss through dietary interventions and exercise are the most effective treatment, but only a minority of patients are able to achieve and sustain the necessary intervention targets.
Weight loss of 3-5 % has been associated with a reduction of hepatic steatosis while
weight loss of ≥5-7 % has correlated with resolution of NASH in some studies. Greater reductions in
weight loss (≥10 %) may improve hepatic
fibrosis. In the absence of
weight loss, no specific diet has demonstrated superiority. Physical activity can improve hepatic steatosis and metabolic indices even without
weight loss. Diet coupled with exercise can produce significant
weight loss and may improve histologic components of the
NAFLD activity score. While formal guidelines for diet and exercise in
NAFLD are lacking, adherence to diet and exercise recommendations similar to those from the American Diabetes Association for diabetic care seems reasonable. Dietary supplementation with
vitamin E in non-diabetics with biopsy-proven NASH has been shown to improve
NAFLD activity score. The role for other macronutrients,
micronutrients,
antioxidants, and probiotics in the treatment of
NAFLD remains limited.