Dietary and Nutraceutical Interventions in Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver pathology characterised by excessive hepatic triglyceride accumulation unrelated to alcohol consumption. With rising global prevalence linked to obesity, metabolic syndrome and type 2 diabetes, current management emphasises weight reduction through lifestyle modification as first-line therapy. Dietary approaches centre on calorie restriction to achieve gradual weight loss and on modification of macronutrient composition—reducing saturated fats and added sugars while increasing monounsaturated fats, dietary fibre and plant bioactives. The Mediterranean diet, rich in fruits, vegetables, whole grains, nuts, olive oil and fatty fish, has emerged as a leading pattern for ameliorating steatosis and improving metabolic markers. Parallel efforts have investigated nutraceutical agents—antioxidants, polyphenols, vitamins, omega-3 polyunsaturated fatty acids (PUFAs), coenzyme Q10, berberine, curcumin and probiotics—to target oxidative stress, inflammation, insulin resistance and gut–liver axis dysfunction. Mechanistic studies implicate restoration of nicotinamide adenine dinucleotide (NAD+) balance, activation of the SIRT1/AMP-activated protein kinase (AMPK) pathway, inhibition of de novo lipogenesis and enhancement of fatty acid oxidation. Combined dietary and targeted nutraceutical protocols demonstrate additive benefits in reducing transaminases, intrahepatic fat content and inflammatory biomarkers. Given the heterogeneity of trials and formulations, standardised clinical studies are required to refine dosing regimens, assess long-term safety and integrate patient-centred outcomes across diverse populations.

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Dietary and Nutraceutical Interventions in Non-Alcoholic Fatty Liver Disease publication trend

The graph below shows the total number of articles in dietary and nutraceutical interventions in non-alcoholic fatty liver disease across all publications each year (not limited to Nature Index journals).

Technical terms

Non-alcoholic fatty liver disease (NAFLD): Excessive accumulation of triglycerides in hepatocytes in the absence of significant alcohol intake.

Non-alcoholic steatohepatitis (NASH): Progressive, inflammatory form of NAFLD characterised by hepatocellular injury and fibrosis risk.

Adenosine monophosphate-activated protein kinase (AMPK): Cellular energy sensor that regulates lipid synthesis and oxidative pathways.

Nicotinamide adenine dinucleotide (NAD+): Coenzyme central to redox reactions, influencing sirtuin-mediated metabolic regulation.

Fatty Liver Index (FLI): Composite surrogate score derived from biochemical and anthropometric measures to estimate hepatic steatosis.

Polyunsaturated fatty acids (PUFAs): Essential dietary fats with multiple double bonds, including omega-3 series, that modulate inflammation and lipid metabolism.

References

1. Mediterranean Diet Improves Plasma Biomarkers Related to Oxidative Stress and Inflammatory Process in Patients with Non-Alcoholic Fatty Liver Disease. Antioxidants (2023).
2. Nutraceutical Approach to Non-Alcoholic Fatty Liver Disease (NAFLD): The Available Clinical Evidence. Nutrients (2018).
3. Effect of Mediterranean Diet and Antioxidant Formulation in Non-Alcoholic Fatty Liver Disease: A Randomized Study. Nutrients (2017).
4. Silibinin Restores NAD+ Levels and Induces the SIRT1/AMPK Pathway in Non-Alcoholic Fatty Liver. Nutrients (2017).
5. The effectiveness and acceptability of Mediterranean diet and calorie restriction in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis. Clinical Nutrition (2022).
6. Practical Dietary Recommendations for the Prevention and Management of Nonalcoholic Fatty Liver Disease in Adults. Advances in Nutrition (2018).