Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2022; 28(27): 3314-3333
Published online Jul 21, 2022. doi: 10.3748/wjg.v28.i27.3314
Crosstalk between dietary patterns, obesity and nonalcoholic fatty liver disease
Danijela Ristic-Medic, Joanna Bajerska, Vesna Vucic
Danijela Ristic-Medic, Vesna Vucic, Group for Nutritional Biochemistry and Dietology, Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic Serbia, Belgrade PO Box 102, Serbia
Joanna Bajerska, Department of Human Nutrition and Dietetics, Poznań University of Life Sciences, Poznań 60-624, Poland
Author contributions: Ristic-Medic D designed the review; Ristic-Medic D and Bajerska J analyzed and interpreted the data and drafted the manuscript; Vucic V critically revised the paper.
Supported by Ministry of Education, Science and Technological Development of the Republic of Serbia, No. 451-03-68/2022-14/200042.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Danijela Ristic-Medic, Doctor, MD, PhD, Professor, Senior Researcher, Group for Nutritional Biochemistry and Dietology, Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic Serbia, Tadeusa Koscuska 1, Belgrade PO Box 102, Serbia.
Received: January 17, 2022
Peer-review started: January 17, 2022
First decision: April 11, 2022
Revised: May 3, 2022
Accepted: June 18, 2022
Article in press: June 18, 2022
Published online: July 21, 2022

The prevalence of nonalcoholic fatty liver disease (NAFLD) is rising worldwide, paralleling the epidemic of obesity. The liver is a key organ for the metabolism of proteins, fats and carbohydrates. Various types of fats and carbohydrates in isocaloric diets differently influence fat accumulation in the liver parenchyma. Therefore, nutrition can manage hepatic and cardiometabolic complications of NAFLD. Even moderately reduced caloric intake, which leads to a weight loss of 5%-10% of initial body weight, is effective in improving liver steatosis and surrogate markers of liver disease status. Among dietary patterns, the Mediterranean diet mostly prevents the onset of NAFLD. Furthermore, this diet is also the most recommended for the treatment of NAFLD patients. However, clinical trials based on the dietary interventions in NAFLD patients are sparse. Since there are only a few studies examining dietary interventions in clinically advanced stages of NAFLD, such as active and fibrotic steatohepatitis, the optimal diet for patients in these stages of the disease must still be determined. In this narrative review, we aimed to critically summarize the associations between different dietary patterns, obesity and prevention/risk for NAFLD, to describe specific dietary interventions’ impacts on liver steatosis in adults with NAFLD and to provide an updated overview of dietary recommendations that clinicians potentially need to apply in their daily practice.

Keywords: Nonalcoholic fatty liver disease, Dietary patterns, Obesity, Diet, Mediterranean diet, Nutrition, Treatment, Clinical guidance

Core Tip: In this review, we emphasize that based on the current evidence, there is no consensus on the ideal macronutrient composition of the diet for nonalcoholic fatty liver disease (NAFLD) patients. We have shown that dietary habits are the most important factor in NAFLD prevention. The Mediterranean and healthy dietary pattern, characterized by high consumption of vegetables, fruits, nuts, olive oil, low-fat dairy products and fish, were linked with a reduced NAFLD risk. The Dietary Approach to Stop Hypertension diet, intermittent fasting and ketogenic diet are other dietary regimes that have growing interest among specialists who advise patients with NAFLD. Nevertheless, new studies designed to assess the effects of these diets on liver-related outcomes and liver histology are needed. We also noted that dietary advice should be personalized in NAFLD patients.