Crosstalk between dietary patterns, obesity and nonalcoholic fatty liver disease

Table 3 Summary of international guidelines on diet for nonalcoholic fatty liver disease patients

	EASL/EASD/EASO clinical practice guidelines for the management of NAFLD[48]	ESPEN guideline on clinical nutrition in liver disease[68]	AASLD practice guidance: The diagnosis and management of NAFLD[69,70]	APASL clinical practice guidelines for the management of MAFLD[71]	AGA clinical practice guidelines for diagnosis and management of NAFLD[7]	WGO guidance for NAFLD/NASH[72]
Target for weight loss	7%-10%	7%-10% (in obese patient); > 10% to improve fibrosis	3%-5% (to improve steatosis); 7%-10% for histological improvement	7%-10%	≥ 5% if steatosis; ≥ 7% if NASH; ≥ 10% if fibrosis	5%-10%
Macronutrient composition	Low to moderate fat and moderate to higher carbohydrate; low carbohydrate, ketogenic diets or high protein	Irrespective of macronutrient composition, MD to improve steatosis and IR	Less relevant	Low-carbohydrate, low-fat and Mediterranean-type diets	Minimize SFA, ↓ red and processed meat	Avoid trans-fats; ↑ omega 3/omega 6 PUFA
Energy restriction	Hypocaloric: Reduction of 500-1000 kcal/d target weight loss of 0.5-1.0 kg/wk	Hypocaloric diet according to obesity guidance	Hypocaloric diet reduction of 500-1000 kcal/d	Hypocaloric diet reduction of 500-1000 kcal/d	Hypocaloric: 1200-1500 kcal/d or ↓ from baseline 500-1000 kcal/d	Hypocaloric: ↓ calories intake 25%
Fructose intake	Avoid fructose-containing beverages and foods				Avoid fructose commercially produced	Avoid fructose and soft drinks
Coffee intake	No liver-related limitations	“More likely to benefit health than harm”		“More likely to benefit health than harm”
Alcohol intake	Risk below (< 30 g men, < 20 g women)	Abstain	Not consume heavy amounts		Restrict

AGA: American Gastroenterological Association; AASLD: American Association for the Study of the Liver; APASL: Asian Pacific Association for the Study of the Liver; EASL: European Association for the Study of the Liver; EASD: European Association for the Study of Diabetes; EASO: European Association for the Study of Obesity; ESPEN: European Society for Clinical Nutrition and Metabolism; IR: Insulin resistance; MAFLD: Metabolic associated fatty liver disease; MD: Mediterranean diet; NAFLD: Nonalcoholic fatty liver disease; NASH: Nonalcoholic steatohepatitis; PUFA: Polyunsaturated fatty acid; SFA: Saturated fatty acid; WGO: World Gastroenterology Organization.