Nonalcoholic Fatty Liver Disease: Diagnosis and Treatment

There are few, if any, warning signs or symptoms of non-alcoholic fatty liver disease (NAFLD). The FIB-4 Index is a non-invasive scoring system used to indicate the risk of advanced fibrosis. The FIB-4 includes four numbers:  a person’s age, liver enzyme results (ALT and AST), and blood platelet level. People with a FIB-4 score <1.3 are at low risk and those with a score >2.67 are at high risk for NAFLD. People at intermediate risk may benefit from additional tests. NAFLD Treatment:The primary treatment for NAFLD is weight loss using an eating plan that decreases saturated fat and sugars and includes more vegetables, fruit, whole grains, lean proteins, and minimally-processed whole foods. Exercise is also a key lifestyle treatment. Losing at least 5% of a person's starting weight is associated with decreased liver fat and improved cardiometabolic health. A weight loss of >10% may reverse liver fibrosis. Keeping blood sugars in healthy ranges is another key strategy to treat NAFLD. Food Plans Used to Treat NAFLD:Research has identified four different food plans/styles of eating that lead to weight loss and reduce fat build-up and inflammation in the liver. They include...

• A Mediterranean-style eating pattern that is low in carbohydrates and saturated fat while higher in monounsaturated fat due to greater emphasis on vegetables, fruit, whole grains, seafood, olive oil, and minimally-processed foods.
• A lower-calorie DASH-style plan (originally designed to lower high blood pressure, DASH also helps promote weight loss) that includes at least 9 daily servings of fruit and vegetables, whole grains, and low-fat dairy. It is also low in saturated fat and refined grains.
• Higher protein/lower carbohydrate plans with 30% protein, 40% carbohydrate, and 30% fat (emphasis on monounsaturated instead of saturated fat).
• Intermittent-fasting/time-restricted eating patterns.

Reducing sugars is another key strategy to decrease inflammation. Added sugars in sweetened beverages, cookies, cakes, candies and many breakfast cereals, granola/energy bars and yogurts; as well as sugars you might add at home to coffee, tea, or oatmeal are key drivers of inflammation.Our Tips:

• Fill half your plate with vegetables and fruit at all meals and snacks.
• Replace processed grains (chips, white rice, cookies, cakes) with whole grains like brown rice, whole grain cereal, and crackers and breads with the word ‘whole’ in the first ingredient.
• Replace red meat with seafood 2-3 times per week. Choose baked, broiled, or grilled seafood instead of fried.
• Use olive or canola oil instead of vegetable oils or coconut oil to reduce saturated fat and increase monounsaturated fat.
• Prepare more meals and snacks at home from scratch instead of dining out, ordering take-out, or buying convenience foods.
• Avoid fried foods and crispy snack foods that tend to be higher in saturated fat and instead bake, broil, grill or use an air fryer.
• Avoid eating after dinner so that you have at least 10-12 hours between your last meal at night and the first meal the next morning.
• Replace sweetened beverages with plain water, or flavored waters that contain no sweeteners.
• Instead of sweet tea, enjoy herbal tea with no added sugar.
• Instead of sweetened coffee beverages, learn to enjoy coffee with low-fat milk or unflavored plant milks.
• Choose fresh fruit for dessert instead of cookies, cakes, pies, ice cream or other sweet desserts.

By Lynn Grieger, RDN, CDCES, CPT, CHWCResources:

1. DiaTribe Learn. Maintain the Health of Your Liver: Latest ADA Standards of Care. Hope Warshaw. https://diatribe.org/maintain-health-your-liver-latest-ada-standards-care  accessed 6-5-22; published 5-16-22.
2. American Diabetes Association Professional Practice Committee; 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes—2022. Diabetes Care 1 January 2022; 45 (Supplement_1): S46–S59. https://doi.org/10.2337/dc22-S004
3. Cusi K, Isaacs S, Barb D, Basu R, Caprio S, Garvey WT, Kashyap S, Mechanick JI, Mouzaki M, Nadolsky K, Rinella ME, Vos MB, Younossi Z. American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022 May;28(5):528-562. doi: 10.1016/j.eprac.2022.03.010. PMID: 35569886.