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DOI: 10.1055/s-0042-1757711
Dietary Recommendations for the Management of Non-alcoholic Fatty Liver Disease (NAFLD): A Nutritional Geometry Perspective
Funding This study was supported by grants from ISCIII PI19/00589, PMP21/00078, and Junta de Andalucía P20_01075 and PYC20 RE010 USE to M.R.-G.; grants from Junta de Andalucía (UPO-1380683) to F.M. and GLD1900025 by Gilead-AEEH to R.A.
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Abstract
Diet could be both culprit and solution of NAFLD. Dietary modifications have been associated with histological features improvement in NAFLD. The Western diet was related to a greater risk of disease progression while the Mediterranean diet (MD) could promote regression of histological lesions. Modifications in the nutrient composition seems to have lesser impact on NAFLD than dietary modifications. An intrinsic interaction between nutrients in the diet support a specific effect not seen when added separately. Dietary modifications should focus on promoting weight loss but also look for patterns that are able to promote histological improvement. Although several micronutrients' deficit has been related to NAFLD progression, prescribing these micronutrients' supplementation did not reach a positive impact. However, an enriching diet with specific nutrients could be useful, like olive oil supplemented in MD. Geometry of nutrition defines a framework to better understand the interaction between nutrients, foods, and dietetic pattern in the model of diseases and how we could approach taking into consideration the interaction between meals and disease features. After analyzing baseline diet and histological lesions, we could calculate the distance to optimal diet and to promote changes in lifestyle to reach all these goals. A standard MD menu would be recommended.
Publikationsverlauf
Artikel online veröffentlicht:
28. Oktober 2022
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References
- 1 Romero-Gómez M, Zelber-Sagi S, Trenell M. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol 2017; 67 (04) 829-846
- 2 Vilar-Gomez E, Calzadilla-Bertot L, Wai-Sun Wong V. et al. Fibrosis severity as a determinant of cause-specific mortality in patients with advanced nonalcoholic fatty liver disease: a multi-national cohort study. Gastroenterology 2018; 155 (02) 443-457.e17
- 3 Lazarus JV, Mark HE, Anstee QM. et al. Advancing the global public health agenda for NAFLD: a consensus statement. Nat Rev Gastroenterol Hepatol 2022; Jan; 19 (01) 60-78
- 4 Noureddin M, Zelber-Sagi S, Wilkens LR. et al. Diet associations with nonalcoholic fatty liver disease in an ethnically diverse population: the multiethnic cohort. Hepatology 2020; 71 (06) 1940-1952
- 5 Manippa V, Padulo C, van der Laan LN, Brancucci A. Gender differences in food choice: effects of superior temporal sulcus stimulation. Front Hum Neurosci 2017; 11: 597
- 6 Zelber-Sagi S. Dietary treatment for NAFLD: new clinical and epidemiological evidence and updated recommendations. Semin Liver Dis 2021; 41 (03) 248-262
- 7 Promrat K, Kleiner DE, Niemeier HM. et al. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology 2010; 51 (01) 121-129
- 8 Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L. et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology 2015; 149 (02) 367-78.e5 , quiz e14–e15
- 9 Younes R, Govaere O, Petta S. et al. Caucasian lean subjects with non-alcoholic fatty liver disease share long-term prognosis of non-lean: time for reappraisal of BMI-driven approach?. Gut 2022; Feb; 71 (02) 382-390
- 10 Youssef NA, Abdelmalek MF, Binks M. et al. Associations of depression, anxiety and antidepressants with histological severity of nonalcoholic fatty liver disease. Liver Int 2013; 33 (07) 1062-1070
- 11 Abdelmalek MF, Suzuki A, Guy C. et al; Nonalcoholic Steatohepatitis Clinical Research Network. Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. Hepatology 2010; 51 (06) 1961-1971
- 12 Abenavoli L, Boccuto L, Federico A. et al. Diet and non-alcoholic fatty liver disease: the Mediterranean way. Int J Environ Res Public Health 2019; 16 (17) E3011
- 13 Zelber-Sagi S, Ivancovsky-Wajcman D, Fliss Isakov N. et al. High red and processed meat consumption is associated with non-alcoholic fatty liver disease and insulin resistance. J Hepatol 2018; 68 (06) 1239-1246
- 14 Musso G, Gambino R, Pacini G, De Michieli F, Cassader M. Prolonged saturated fat-induced, glucose-dependent insulinotropic polypeptide elevation is associated with adipokine imbalance and liver injury in nonalcoholic steatohepatitis: dysregulated enteroadipocyte axis as a novel feature of fatty liver. Am J Clin Nutr 2009; 89 (02) 558-567
- 15 Machado MV, Ravasco P, Jesus L. et al. Blood oxidative stress markers in non-alcoholic steatohepatitis and how it correlates with diet. Scand J Gastroenterol 2008; 43 (01) 95-102
- 16 Assy N, Nassar F, Nasser G, Grosovski M. Olive oil consumption and non-alcoholic fatty liver disease. World J Gastroenterol 2009; 15 (15) 1809-1815
- 17 Jebb SA, Lovegrove JA, Griffin BA. et al; RISCK Study Group. Effect of changing the amount and type of fat and carbohydrate on insulin sensitivity and cardiovascular risk: the RISCK (Reading, Imperial, Surrey, Cambridge, and Kings) trial. Am J Clin Nutr 2010; 92 (04) 748-758
- 18 Soriguer F, Morcillo S, Cardona F. et al. Pro12Ala polymorphism of the PPARG2 gene is associated with type 2 diabetes mellitus and peripheral insulin sensitivity in a population with a high intake of oleic acid. J Nutr 2006; 136 (09) 2325-2330
- 19 Rezaei S, Akhlaghi M, Sasani MR, Barati Boldaji R. Olive oil lessened fatty liver severity independent of cardiometabolic correction in patients with non-alcoholic fatty liver disease: a randomized clinical trial. Nutrition 2019; 57: 154-161
- 20 Jurado-Ruiz E, Álvarez-Amor L, Varela LM. et al. Extra virgin olive oil diet intervention improves insulin resistance and islet performance in diet-induced diabetes in mice. Sci Rep 2019; 9 (01) 11311
- 21 Errazuriz I, Dube S, Slama M. et al. Randomized controlled trial of a MUFA or fiber-rich diet on hepatic fat in prediabetes. J Clin Endocrinol Metab 2017; 102 (05) 1765-1774
- 22 Das A, Schattenberg J, Woreta TA, Noureddin M, Alqahtani S. Effects of dietary or supplemental intake of fatty acids on non-alcoholic fatty liver disease: a systematic review. Hepatology 2021; 71 (Suppl. 01) 79A
- 23 Zhou K, Dodge J, Lim T, Terrault N, Setiawan VW. Coffee emerges as dominant lifestyle factor in population attributable risk of hepatocellular carcinoma in an ethnically diverse cohort. Hepatology 2021; 71 (Suppl. 01) 626A
- 24 Kanoni S, Kumar S, Amerikanou C. et al. Nutrigenetic interactions might modulate the antioxidant and anti-inflammatory status in Mastiha-supplemented patients with NAFLD. Front Immunol 2021; 12: 683028
- 25 Romeo S, Kozlitina J, Xing C. et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet 2008; 40 (12) 1461-1465
- 26 Sookoian S, Pirola CJ. Meta-analysis of the influence of I148M variant of patatin-like phospholipase domain containing 3 gene (PNPLA3) on the susceptibility and histological severity of nonalcoholic fatty liver disease. Hepatology 2011; 53 (06) 1883-1894
- 27 Zhang L, You W, Zhang H. et al. PNPLA3 polymorphisms (rs738409) and non-alcoholic fatty liver disease risk and related phenotypes: a meta-analysis. J Gastroenterol Hepatol 2015; 30 (05) 821-829
- 28 Yki-Järvinen H. Nutritional modulation of non-alcoholic fatty liver disease and insulin resistance. Nutrients 2015; 7 (11) 9127-9138
- 29 Sevastianova K, Kotronen A, Gastaldelli A. et al. Genetic variation in PNPLA3 (adiponutrin) confers sensitivity to weight loss-induced decrease in liver fat in humans. Am J Clin Nutr 2011; 94 (01) 104-111
- 30 Kozlitina J, Smagris E, Stender S. et al. Exome-wide association study identifies a TM6SF2 variant that confers susceptibility to nonalcoholic fatty liver disease. Nat Genet 2014; 46 (04) 352-356
- 31 De Luis DA, Aller R, Izaola O, Pacheco D. Role of rs9939609 FTO gene variant in weight loss, insulin resistance and metabolic parameters after a high monounsaturagted vs. a high polyunsaturated fat hypocaloric diets. Nutr Hosp 2015; 32 (01) 175-181
- 32 Miele L, Dall'armi V, Cefalo C. et al. A case-control study on the effect of metabolic gene polymorphisms, nutrition, and their interaction on the risk of non-alcoholic fatty liver disease. Genes Nutr 2014; 9 (02) 383
- 33 Kaliora AC, Gioxari A, Kalafati IP, Diolintzi A, Kokkinos A, Dedoussis GV. The effectiveness of Mediterranean diet in nonal-490 coholic fatty liver disease clinical course: an intervention study. J Med Food 2019; 22 (07) 729-740
- 34 Allard JP, Aghdassi E, Mohammed S. et al. Nutritional assessment and hepatic fatty acid composition in non-alcoholic fatty liver disease (NAFLD): a cross-sectional study. J Hepatol 2008; 48 (02) 300-307
- 35 Raubenheimer D, Simpson SJ, Mayntz D. Nutrition, ecology and nutritional ecology: toward an integrative framework. Funct Ecol 2009; 23: 4-16
- 36 Raubenheimer D. Toward a quantitative nutritional ecology: the right-angled mixture triangle. Ecol Monogr 2011; 81: 407-427
- 37 Raubenheimer D, Simpson SJ. Nutritional ecology and human health. Annu Rev Nutr 2016; 36: 603-626
- 38 Solon-Biet SM, McMahon ACO, Ballard JW. et al. The ratio of macronutrients, not caloric intake, dictates cardiometabolic health, aging, and longevity in ad libitum-fed mice. Cell Metab 2014; 19 (03) 418-430
- 39 Raubenheimer D, Simpson SJ. Nutritional ecology and foraging theory. Curr Opin Insect Sci 2018; 27: 38-45
- 40 Trumbo P, Schlicker S, Yates AA, Poos M. Food and Nutrition Board of the Institute of Medicine, The National Academies. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc 2002; 102 (11) 1621-1630
- 41 Ruiz E, Ávila JM, Valero T. et al. Energy intake, profile, and dietary sources in the Spanish population: findings of the ANIBES Study. Nutrients 2015; 7 (06) 4739-4762
- 42 Zhang R, Wang Z, Fei Y. et al. The difference in nutrient intakes between Chinese and Mediterranean, Japanese and American Diets. Nutrients 2015; 7 (06) 4661-4688
- 43 National Institution of Health and Nutrition. Outline for the results of the National Health and Nutrition Survey Japan, 2007. Accessed November 15, 2021, at: http://www.nih.go.jp/eiken/english/research/pdf/nhns2007.pdf
- 44 Sette S, Le Donne C, Piccinelli R, Arcella D, Turrini A, Leclercq C. INRAN-SCAI 2005-6 Study Group. The third Italian National Food Consumption Survey, INRAN-SCAI 2005-06–part 1: nutrient intakes in Italy. Nutr Metab Cardiovasc Dis 2011; 21 (12) 922-932
- 45 U.S. Department of Agriculture, Agricultural Research Service. 2020. Energy Intakes: Percentages of Energy from Protein, Carbohydrate, Fat, and Alcohol, by Gender and Age, What We Eat in America, NHANES 2017–2018. Accessed November 15, 2021, at: https://www.cdc.gov/nchs/nhanes/index.htm
- 46 Australian Bureau of Statistics. Australian Health Survey: Nutrition First Results - Foods and Nutrients, 2011–2012. Accessed November 15, 2021, at: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/australian-health-survey-nutrition-first-results-foods-and-nutrients/latest-release
- 47 Whitton C, Nicholson SK, Roberts C. et al. National diet and nutrition survey: UK food consumption and nutrient intakes from the first year of the rolling programme and comparisons with previous surveys. Br J Nutr 2011; 106 (12) 1899-1914
- 48 Gose M, Krems C, Heuer T, Hoffmann I. Trends in food consumption and nutrient intake in Germany between 2006 and 2012: results of the German National Nutrition Monitoring (NEMONIT). Br J Nutr 2016; 115 (08) 1498-1507
- 49 Barquera S, Hernández-Barrera L, Campos-Nonato I. et al. Energy and nutrient consumption in adults: analysis of the Mexican National Health and Nutrition Survey 2006. Salud Publica Mex 2009; 51 (Suppl. 04) S562-S573
- 50 Heidari Z, Feizi A, Azadbakht L, Mohammadifard N, Maghroun M, Sarrafzadegan N. Usual energy and macronutrient intakes in a large sample of Iranian middle-aged and elderly populations. Nutr Diet 2019; 76 (02) 174-183
- 51 Gosby AK, Conigrave AD, Lau NS. et al. Testing protein leverage in lean humans: a randomised controlled experimental study. PLoS One 2011; 6 (10) e25929
- 52 Felton MA, Felton A, Raubenheimer D. et al. Protein content of diets dictates the daily energy intake of a free-ranging primate. Behav Ecol 2009; 20: 685-690
- 53 Sørensen A, Mayntz D, Raubenheimer D, Simpson SJ. Protein-leverage in mice: the geometry of macronutrient balancing and consequences for fat deposition. Obesity (Silver Spring) 2008; 16 (03) 566-571
- 54 Simpson SJ, Raubenheimer D. Obesity: the protein leverage hypothesis. Obes Rev 2005; 6 (02) 133-142
- 55 Simpson SJ, Raubenheimer D, Cogger VC. et al. The nutritional geometry of liver disease including non-alcoholic fatty liver disease. J Hepatol 2018; 68 (02) 316-325
- 56 Perdomo CM, Frühbeck G, Escalada J. Impact of nutritional changes on nonalcoholic fatty liver disease. Nutrients 2019; 11 (03) 677
- 57 Younossi ZM. Non-alcoholic fatty liver disease - a global public health perspective. J Hepatol 2019; 70 (03) 531-544
- 58 Chung M, Ma J, Patel K, Berger S, Lau J, Lichtenstein AH. Fructose, high-fructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: a systematic review and meta-analysis. Am J Clin Nutr 2014; 100 (03) 833-849
- 59 Martin F, Berná G, López-Bermudo L. et al. Rocio Aller, Romero-Gómez M. Low hypocaloric Mediterranean Diet versus Standard diet in biopsy proven NAFLD patients. Hepatology 2021; 74 (Suppl. 01) 71A
- 60 Yin C, Li Z, Xiang Y. et al. Effect of intermittent fasting on non-alcoholic fatty liver disease: systematic review and meta-analysis. Front Nutr 2021; 8: 709683
- 61 Canivet CM, Perney P, Cherick F. et al. No association between binge eating disorder and severity of non-alcoholic fatty liver disease in severely obese patients. JGH Open 2020; 4 (03) 525-531
- 62 Rose DJ. Impact of whole grains on the gut microbiota: the next frontier for oats?. Br J Nutr 2014; 112 (Suppl. 02) S44-S49
- 63 Marshall JA, Bessesen DH, Hamman RF. High saturated fat and low starch and fibre are associated with hyperinsulinaemia in a non-diabetic population: the San Luis Valley Diabetes Study. Diabetologia 1997; 40 (04) 430-438
- 64 Madigan C, Ryan M, Owens D, Collins P, Tomkin GH. Dietary unsaturated fatty acids in type 2 diabetes: higher levels of postprandial lipoprotein on a linoleic acid-rich sunflower oil diet compared with an oleic acid-rich olive oil diet. Diabetes Care 2000; 23 (10) 1472-1477
- 65 Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother 2002; 56 (08) 365-379
- 66 Etemadi A, Sinha R, Ward MH. et al. Mortality from different causes associated with meat, heme iron, nitrates, and nitrites in the NIH-AARP Diet and Health Study: population based cohort study. BMJ 2017; 357: j1957
- 67 Rietman A, Sluik D, Feskens EJM, Kok FJ, Mensink M. Associations between dietary factors and markers of NAFLD in a general Dutch adult population. Eur J Clin Nutr 2018; 72 (01) 117-123
- 68 Malaguarnera M, Vacante M, Antic T. et al. Bifidobacterium longum with fructo-oligosaccharides in patients with non alcoholic steatohepatitis. Dig Dis Sci 2012; 57 (02) 545-553
- 69 Lavine JE, Schwimmer JB, Van Natta ML. et al; Nonalcoholic Steatohepatitis Clinical Research Network. Effect of vitamin E or metformin for treatment of nonalcoholic fatty liver disease in children and adolescents: the TONIC randomized controlled trial. JAMA 2011; 305 (16) 1659-1668
- 70 Raza S, Tewari A, Rajak S, Sinha RA. Vitamins and non-alcoholic fatty liver disease: a molecular insight*. Liver Res 2021; 5 (02) 62-71
- 71 Zhu S, Wang Y, Luo F. et al. The level of vitamin D in children and adolescents with nonalcoholic fatty liver disease: a meta-analysis. BioMed Res Int 2019; 2019: 7643542
- 72 Amengual J, Ribot J, Bonet ML, Palou A. Retinoic acid treatment enhances lipid oxidation and inhibits lipid biosynthesis capacities in the liver of mice. Cell Physiol Biochem 2010; 25 (06) 657-666
- 73 Sherriff JL, O'Sullivan TA, Properzi C, Oddo J-L, Adams LA. Choline, its potential role in nonalcoholic fatty liver disease, and the case for human and bacterial genes. Adv Nutr 2016; 7 (01) 5-13
- 74 Scalbert A, Williamson G. Dietary intake and bioavailability of polyphenols. J Nutr 2000; 130 (suppl 8S): 2073S-2085S
- 75 Zelber-Sagi S, Salomone F, Webb M. et al. Coffee consumption and nonalcoholic fatty liver onset: a prospective study in the general population. Transl Res 2015; 165 (03) 428-436
- 76 Dongiovanni P, Lanti C, Gatti S. et al. High fat diet subverts hepatocellular iron uptake determining dysmetabolic iron overload. PLoS One 2015; 10 (02) e0116855
- 77 Aigner E, Strasser M, Haufe H. et al. A role for low hepatic copper concentrations in nonalcoholic fatty liver disease. Am J Gastroenterol 2010; 105 (09) 1978-1985
- 78 Himoto T, Masaki T. Associations between zinc deficiency and metabolic abnormalities in patients with chronic liver disease. Nutrients 2018; 10 (01) E88
- 79 Yasutake K, Nakamuta M, Shima Y. et al. Nutritional investigation of non-obese patients with non-alcoholic fatty liver disease: the significance of dietary cholesterol. Scand J Gastroenterol 2009; 44 (04) 471-477
- 80 Weickert MO, Möhlig M, Schöfl C. et al. Cereal fiber improves whole-body insulin sensitivity in overweight and obese women. Diabetes Care 2006; 29 (04) 775-780
- 81 Bortolotti M, Kreis R, Debard C. et al. High protein intake reduces intrahepatocellular lipid deposition in humans. Am J Clin Nutr 2009; 90 (04) 1002-1010
- 82 Stanhope KL, Schwarz JM, Keim NL. et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest 2009; 119 (05) 1322-1334
- 83 Chakravarthy MV, Waddell T, Banerjee R, Guess N. Nutrition and nonalcoholic fatty liver disease: current perspectives. Gastroenterol Clin North Am 2020; 49 (01) 63-94