The prevalence of non-alcoholic fatty liver disease (NAFLD) has increased day by day due to the change in eating habits. Now NAFLD is a disease with significant public health importance. Lifestyle-related factors such as poor diet, obesity, diabetes, and hyperlipidemia all are responsible for the onset and progress of NAFLD. Diet is very important for fatty liver patients.
If neglected, NAFLD patients may also exhibit inflammation, necrosis, and fibrosis of the liver, which are known as non-alcoholic steatohepatitis (NASH). NASH is a more serious liver condition than NAFLD. NASH may further progress to cirrhosis of the liver and liver cancer. 
Currently, no specific medicine is available for the treatment of NAFLD. Lifestyle modifications like improvement of eating habits and regular physical activity are commonly recommended for NAFLD and NASH patients .
Lifestyle modifications towards a healthy diet and habitual physical activity are desirable in NAFLD. A 7–10% weight loss and its sustainability is the goal in NAFLD patients. But the question is what type of diet is suitable for the patients suffering from Non-alcoholic Fatty Liver disease (NAFLD) and /or non-alcoholic steatohepatitis (NASH)?
What is the best diet for treating fatty liver?
Replacement of habitually consumed unhealthy “western type of diet” with the healthy “Mediterranean diet” is the key to achieve good liver health and avoiding further complications.
Mediterranean diet is the generic name of the traditional dietary patterns of the individuals living in the Mediterranean region.
The typical Mediterranean diet is characterized by the consumption of complex carbohydrates, fiber and antioxidant-rich vegetables, and polyunsaturated fatty acids. It is considered as the healthiest diet associated with favorable hepatic outcomes.
Characteristics features of the “Mediterranean diet”
Mediterranean diet is mainly consisting of whole grains and legumes as a staple diet. ,. If you notice carefully, it is the most sustainable and traditional diet for everyone across the world.
- It contains plenty of different types of fresh vegetables.
- Cold-pressed extra-virgin olive oil, nuts and seeds are the principal sources of fat in such diet.
- Fresh fruits as the typical daily dessert;
- Sweets based on nuts, olive oil, and honey are consumed during celebratory occasions.
- Local cheese and yogurt are the main dairy products used in such a diet.
- Adults do not drink milk as such except using milk in preparing coffee but infants regularly consume milk.
- This diet contains a moderate amount of fish, mainly sea fish.
- Small amounts of red meat and processed meat products are consumed occasionally (only once every week or two).
- Only very small quantities of sugar and potatoes are consumed, but butter and cream are not used.
- Fruits are regularly consumed.
What is the “western” type of diet”?
The “western type of diet” is high in saturated fats and sugars. It is well-rooted in the lifestyle of the majority of Americans. Over 35% of daily energy consumed by Americans is from solid fat, including trans fats and saturated fats, and added sugars.
High fat, high sugar Western diet is popular worldwide. But habitual intake of such diet is associated with an increased risk of obesity and accumulation of fat in the liver, leading to the development of non-alcoholic fatty liver diseases .
Unfortunately, the Mediterranean diet is no longer the standard food choice even in the Mediterranean area, where it has largely been replaced by a Western-type diet, rich in saturated fatty acids and sugars, which are associated with a higher risk of metabolic liver disease .
How Western Diet aggravates NAFLD?
Excess consumption of saturated fats and sugars, including sucrose –
- Increases the deposition of body fat
- contributes to the progression of NAFLD.
- Saturated fatty acids (SFAs), present in the Western diet, are a poor source of energy, because they are not the primary substrate for β oxidation, and tend to be directed toward storage. So saturated fat intake increases the tendency of weight gain instead of producing energy for our daily work.
- In the liver, excess intake of SFAs increases the stress in the cellular endoplasmic reticulum and produces more free radicals in the mitochondria, promoting the development of NASH.
- Fructose, which can be ingested directly or in the form of sucrose, is a highly lipogenic nutrient, enhancing hepatic lipid accumulation.
Hence a Westernized diet disrupts lipid homeostasis and oxidative balance in the liver and worsens the development of NAFLD .
Dietary principles to be followed by patients suffering from a fatty liver?
Reduced calorie intake, improved macronutrient composition, and increased physical activity may act independently to stop disease progression. Dietary adherence is an important determinant of weight loss sustainability , . The basic principles of diet include-
Energy restriction –
NAFLD patients are either overweight or obese. So at least 10% weight loss is the goal. So, the diet should be low in calories. All the fatty foods, fried foods should be avoided. The empty sources of carbohydrate (and/ or sugar) are to be restricted.
- The carbohydrate intake should be reduced to restrict energy intake.
- Simple sugars, like sucrose, glucose and fructose intake should be minimized as far as possible.
- Whole grains are always preferred than their refined counterparts. For example, whole wheat flour (atta) is better than the refined wheat flour (maida).
- Foods having low glycaemic index are good for fatty liver patients.
- Oats and unrefined wheat flour (atta) are a better option for the breakfast than the commercially available processed breakfast cereals.
- The total fat intake should be restricted within 20% of the calorie intake.
- Fried foods like pakoda, chips, etc. should be restricted
- All fast foods are rich in fats, containing mainly saturated fats and trans-fat. They are a poor source of monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA). So, fast foods should be avoided.
- Olive oil is good for liver health as it is rich in MUFA and PUFA. It can be used as a cooking oil.
- Vegetable oils like sunflower oil, safflower oil, rice bran oil, soybean oil, etc, can also be used as cooking oil.
- Hydrogenated fats like vanaspati, margarine is not recommended as they are a rich source of saturated fatty acids (SFA) and a poor source of MUFAs and omega-3 PUFAs.
- Ghee is also rich in SFA, so its intake should also be reduced.
- Polyunsaturated fatty acids (PUFA), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), helps to improve the liver condition of the NAFLD patients. Foodslikesea fish, green leafy vegetables, flax seeds, etc are rich in EPA and DHA.
- Consumption of fish oil help to improve the general health of NAFLD and NASH patients.
- Adequate protein intake is essential. An adult man and/ or woman requires around 60g of protein.
- Vegetable protein sources like cereals, pulses, nuts, and beans are better than animal protein sources.
- Red meat is to be avoided.
- Fish and milk can be taken.
- Sea fish is preferred than fresh-water fish because the former is a better source of omega-3 fatty acids.
- Among the milk products, curds and yogurt are preferred since they supply a good number of gut-friendly bacteria that are well-known for their health-promoting beneficial roles.
- Eggs can be consumed as it is a rich source of several nutrients but their intake should be restricted to a maximum of 2 to 3 eggs in a week.
Prebiotics and Probiotics
- Regular intake of high fiber diet supplies the prebiotic fiber and frequent consumption of probiotic enriched curds and yogurt is recommended to ensure reduced calorie intake and a favorable microbiota in the gut.
- To ensure a high fiber diet, intake of fresh fruit, fruit salad, fruits, and nuts dessert, etc. should be increased.
- Different types of vegetable salads should also be consumed regularly.
Vitamins, Minerals, and Antioxidants
- Consumption of plenty of locally available, seasonal fruits and vegetables ensure adequate intake of vitamins, minerals, and antioxidants.
Several types of drinks as beverages which can be classified as-
These are also called hard drinks. Several types of alcoholic drinks are commonly consumed in different parts of the world. All types of alcohol consumption are harmful to patients suffering from liver disease. So alcoholic drinks should be avoided by them.
These beverages do not contain any alcohol. They can be subdivided into 2 types like-
Hot drinks, mostly coffee) is the most commonly consumed hot drinks, popular throughout the world. In different countries, tea and coffee are prepared and consumed in different ways. Moderate intake of both tea and coffee are beneficial for liver health. But their excessive intake may be harmful. Intake of 2 to 3 cups of tea or coffee in a day is good for the individuals.
Cold drinks -Soft drinks are commonly known as cold drinks. But there are several types of beverages that are served in cold temperatures. So cold drinks are of following types-
Soft drinks – A soft drink usually contains carbonated water, sweetened by a natural or artificial flavoring agent. The sweeter maybe sugar, high fructose corn syrup, fruit juice or a sugar substitute (in case of diet drinks) or combination of these . These are an empty source of calories. They have no health benefits, instead, they harm our bodies. So soft drinks are not recommended.
Fruit juice– Various types of commercially prepared fruit juices are available in the market. They contain little amount of preserved fruit juices along with a lot of sugars and preservatives. So, these commercially available fruit juices have little nutritive values. They mainly contain sugar syrup. From the nutritional point of view, it is better to consume home-made, freshly prepared, unsweetened fruit juices instead of consuming such preserved, sweetened artificial fruit juices.
Milk Shakes – Nowadays various types of milkshakes are available in the market. They have certain nutritive value but contain sugar. So, for a NAFLD or NASH patient, it is not recommended, rather he or she should consume freshly available, low fat boiled and pasteurized milk without adding any sugar.
Probiotic drinks – These include various types of commercially available probiotics rich milk products like buttermilk, chaas, etc. They also contain preservatives and flavoring compounds but have certain health benefits due to the presence of gut-friendly bacteria. But as a nutritionist, I will always advise you to make your curds at home and then prepare the chaas in the home by adding little salt and spice according to your taste. This is best for your health.
Non-alcoholic fatty liver disease (NAFLD) is a disease in which fat is accumulated in the liver. Obese persons and diabetic individuals are at risk of NAFLD. The prevalence of NAFLD is increasing in the world day by day.
An energy-restricted, moderate carbohydrate low-fat diet supplying adequate protein, vitamins, minerals, antioxidants, and probiotics is suitable for fatty liver patients. Olive oil, sunflower oil, soybean oil, rice bran oil can also be used as cooking oil. Curds and yogurt should be taken literally. A lot of fresh seasonal fruits should be taken. Locally available diverse types of vegetables should be included.
All types of alcoholic drinks should be avoided. Hot beverages like coffee and tea are can be consumed but in moderate amounts, excess intake of these hot drinks is harmful to the liver. Commercially available fruit juice should be replaced by home-made, freshly prepared, unsweetened fruit juice. Freshly prepared probiotic drinks like chaos, buttermilk, etc. should be included liberally.