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Nutrition and physical activity in NAFLD: an overview of the epidemiological evidence.
World J Gastroenterol 2011; 17(29):3377-89WJ

Abstract

Nonalcoholic fatty liver disease (NAFLD) has been recognized as a major health burden. The high prevalence of NAFLD is probably due to the contemporary epidemics of obesity, unhealthy dietary pattern, and sedentary lifestyle. The efficacy and safety profile of pharmacotherapy in the treatment of NAFLD remains uncertain and obesity is strongly associated with hepatic steatosis; therefore, the first line of treatment is lifestyle modification. The usual management of NAFLD includes gradual weight reduction and increased physical activity (PA) leading to an improvement in serum liver enzymes, reduced hepatic fatty infiltration, and, in some cases, a reduced degree of hepatic inflammation and fibrosis. Nutrition has been demonstrated to be associated with NAFLD and Non-alcoholic steatohepatitis (NASH) in both animals and humans, and thus serves as a major route of prevention and treatment. However, most human studies are observational and retrospective, allowing limited inference about causal associations. Large prospective studies and clinical trials are now needed to establish a causal relationship. Based on available data, patients should optimally achieve a 5%-10% weight reduction. Setting realistic goals is essential for long-term successful lifestyle modification and more effort must be devoted to informing NAFLD patients of the health benefits of even a modest weight reduction. Furthermore, all NAFLD patients, whether obese or of normal weight, should be informed that a healthy diet has benefits beyond weight reduction. They should be advised to reduce saturated/trans fat and increase polyunsaturated fat, with special emphasize on omega-3 fatty acids. They should reduce added sugar to its minimum, try to avoid soft drinks containing sugar, including fruit juices that contain a lot of fructose, and increase their fiber intake. For the heavy meat eaters, especially those of red and processed meats, less meat and increased fish intake should be recommended. Minimizing fast food intake will also help maintain a healthy diet. PA should be integrated into behavioral therapy in NAFLD, as even small gains in PA and fitness may have significant health benefits. Potentially therapeutic dietary supplements are vitamin E and vitamin D, but both warrant further research. Unbalanced nutrition is not only strongly associated with NAFLD, but is also a risk factor that a large portion of the population is exposed to. Therefore, it is important to identify dietary patterns that will serve as modifiable risk factors for the prevention of NAFLD and its complications.

Authors+Show Affiliations

The Liver Unit, Department of Gastroenterology, Tel Aviv Sourasky Medical Center, 64239 Tel-Aviv, Israel. zelbersagi@bezeqint.netNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

21876630

Citation

Zelber-Sagi, Shira, et al. "Nutrition and Physical Activity in NAFLD: an Overview of the Epidemiological Evidence." World Journal of Gastroenterology, vol. 17, no. 29, 2011, pp. 3377-89.
Zelber-Sagi S, Ratziu V, Oren R. Nutrition and physical activity in NAFLD: an overview of the epidemiological evidence. World J Gastroenterol. 2011;17(29):3377-89.
Zelber-Sagi, S., Ratziu, V., & Oren, R. (2011). Nutrition and physical activity in NAFLD: an overview of the epidemiological evidence. World Journal of Gastroenterology, 17(29), pp. 3377-89. doi:10.3748/wjg.v17.i29.3377.
Zelber-Sagi S, Ratziu V, Oren R. Nutrition and Physical Activity in NAFLD: an Overview of the Epidemiological Evidence. World J Gastroenterol. 2011 Aug 7;17(29):3377-89. PubMed PMID: 21876630.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nutrition and physical activity in NAFLD: an overview of the epidemiological evidence. AU - Zelber-Sagi,Shira, AU - Ratziu,Vlad, AU - Oren,Ran, PY - 2010/10/27/received PY - 2011/02/15/revised PY - 2011/02/22/accepted PY - 2011/8/31/entrez PY - 2011/8/31/pubmed PY - 2011/12/13/medline KW - Carbohydrates KW - Fat KW - Nonalcoholic fatty liver disease KW - Nutrients KW - Nutrition KW - Physical activity KW - Soft drinks KW - Weight reduction SP - 3377 EP - 89 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 17 IS - 29 N2 - Nonalcoholic fatty liver disease (NAFLD) has been recognized as a major health burden. The high prevalence of NAFLD is probably due to the contemporary epidemics of obesity, unhealthy dietary pattern, and sedentary lifestyle. The efficacy and safety profile of pharmacotherapy in the treatment of NAFLD remains uncertain and obesity is strongly associated with hepatic steatosis; therefore, the first line of treatment is lifestyle modification. The usual management of NAFLD includes gradual weight reduction and increased physical activity (PA) leading to an improvement in serum liver enzymes, reduced hepatic fatty infiltration, and, in some cases, a reduced degree of hepatic inflammation and fibrosis. Nutrition has been demonstrated to be associated with NAFLD and Non-alcoholic steatohepatitis (NASH) in both animals and humans, and thus serves as a major route of prevention and treatment. However, most human studies are observational and retrospective, allowing limited inference about causal associations. Large prospective studies and clinical trials are now needed to establish a causal relationship. Based on available data, patients should optimally achieve a 5%-10% weight reduction. Setting realistic goals is essential for long-term successful lifestyle modification and more effort must be devoted to informing NAFLD patients of the health benefits of even a modest weight reduction. Furthermore, all NAFLD patients, whether obese or of normal weight, should be informed that a healthy diet has benefits beyond weight reduction. They should be advised to reduce saturated/trans fat and increase polyunsaturated fat, with special emphasize on omega-3 fatty acids. They should reduce added sugar to its minimum, try to avoid soft drinks containing sugar, including fruit juices that contain a lot of fructose, and increase their fiber intake. For the heavy meat eaters, especially those of red and processed meats, less meat and increased fish intake should be recommended. Minimizing fast food intake will also help maintain a healthy diet. PA should be integrated into behavioral therapy in NAFLD, as even small gains in PA and fitness may have significant health benefits. Potentially therapeutic dietary supplements are vitamin E and vitamin D, but both warrant further research. Unbalanced nutrition is not only strongly associated with NAFLD, but is also a risk factor that a large portion of the population is exposed to. Therefore, it is important to identify dietary patterns that will serve as modifiable risk factors for the prevention of NAFLD and its complications. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/21876630/Nutrition_and_physical_activity_in_NAFLD:_an_overview_of_the_epidemiological_evidence_ L2 - http://www.wjgnet.com/1007-9327/full/v17/i29/3377.htm DB - PRIME DP - Unbound Medicine ER -