[4 min read] Medical nutrition for non-alcoholic fatty liver disease

Did you know that non-alcoholic fatty liver disease affects at least 1 in 4 people worldwide (1)? The condition is reversible in patients who implement lifestyle changes such as medical nutrition therapy, and primary care physicians are in a pivotal position for prevention, screening, and care.

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in Medical Nutrition Management.

Non-alcoholic fatty liver disease (NAFLD) is the most common form of liver disease, referring to the build-up of excess fat in the liver that is unrelated to alcohol consumption. It begins with simple fatty liver and can progress to a more advanced and life-threatening liver cirrhosis, in which the liver is loaded with scar tissue and can no longer function properly – this is called non-alcoholic steatohepatitis (NASH).

There are several common and well-documented risk factors associated with developing NAFLD and NASH including:

  • having characteristics of metabolic syndrome (this includes factors such as high blood pressure, high cholesterol, diabetes mellitus or insulin resistance, and large waist circumference);
  • excess body weight;
  • excessive energy intake, particularly of fat and added sugar; and
  • genetic risk factors.

While there is currently no evidence-based, approved drug therapy for NAFLD/NASH, the condition is fortunately reversible in patients who implement lifestyle changes, whether through medical nutrition therapy, physical activity, or behavioural therapy.

Primary care physicians are seeing the majority of NAFLD patients and are in a pivotal position for prevention, screening, and quality care (2, 3).

Given the critical role that diet plays in the development of NAFLD, dietitians remain a cornerstone of NAFLD treatment and should work with patients’ healthcare team members, including primary care physicians and hepatologists.

There is no standard “NAFLD diet”, but there are key dietary concepts that are linked to better outcomes in afflicted individuals. These include:

  • Reducing saturated fat intake. In epidemiologic studies, both total fat and saturated fat in the diet have been correlated with liver triglyceride content and the presence of NASH (4, 5).
  • Reducing intake of simple carbohydrates, especially fructose. High consumption of simple sugars and highly processed grains can contribute to the development of a fatty liver through increased synthesis of fatty acids and triglycerides (6).
  • Increasing consumption of unsaturated fats such as omega-3s. Omega-3 fatty acids have been shown to help with reducing inflammation and fat synthesis in the liver (7, 8).
  • Increasing physical activity. Mindful and intentional movement is a key component of reducing fat deposits in the liver through enhancing insulin sensitivity and modifying lipid profiles independent of weight loss (9). Improvement in insulin sensitivity has been linked with a reduction in total body fat, especially in visceral fat, which in turn attenuates inflammatory processes, dyslipidaemia, and thus NAFLD pathogenesis (10).

The bottom line

Working with a multidisciplinary team including a qualified dietitian is an ideal approach and will provide patients with a structured care plan and follow up visits, which can help with long-term adherence and weight maintenance.

Dietary approaches with less carbohydrate and more fat have relatively greater benefits for insulin levels, triglycerides, and HDL cholesterol concentrations than do hypocaloric, low-fat diets for addressing NAFLD and NASH.

Learn more about medical nutrition for non-alcoholic fatty liver disease with the online HealthCert Professional Diploma program in Medical Nutrition Management.

– Lynette Law, Accredited Practising Dietitian

Read another article like this one: Irritable Bowel Syndrome & the low FODMAP diet


  1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73-84.
  2. Carrieri P, Mourad A, Marcellin F, Trylesinski A, Calleja JL, Protopopescu C, et al. Knowledge of liver fibrosis stage among adults with NAFLD/NASH improves adherence to lifestyle changes. Liver Int. 2022;42(5):984-94.
  3. Wong VWS, Zelber-Sagi S, Cusi K, Carrieri P, Wright E, Crespo J, et al. Management of NAFLD in primary care settings. Liver Int. 2022;42(11):2377-89.
  4. Tiikkainen M, Bergholm R, Vehkavaara S, Rissanen A, Häkkinen AM, Tamminen M, et al. Effects of identical weight loss on body composition and features of insulin resistance in obese women with high and low liver fat content. Diabetes. 2003;52(3):701-7.
  5. Vilar L, Oliveira CP, Faintuch J, Mello ES, Nogueira MA, Santos TE, et al. High-fat diet: a trigger of non-alcoholic steatohepatitis? Preliminary findings in obese subjects. Nutrition. 2008;24(11-12):1097-102.
  6. Basaranoglu M, Basaranoglu G, Bugianesi E. Carbohydrate intake and nonalcoholic fatty liver disease: fructose as a weapon of mass destruction. Hepatobiliary Surg Nutr. 2015;4(2):109-16.
  7. Lu W, Li S, Li J, Wang J, Zhang R, Zhou Y, et al. Effects of Omega-3 Fatty Acid in Nonalcoholic Fatty Liver Disease: A Meta-Analysis. Gastroenterol Res Pract. 2016;2016:1459790.
  8. Spooner MH, Jump DB. Omega-3 fatty acids and nonalcoholic fatty liver disease in adults and children: where do we stand? Curr Opin Clin Nutr Metab Care. 2019;22(2):103-10.
  9. Cigrovski Berkovic M, Bilic-Curcic I, Mrzljak A, Cigrovski V. NAFLD and Physical Exercise: Ready, Steady, Go! Front Nutr. 2021;8:734859.
  10. Hanlon CL, Yuan L. Nonalcoholic Fatty Liver Disease: The Role of Visceral Adipose Tissue. Clinical Liver Disease. 2022;19(3):106-10.


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