NAFLD Awareness: Recognizing and Managing the Silent Threat
Article by: Consultant Dietitian Su Hua Cheng
“I don’t drink alcohol, so why am I diagnosed with fatty liver?”
You have probably heard people around you asking this kind of question. Did you know you can still get fatty liver disease without consuming a drop of alcohol? This is known as non-alcoholic fatty liver disease (NAFLD). As the name implies, it is caused by excessive fat buildup in your liver that is not related to alcohol consumption.
In the realm of energy regulation within our bodies, the liver plays a crucial role. However, it is not supposed to store fat; instead, fats are typically stored in fat tissue. When our energy intake exceeds the storage capacity of fat tissue, fats accumulate in other areas, including the liver. [1]
In many instances, NAFLD arises from a combination of consuming a high-calorie diet and leading a sedentary lifestyle. As a result, NAFLD often affects individuals who are overweight and obese. Other high-risk groups include individuals with metabolic syndromes such as type 2 diabetes, hypertension, or dyslipidemia. [1,2]
The many stages of NAFLD[2]
Simple fatty liver (steatosis)
This is the early stage of fatty liver. It occurs when excess fat starts to build up in liver cells. Simple fatty liver does not usually cause any harm, but it can progress to steatohepatitis if no action is taken.
Non-Alcoholic Steatohepatitis (NASH)
At this stage, fatty liver cells have become inflamed.
Fibrosis
Persistent inflammation leads to the scarring of liver tissue, but the liver can still function properly. The liver condition is still reversible at this stage.
Cirrhosis
This is the most severe stage and is irreversible. This occurs when liver cells become very scarred and no longer function properly.
The symptoms of NAFLD
In the initial stages, NAFLD typically does not manifest any symptoms. As it progresses to more severe stages such as NASH and fibrosis, individuals may experience lethargy and right-sided abdominal discomfort. At its most advanced stage, cirrhosis can lead to more severe symptoms such as unexplained weight loss, jaundice, itchy skin, and edema. [1,2]
Can NAFLD be treated?
Unfortunately, there are currently no medications for NAFLD. However, the good news is that your liver can regenerate and reverse itself through diet and lifestyle modifications. Isn’t that incredible? Here are some adjustments you can make to your diet and lifestyle:
Weight Loss
The first step in managing NAFLD is weight loss. Weight loss has been shown to promote NAFLD remission. For overweight and obese individuals, losing 10% of their current total body weight can improve their liver inflammation and fibrosis. [1,3] Even in normal-weight individuals, a 3 to 5% weight loss can lead to NAFLD remission. [1] Remember, weight loss should be done gradually and steadily, as rapid weight loss can actually worsen the liver condition. An ideal weight loss target is 0.5 to 1 kg per week. [4]
Diet
When it comes to eating, it is important to consume a balanced and healthy diet because your liver needs nutrients to regenerate. Make sure you include complex carbohydrates (e.g., whole grains, vegetables, fruits), protein (e.g., lean meat, fish, low-fat dairy products), and healthy fats (e.g., canola oil, avocado, nuts) in each meal. You can also incorporate the ‘5 a day’ concept into your diet, which is a great way to ensure you are getting enough fiber, vitamins, and minerals. [2, 5]
Foods that you need to watch out for in your diet are:
Saturated Fat
Saturated fat, also known as unhealthy fat, has been shown to exacerbate the accumulation of fat in the liver. Therefore, limiting saturated fat can help improve the liver condition. Saturated fat is typically found in baked products, processed foods, fatty cuts of meat, etc. [1]
Try to replace saturated fat in your diet with healthy fats, especially omega-3 fatty acids, as they have been shown to optimize liver fat and liver enzyme levels in individuals with NAFLD. [6] Omega-3 rich foods include salmon, tuna, chia seeds, canola oil, etc.
Refined Sugar
Limit foods and beverages that contain refined sugar. A study suggested that overconsumption of refined sugar can worsen the degree of inflammation and fibrosis in the liver. [7] Therefore, watch out for refined sugars, which are mainly found in sugary drinks, baked goods, sweetened dairy products, and table sugar, among others.
Note: Saturated fat and refined sugar are high in calories and can contribute to weight gain. Therefore, it is best to limit these foods.
Physical Activity and Exercise
A sedentary lifestyle is common in NAFLD, and research has shown that an inactive lifestyle is one of the risk factors for NAFLD. Therefore, breaking up a sedentary lifestyle and becoming active is an effective way to improve NAFLD. [2] Not sure which type of exercise is better—aerobic, strength training, or stretching? Don’t worry, we’ll discuss it! Surprisingly, any of these exercises can bring you health benefits, but the key is consistency.
Each type of exercise has its own unique characteristics that make them suitable for different groups of people. If you have poor fitness and cannot perform aerobic exercises, you can opt for strength training or stretching. You may always choose the type of exercise that you enjoy the most, but often a combination of different types of exercises provides greater health benefits.
If you are a beginner, start by walking (or any preferred exercise) for 10 minutes, 3 days a week, then gradually increase to 20-30 minutes of more intense walking. Once exercise becomes a habit, aim to increase your total exercise time to at least 150 minutes per week, preferably moderate-intensity exercises. [8]
Does coffee or green tea help with NAFLD?
Both coffee and green tea have been shown to improve liver conditions in people with NAFLD due to their phytonutrient content. Studies have shown that coffee reduces liver fibrosis, while green tea improves liver fat content and inflammation in individuals with NAFLD. [9,10] While coffee and green tea are beneficial for liver health, it is important not to add extra fat and sugar to your drinks, as this can contribute to increased calorie intake and offset their benefits. Black coffee or pure green tea is often the best choice.
Do keep in mind that while drinking coffee or green tea may help improve liver condition, the key message for good liver health remains maintaining a healthy body weight, eating a nutritious diet, and increasing physical activity.
References:
- Francque SM, Marchesini G, Kautz A, Walmsley M, Dorner R, Lazarus JV, Zelber-Sagi S, Hallsworth K, Busetto L, Frühbeck G, Dicker D. Non-alcoholic fatty liver disease: A patient guideline. JHEP Rep. 2021 Oct 1;3(5):100322.
- Bischoff SC, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, Plauth M. ESPEN practical guideline: Clinical nutrition in liver disease. Clin. Nutr. ESPEN. 2020 Dec 1;39(12):3533-62.
- Non-alcoholic fatty liver disease (NAFLD) [Internet]. NSH. 2022 [cited 16 March 2022]. Available from: https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/
- Lose Weight [Internet]. CDC. 2020 [cited 17 March 2022]. Available from: https://www.cdc.gov/healthyweight/losing_weight/index.html
- Eating, Diet, Nutrition for NAFLD & NASH [Internet]. NIDDK. 2021 [cited 17 March 2022]. Available from: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/eating-diet-nutrition
- Lu W, Li S, Li J, Wang J, Zhang R, Zhou Y, Yin Q, Zheng Y, Wang F, Xia Y, Chen K. Effects of omega-3 fatty acid in nonalcoholic fatty liver disease: a meta-analysis. Gastroenterol Res Pract. 2016 Oct 28;2016.
- Muriel P, López-Sánchez P, Ramos-Tovar E. Fructose and the Liver. Int. J. Mol. Sci. 2021 Jan;22(13):6969.
- Wharton S, Lau DC, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, Adamo K, Alberga A, Bell R, Boulé N, Boyling E. Obesity in adults: a clinical practice guideline. Cmaj. 2020 Aug 4;192(31):E875-91.
- Wijarnpreecha K, Thongprayoon C, Ungprasert P. Coffee consumption and risk of nonalcoholic fatty liver disease: a systematic review and meta-analysis. Eur. J. Gastroenterol. Hepatol. 2017 Feb 1;29(2):e8-12.
- Sakata R, Nakamura T, Torimura T, Ueno T, Sata M. Green tea with high-density catechins improves liver function and fat infiltration in non-alcoholic fatty liver disease (NAFLD) patients: a double-blind placebo-controlled study. Int. J. Mol. Med. 2013 Nov 1;32(5):989-94.
