Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Australia; Departments of Nutrition and Gastroenterology, Alfred Health, Prahran, Australia.
Department of Nutrition and Gastroenterology, Alfred Health, Prahran, Australia.
Adv Nutr. 2018 Jan 1;9(1):30-40. doi: 10.1093/advances/nmx007.
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. In the absence of effective pharmacotherapies, clinical guidelines focus primarily on weight loss to treat this condition. Established consensus, evidence-based, and clinical dietary recommendations for NAFLD are currently lacking. The aim of this paper is to provide evidence-based practical dietary recommendations for the prevention and management of NAFLD in adults. A literature review focusing on established principles for the development of clinical practice recommendations was employed using the following criteria: based on substantial evidence, ensures risk minimization, is flexible for an individual patient approach, and is open to further modification as evidence emerges. The Practice-based Evidence in Nutrition classification system was used to grade these principles. Five key dietary recommendations were developed: 1) follow traditional dietary patterns, such as the Mediterranean diet; 2) limit excess fructose consumption and avoid processed foods and beverages with added fructose; 3) PUFAs, especially long-chain omega-3 rich foods and MUFAs, should replace SFAs in the diet; 4) replace processed food, fast food, commercial bakery goods, and sweets with unprocessed foods high in fiber, including whole grains, vegetables, fruits, legumes, nuts, and seeds; and 5) avoid excess alcohol consumption. Improving diet quality may reduce the incidence and progression of NAFLD and associated risk factors. Many of the benefits are likely to result from the collective effect of dietary patterns. High-quality research-in particular, randomized clinical trials assessing dietary interventions that focus on liver-specific endpoints-are needed as a priority.
非酒精性脂肪性肝病 (NAFLD) 是全球最常见的肝脏疾病。由于缺乏有效的药物治疗方法，临床指南主要侧重于通过减轻体重来治疗这种疾病。目前缺乏针对 NAFLD 的既定共识、基于证据的和临床饮食建议。本文旨在为成人 NAFLD 的预防和管理提供基于证据的实用饮食建议。使用以下标准，对以下标准进行了重点关注既定临床实践建议制定原则的文献回顾：基于充分证据，确保风险最小化，为个体化患者方法留有灵活性，并随着证据的出现接受进一步修改。使用基于实践的营养分类系统对这些原则进行了分级。制定了五项关键饮食建议：1）遵循传统的饮食模式，如地中海饮食；2）限制过量果糖的摄入，避免食用含添加果糖的加工食品和饮料；3）多不饱和脂肪酸 (PUFA)，特别是富含长链ω-3 的食物和 MUFA，应取代饮食中的饱和脂肪酸 (SFA)；4）用富含纤维的未加工食品代替加工食品、快餐、商业烘焙食品和甜食，包括全谷物、蔬菜、水果、豆类、坚果和种子；5）避免过量饮酒。改善饮食质量可能会降低 NAFLD 及其相关风险因素的发生率和进展。许多益处可能是饮食模式综合作用的结果。急需高质量的研究，特别是评估侧重于肝脏特定终点的饮食干预的随机临床试验。
