Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Children's Digestion and Nutrition, Shanghai, China.
J Gastroenterol Hepatol. 2013 Dec;28 Suppl 4:81-7. doi: 10.1111/jgh.12244.
Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum ranging from simple steatosis to non-alcoholic steatohepatitis, which causes an increased risk of cirrhosis, type 2 diabetes, and cardiovascular complications. With the worldwide growing incidence of obesity, sedentary lifestyle, and unhealthy dietary pattern, NAFLD has currently been recognized as a major health burden. Dietary patterns and nutrients are the important contributors to the development, progression, and treatment of NAFLD and associated metabolic comorbidities. Generally, hypercaloric diet, especially rich in trans/saturated fat and cholesterol, and fructose-sweetened beverages seem to increase visceral adiposity and stimulate hepatic lipid accumulation and progression into non-alcoholic steatohepatitis, whereas reducing caloric intake, increasing soy protein and whey consumption, and supplement of monounsaturated fatty acids, omega-3 fatty acids, and probiotics have preventive and therapeutic effects. In addition, choline, fiber, coffee, green tea, and light alcohol drinking might be protective factors for NAFLD. Based on available data, at least 3-5% of weight loss, achieved by hypocaloric diet alone or in conjunction with exercise and behavioral modification, generally reduces hepatic steatosis, and up to 10% weight loss may be needed to improve hepatic necroinflammation. A sustained adherence to diet rather than the actual diet type is a major predictor of successful weight loss. Moreover, a healthy diet has benefits beyond weight reduction on NAFLD patients whether obese or of normal weight. Therefore, nutrition serves as a major route of prevention and treatment of NAFLD, and patients with NAFLD should have an individualized diet recommendation.
非酒精性脂肪性肝病（NAFLD）涵盖了从单纯性脂肪变性到非酒精性脂肪性肝炎的一系列病变，后者会增加肝硬化、2 型糖尿病和心血管并发症的风险。随着全球肥胖、久坐不动的生活方式和不健康饮食模式的发生率不断上升，NAFLD 目前已被认为是一个主要的健康负担。饮食模式和营养物质是 NAFLD 及其相关代谢性合并症发展、进展和治疗的重要因素。一般来说，高热量饮食，尤其是富含反式/饱和脂肪和胆固醇以及果糖甜味饮料的饮食，似乎会增加内脏脂肪堆积并刺激肝脏脂质积累，进而发展为非酒精性脂肪性肝炎，而减少热量摄入、增加大豆蛋白和乳清蛋白的摄入以及补充单不饱和脂肪酸、ω-3 脂肪酸和益生菌则具有预防和治疗作用。此外，胆碱、纤维、咖啡、绿茶和适量饮酒可能是 NAFLD 的保护因素。基于现有数据，通过低热量饮食单独或与运动和行为改变相结合实现至少 3-5%的体重减轻通常可以减轻肝脂肪变性，而需要减轻 10%的体重可能有助于改善肝坏死性炎症。持续坚持饮食而非实际的饮食类型是成功减轻体重的主要预测因素。此外，对于肥胖或体重正常的 NAFLD 患者，健康饮食除了减轻体重之外还有其他益处。因此，营养是预防和治疗 NAFLD 的主要途径，NAFLD 患者应接受个性化的饮食建议。
