Lifestyle and Dietary Interventions in the Management of Nonalcoholic Fatty Liver Disease

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.