Semin Liver Dis 2021; 41(03): 248-262
DOI: 10.1055/s-0041-1729971
Review Article

Dietary Treatment for NAFLD: New Clinical and Epidemiological Evidence and Updated Recommendations

Shira Zelber-Sagi
1   School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
› Author Affiliations

Abstract

The key factor in preventing and treating nonalcoholic fatty liver disease (NAFLD) is a holistic lifestyle modification approach, encompassing diet based on healthy eating patterns of unprocessed foods, exercise, balanced drinking, and smoking habits. The Mediterranean diet and other healthy dietary patterns can reduce liver fat and may be related with lower disease progression. The type of diet should be tailored to the patient's cultural and personal preferences. Changing dietary composition without reducing caloric intake may offer an additional and sometimes more feasible alternative, so that the nutritional treatment incorporates, but is not focused on, weight reduction goals. The growing global consumption of ultra-processed foods, which is the polar opposite of the Mediterranean diet and its concept of home-based cooking, poses a great challenge in the prevention of NAFLD and probably hepatocellular carcinoma.

This review will cover the most updated clinical and epidemiological evidence for lifestyle treatment in NAFLD and provide practical treatment tools.



Publication History

Article published online:
17 June 2021

© 2021. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 European Association for the Study of the Liver, European Association for the Study of Diabetes, European Association for the Study of Obesity. EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016; 64 (06) 1388-1402 DOI: 10.1016/j.jhep.2015.11.004.
  • 2 Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L. et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology 2015; 149 (02) 367-78.e5 , quiz e14–e15
  • 3 Koutoukidis DA, Astbury NM, Tudor KE. et al. Association of weight loss interventions with changes in biomarkers of nonalcoholic fatty liver disease: a systematic review and meta-analysis. JAMA Intern Med 2019; 179 (09) 1262-1271
  • 4 Glass LM, Dickson RC, Anderson JC. et al. Total body weight loss of ≥ 10 % is associated with improved hepatic fibrosis in patients with nonalcoholic steatohepatitis. Dig Dis Sci 2015; 60 (04) 1024-1030
  • 5 Han MAT, Altayar O, Hamdeh S. et al. Rates of and factors associated with placebo response in trials of pharmacotherapies for nonalcoholic steatohepatitis: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2019; 17 (04) 616-629.e26
  • 6 Plauth M, Bernal W, Dasarathy S. et al. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 2019; 38 (02) 485-521
  • 7 Romero-Gómez M, Zelber-Sagi S, Trenell M. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol 2017; 67 (04) 829-846
  • 8 O'Connor EA, Evans CV, Rushkin MC, Redmond N, Lin JS. Behavioral counseling to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2020; 324 (20) 2076-2094
  • 9 Jensen MD, Ryan DH, Apovian CM. et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines, Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014; 129 (25, Suppl 2): S102-S138
  • 10 Ryan DH, Kahan S. Guideline recommendations for obesity management. Med Clin North Am 2018; 102 (01) 49-63
  • 11 Musso G, Cassader M, Rosina F, Gambino R. Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials. Diabetologia 2012; 55 (04) 885-904
  • 12 Kim D, Vazquez-Montesino LM, Li AA, Cholankeril G, Ahmed A. Inadequate physical activity and sedentary behavior are independent predictors of nonalcoholic fatty liver disease. Hepatology 2020; 72 (05) 1556-1568
  • 13 Ye Q, Zou B, Yeo YH. et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 5 (08) 739-752
  • 14 Younes R, Bugianesi E. NASH in lean individuals. Semin Liver Dis 2019; 39 (01) 86-95
  • 15 Sookoian S, Pirola CJ. Systematic review with meta-analysis: risk factors for non-alcoholic fatty liver disease suggest a shared altered metabolic and cardiovascular profile between lean and obese patients. Aliment Pharmacol Ther 2017; 46 (02) 85-95
  • 16 Wong VW, Wong GL, Chan RS. et al. Beneficial effects of lifestyle intervention in non-obese patients with non-alcoholic fatty liver disease. J Hepatol 2018; 69 (06) 1349-1356
  • 17 Yasutake K, Nakamuta M, Shima Y. et al. Nutritional investigation of non-obese patients with non-alcoholic fatty liver disease: the significance of dietary cholesterol. Scand J Gastroenterol 2009; 44 (04) 471-477
  • 18 Chen F, Esmaili S, Rogers G. et al. Lean NAFLD: a distinct entity shaped by differential metabolic adaptation. Hepatology 2019; 71 (04) 1213-1227
  • 19 Rosqvist F, Kullberg J, Ståhlman M. et al. Overeating saturated fat promotes fatty liver and ceramides compared with polyunsaturated fat: a randomized trial. J Clin Endocrinol Metab 2019; 104 (12) 6207-6219
  • 20 Luukkonen PK, Sädevirta S, Zhou Y. et al. Saturated fat is more metabolically harmful for the human liver than unsaturated fat or simple sugars. Diabetes Care 2018; 41 (08) 1732-1739
  • 21 World Health Organisation (WHO) Guideline: Sugars Intake for Adults and Children. Geneva, Switzerland: WHO; 2015. . Available at: https://books.google.co.il/books?id=jVk0DgAAQBAJ&printsec=frontcover&hl=iw#v=onepage&q&f=false
  • 22 Muth ND, Dietz WH, Magge SN, Johnson RK. American Academy of Pediatrics, Section on Obesity, Committee on Nutrition, American Heart Association. Public policies to reduce sugary drink consumption in children and adolescents. Pediatrics 2019; 143 (04) 143
  • 23 Dietary Guidelines Advisory Committee. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. Washington, DC: U.S. Department of Agriculture, Agricultural Research Service; 2020
  • 24 Mosca A, Nobili V, De Vito R. et al. Serum uric acid concentrations and fructose consumption are independently associated with NASH in children and adolescents. J Hepatol 2017; 66 (05) 1031-1036
  • 25 Schwarz JM, Noworolski SM, Erkin-Cakmak A. et al. Effects of dietary fructose restriction on liver fat, de novo lipogenesis, and insulin kinetics in children with obesity. Gastroenterology 2017; 153 (03) 743-752
  • 26 Schwimmer JB, Ugalde-Nicalo P, Welsh JA. et al. Effect of a low free sugar diet vs usual diet on nonalcoholic fatty liver disease in adolescent boys: a randomized clinical trial. JAMA 2019; 321 (03) 256-265
  • 27 Geurtsen ML, Santos S, Gaillard R, Felix JF, Jaddoe VWV. Associations between intake of sugar-containing beverages in infancy with liver fat accumulation at school age. Hepatology 2021; 73 (02) 560-570
  • 28 Jensen T, Abdelmalek MF, Sullivan S. et al. Fructose and sugar: a major mediator of non-alcoholic fatty liver disease. J Hepatol 2018; 68 (05) 1063-1075
  • 29 Lelis DF, Andrade JMO, Almenara CCP, Broseguini-Filho GB, Mill JG, Baldo MP. High fructose intake and the route towards cardiometabolic diseases. Life Sci 2020; 259: 118235
  • 30 Skytte MJ, Samkani A, Petersen AD. et al. A carbohydrate-reduced high-protein diet improves HbA1c and liver fat content in weight stable participants with type 2 diabetes: a randomised controlled trial. Diabetologia 2019; 62 (11) 2066-2078
  • 31 Maskarinec G, Lim U, Jacobs S. et al. Diet quality in midadulthood predicts visceral adiposity and liver fatness in older ages: the Multiethnic Cohort Study. Obesity (Silver Spring) 2017; 25 (08) 1442-1450
  • 32 Ma J, Hennein R, Liu C. et al. Improved diet quality associates with reduction in liver fat, particularly in individuals with high genetic risk scores for nonalcoholic fatty liver disease. Gastroenterology 2018; 155 (01) 107-117
  • 33 Gepner Y, Shelef I, Schwarzfuchs D. et al. Effect of distinct lifestyle interventions on mobilization of fat storage pools: CENTRAL Magnetic Resonance Imaging Randomized Controlled Trial. Circulation 2018; 137 (11) 1143-1157
  • 34 Tsaban G, Yaskolka Meir A, Rinott E. et al. The effect of green Mediterranean diet on cardiometabolic risk; a randomised controlled trial. Heart 2020; heartjnl-2020-317802. Doi: 10.1136/heartjnl-2020-317802. Online ahead of print
  • 35 Gepner Y, Shelef I, Komy O. et al. The beneficial effects of Mediterranean diet over low-fat diet may be mediated by decreasing hepatic fat content. J Hepatol 2019; 71 (02) 379-388
  • 36 Properzi C, O'Sullivan TA, Sherriff JL. et al. Ad libitum Mediterranean and low-fat diets both significantly reduce hepatic steatosis: a randomized controlled trial. Hepatology 2018; 68 (05) 1741-1754
  • 37 Alferink LJM, Erler NS, de Knegt RJ. et al. Adherence to a plant-based, high-fibre dietary pattern is related to regression of non-alcoholic fatty liver disease in an elderly population. Eur J Epidemiol 2020; 35 (11) 1069-1085
  • 38 Maskarinec G, Namatame LA, Kang M. et al. Differences in the association of diet quality with body fat distribution between men and women. Eur J Clin Nutr 2020; 74 (10) 1434-1441
  • 39 Willett W, Rockström J, Loken B. et al. Food in the anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet 2019; 393 (10170): 447-492
  • 40 León-Muñoz LM, Guallar-Castillón P, Graciani A. et al. Adherence to the Mediterranean diet pattern has declined in Spanish adults. J Nutr 2012; 142 (10) 1843-1850
  • 41 Sánchez-Villegas A, Martínez JA, De Irala J, Martínez-González MA. Determinants of the adherence to an “a priori” defined Mediterranean dietary pattern. Eur J Nutr 2002; 41 (06) 249-257
  • 42 Grosso G, Marventano S, Giorgianni G, Raciti T, Galvano F, Mistretta A. Mediterranean diet adherence rates in Sicily, southern Italy. Public Health Nutr 2014; 17 (09) 2001-2009
  • 43 Golovaty I, Tien PC, Price JC, Sheira L, Seligman H, Weiser SD. Food insecurity may be an independent risk factor associated with nonalcoholic fatty liver disease among low-income adults in the United States. J Nutr 2020; 150 (01) 91-98
  • 44 Fretts AM, Follis JL, Nettleton JA. et al. Consumption of meat is associated with higher fasting glucose and insulin concentrations regardless of glucose and insulin genetic risk scores: a meta-analysis of 50,345 Caucasians. Am J Clin Nutr 2015; 102 (05) 1266-1278
  • 45 Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation 2016; 133 (02) 187-225
  • 46 Alferink LJ, Kiefte-de Jong JC, Erler NS. et al. Association of dietary macronutrient composition and non-alcoholic fatty liver disease in an ageing population: the Rotterdam Study. Gut 2019; 68 (06) 1088-1098
  • 47 Baratta F, Pastori D, Polimeni L. et al. Adherence to Mediterranean diet and non-alcoholic fatty liver disease: effect on insulin resistance. Am J Gastroenterol 2017; 112 (12) 1832-1839
  • 48 Zelber-Sagi S, Ivancovsky-Wajcman D, Fliss Isakov N. et al. High red and processed meat consumption is associated with non-alcoholic fatty liver disease and insulin resistance. J Hepatol 2018; 68 (06) 1239-1246
  • 49 Noureddin M, Zelber-Sagi S, Wilkens LR. et al. Diet associations with nonalcoholic fatty liver disease in an ethnically diverse population: the Multiethnic Cohort. Hepatology 2020; 71 (06) 1940-1952
  • 50 Etemadi A, Sinha R, Ward MH. et al. Mortality from different causes associated with meat, heme iron, nitrates, and nitrites in the NIH-AARP Diet and Health Study: population based cohort study. BMJ 2017; 357: j1957
  • 51 Singh R, Barden A, Mori T, Beilin L. Advanced glycation end-products: a review. Diabetologia 2001; 44 (02) 129-146
  • 52 Miele L, Dall'armi V, Cefalo C. et al. A case-control study on the effect of metabolic gene polymorphisms, nutrition, and their interaction on the risk of non-alcoholic fatty liver disease. Genes Nutr 2014; 9 (02) 383
  • 53 Oz F, Kaban G, Kaya M. Effects of cooking methods and levels on formation of heterocyclic aromatic amines in chicken and fish with Oasis extraction method. Lebensm Wiss Technol 2010; 43: 1345-1350
  • 54 Zheng W, Lee SA. Well-done meat intake, heterocyclic amine exposure, and cancer risk. Nutr Cancer 2009; 61 (04) 437-446
  • 55 Wang Y, Hui T, Zhang YW. et al. Effects of frying conditions on the formation of heterocyclic amines and trans fatty acids in grass carp (Ctenopharyngodon idellus). Food Chem 2015; 167: 251-257
  • 56 Layton DW, Bogen KT, Knize MG, Hatch FT, Johnson VM, Felton JS. Cancer risk of heterocyclic amines in cooked foods: an analysis and implications for research. Carcinogenesis 1995; 16 (01) 39-52
  • 57 Carvalho AM, Miranda AM, Santos FA, Loureiro AP, Fisberg RM, Marchioni DM. High intake of heterocyclic amines from meat is associated with oxidative stress. Br J Nutr 2015; 113 (08) 1301-1307
  • 58 Birlouez-Aragon I, Saavedra G, Tessier FJ. et al. A diet based on high-heat-treated foods promotes risk factors for diabetes mellitus and cardiovascular diseases. Am J Clin Nutr 2010; 91 (05) 1220-1226
  • 59 Uribarri J, Woodruff S, Goodman S. et al. Advanced glycation end products in foods and a practical guide to their reduction in the diet. J Am Diet Assoc 2010; 110 (06) 911-16.e12
  • 60 Kellow NJ, Savige GS. Dietary advanced glycation end-product restriction for the attenuation of insulin resistance, oxidative stress and endothelial dysfunction: a systematic review. Eur J Clin Nutr 2013; 67 (03) 239-248
  • 61 Takeuchi M, Takino J, Furuno S. et al. Assessment of the concentrations of various advanced glycation end-products in beverages and foods that are commonly consumed in Japan. PLoS One 2015; 10 (03) e0118652
  • 62 Clarke RE, Dordevic AL, Tan SM, Ryan L, Coughlan MT. Dietary advanced glycation end products and risk factors for chronic disease: a systematic review of randomised controlled trials. Nutrients 2016; 8 (03) 125
  • 63 Teichert T, Hellwig A, Peßler A. et al. Association between advanced glycation end products and impaired fasting glucose: results from the SALIA study. PLoS One 2015; 10 (05) e0128293
  • 64 Kim Y, Keogh J, Clifton P. A review of potential metabolic etiologies of the observed association between red meat consumption and development of type 2 diabetes mellitus. Metabolism 2015; 64 (07) 768-779
  • 65 Ivancovsky-Wajcman D, Zelber-Sagi S, Fliss Isakov N. et al. Serum soluble receptor for AGE (sRAGE) levels are associated with unhealthy lifestyle and nonalcoholic fatty liver disease. Clin Transl Gastroenterol 2019; 10 (05) 1-10
  • 66 Zelber-Sagi S, Salomone F, Kolodkin-Gal I. et al. Protective role of soluble receptor for advanced glycation end-products in patients with non-alcoholic fatty liver disease. Dig Liver Dis 2017; 49 (05) 523-529
  • 67 Moubarac JC, Parra DC, Cannon G, Monteiro CA. Food classification systems based on food processing: significance and implications for policies and actions: a systematic literature review and assessment. Curr Obes Rep 2014; 3 (02) 256-272
  • 68 Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr 2018; 21 (01) 5-17
  • 69 Slimani N, Deharveng G, Southgate DA. et al. Contribution of highly industrially processed foods to the nutrient intakes and patterns of middle-aged populations in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 2009; 63 (Suppl. 04) S206-S225
  • 70 Martínez Steele E, Popkin BM, Swinburn B, Monteiro CA. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul Health Metr 2017; 15 (01) 6
  • 71 Martínez Steele E, Baraldi LG, Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open 2016; 6 (03) e009892
  • 72 Rauber F, Louzada MLDC, Martinez Steele E. et al. Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study. BMJ Open 2019; 9 (10) e027546
  • 73 Monteiro CA, Cannon G, Lawrence M, Costa Louzada ML. Ultra-Processed Foods, Diet Quality, and Health Using the NOVA Classification System. Rome: FAO; 2019
  • 74 Mendonça RD, Lopes AC, Pimenta AM, Gea A, Martinez-Gonzalez MA, Bes-Rastrollo M. Ultra-processed food consumption and the incidence of hypertension in a Mediterranean cohort: the Seguimiento Universidad de Navarra Project. Am J Hypertens 2017; 30 (04) 358-366
  • 75 Fiolet T, Srour B, Sellem L. et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ 2018; 360: k322
  • 76 Lane MM, Davis JA, Beattie S. et al. Ultraprocessed food and chronic noncommunicable diseases: A systematic review and meta-analysis of 43 observational studies. Obes Rev 2021; 22 (03) e13146
  • 77 Srour B, Fezeu LK, Kesse-Guyot E. et al. Ultraprocessed food consumption and risk of type 2 diabetes among participants of the NutriNet-Santé Prospective Cohort. JAMA Intern Med 2020; 180 (02) 283-291
  • 78 Schnabel L, Kesse-Guyot E, Allès B. et al. Association between ultraprocessed food consumption and risk of mortality among middle-aged adults in France. JAMA Intern Med 2019; 179 (04) 490-498
  • 79 Hall KD, Ayuketah A, Brychta R. et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab 2019; 30 (01) 226
  • 80 Takahashi F, Hashimoto Y, Kawano R. et al. Eating fast is associated with nonalcoholic fatty liver disease in men but not in women with type 2 diabetes: a cross-sectional study. Nutrients 2020; 12 (08) 12
  • 81 Uribarri J, del Castillo MD, de la Maza MP. et al. Dietary advanced glycation end products and their role in health and disease. Adv Nutr 2015; 6 (04) 461-473
  • 82 Godos J, Federico A, Dallio M, Scazzina F. Mediterranean diet and nonalcoholic fatty liver disease: molecular mechanisms of protection. Int J Food Sci Nutr 2017; 68 (01) 18-27
  • 83 Tajima R, Kimura T, Enomoto A. et al. No association between fruits or vegetables and non-alcoholic fatty liver disease in middle-aged men and women. Nutrition 2019; 61: 119-124
  • 84 Ivancovsky-Wajcman D, Fliss-Isakov N, Salomone F. et al. Dietary vitamin E and C intake is inversely associated with the severity of nonalcoholic fatty liver disease. Dig Liver Dis 2019; 51 (12) 1698-1705
  • 85 Salomone F, Wajcman DI, Fliss-Isakov N. et al. Higher phenolic acid intake independently associates with lower prevalence of insulin resistance and non-alcoholic fatty liver disease. JHEP Rep 2020; 2 (02) 100069
  • 86 Sawada N, Inoue M, Iwasaki M. et al; Japan Public Health Center-Based Prospective Study Group. Consumption of n-3 fatty acids and fish reduces risk of hepatocellular carcinoma. Gastroenterology 2012; 142 (07) 1468-1475
  • 87 Freedman ND, Cross AJ, McGlynn KA. et al. Association of meat and fat intake with liver disease and hepatocellular carcinoma in the NIH-AARP cohort. J Natl Cancer Inst 2010; 102 (17) 1354-1365
  • 88 Ioannou GN, Morrow OB, Connole ML, Lee SP. Association between dietary nutrient composition and the incidence of cirrhosis or liver cancer in the United States population. Hepatology 2009; 50 (01) 175-184
  • 89 Yang W, Sui J, Ma Y. et al. A prospective study of dairy product intake and the risk of hepatocellular carcinoma in U.S. men and women. Int J Cancer 2020; 146 (05) 1241-1249
  • 90 Yang W, Sui J, Ma Y. et al. High dietary intake of vegetable or polyunsaturated fats is associated with reduced risk of hepatocellular carcinoma. Clin Gastroenterol Hepatol 2020; 18 (12) 2775-2783.e11
  • 91 Fedirko V, Lukanova A, Bamia C. et al. Glycemic index, glycemic load, dietary carbohydrate, and dietary fiber intake and risk of liver and biliary tract cancers in Western Europeans. Ann Oncol 2013; 24 (02) 543-553
  • 92 Yang Y, Zhang D, Feng N. et al. Increased intake of vegetables, but not fruit, reduces risk for hepatocellular carcinoma: a meta-analysis. Gastroenterology 2014; 147 (05) 1031-1042
  • 93 Turati F, Trichopoulos D, Polesel J. et al. Mediterranean diet and hepatocellular carcinoma. J Hepatol 2014; 60 (03) 606-611
  • 94 Ma Y, Yang W, Simon TG. et al. Dietary patterns and risk of hepatocellular carcinoma among U.S. men and women. Hepatology 2019; 70 (02) 577-586
  • 95 Ascha MS, Hanouneh IA, Lopez R, Tamimi TA, Feldstein AF, Zein NN. The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology 2010; 51 (06) 1972-1978
  • 96 Åberg F, Puukka P, Salomaa V. et al. Risks of light and moderate alcohol use in fatty liver disease: follow-up of population cohorts. Hepatology 2020; 71 (03) 835-848
  • 97 Åberg F, Helenius-Hietala J, Puukka P, Jula A. Binge drinking and the risk of liver events: a population-based cohort study. Liver Int 2017; 37 (09) 1373-1381
  • 98 Ruhl CE, Everhart JE. Joint effects of body weight and alcohol on elevated serum alanine aminotransferase in the United States population. Clin Gastroenterol Hepatol 2005; 3 (12) 1260-1268
  • 99 Ekstedt M, Franzén LE, Holmqvist M. et al. Alcohol consumption is associated with progression of hepatic fibrosis in non-alcoholic fatty liver disease. Scand J Gastroenterol 2009; 44 (03) 366-374
  • 100 Ajmera V, Belt P, Wilson LA. et al; Nonalcoholic Steatohepatitis Clinical Research Network. Among patients with nonalcoholic fatty liver disease, modest alcohol use is associated with less improvement in histologic steatosis and steatohepatitis. Clin Gastroenterol Hepatol 2018; 16 (09) 1511-1520.e5
  • 101 Chang Y, Cho YK, Kim Y. et al. Nonheavy drinking and worsening of noninvasive fibrosis markers in nonalcoholic fatty liver disease: a cohort study. Hepatology 2019; 69 (01) 64-75
  • 102 Hajifathalian K, Torabi Sagvand B, McCullough AJ. Effect of alcohol consumption on survival in nonalcoholic fatty liver disease: a national prospective cohort study. Hepatology 2019; 70 (02) 511-521
  • 103 Long MT, Massaro JM, Hoffmann U, Benjamin EJ, Naimi TS. Alcohol use is associated with hepatic steatosis among persons with presumed nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2020; 18 (08) 1831-1841.e5
  • 104 Younossi ZM, Stepanova M, Ong J. et al; Global NASH Council. Effects of alcohol consumption and metabolic syndrome on mortality in patients with nonalcoholic and alcohol-related fatty liver disease. Clin Gastroenterol Hepatol 2019; 17 (08) 1625-1633.e1
  • 105 Chalasani N, Younossi Z, Lavine JE. et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018; 67 (01) 328-357
  • 106 Akhavan Rezayat A, Dadgar Moghadam M, Ghasemi Nour M. et al. Association between smoking and non-alcoholic fatty liver disease: a systematic review and meta-analysis. SAGE Open Med 2018; 6: 2050312117745223
  • 107 Kim NH, Jung YS, Hong HP. et al. Association between cotinine-verified smoking status and risk of nonalcoholic fatty liver disease. Liver Int 2018; 38 (08) 1487-1494
  • 108 Okamoto M, Miyake T, Kitai K. et al. Cigarette smoking is a risk factor for the onset of fatty liver disease in nondrinkers: a longitudinal cohort study. PLoS One 2018; 13 (04) e0195147
  • 109 Liu P, Xu Y, Tang Y. et al. Independent and joint effects of moderate alcohol consumption and smoking on the risks of non-alcoholic fatty liver disease in elderly Chinese men. PLoS One 2017; 12 (07) e0181497
  • 110 Jung HS, Chang Y, Kwon MJ. et al. Smoking and the risk of non-alcoholic fatty liver disease: a cohort study. Am J Gastroenterol 2019; 114 (03) 453-463
  • 111 Zein CO, Unalp A, Colvin R, Liu YC, McCullough AJ. Nonalcoholic Steatohepatitis Clinical Research Network. Smoking and severity of hepatic fibrosis in nonalcoholic fatty liver disease. J Hepatol 2011; 54 (04) 753-759
  • 112 Björkström K, Franzén S, Eliasson B. et al. Risk factors for severe liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol 2019; 17 (13) 2769-2775.e4
  • 113 Saran U, Humar B, Kolly P, Dufour JF. Hepatocellular carcinoma and lifestyles. J Hepatol 2016; 64 (01) 203-214
  • 114 Trichopoulos D, Bamia C, Lagiou P. et al. Hepatocellular carcinoma risk factors and disease burden in a European cohort: a nested case-control study. J Natl Cancer Inst 2011; 103 (22) 1686-1695
  • 115 Lee YC, Cohet C, Yang YC, Stayner L, Hashibe M, Straif K. Meta-analysis of epidemiologic studies on cigarette smoking and liver cancer. Int J Epidemiol 2009; 38 (06) 1497-1511
  • 116 Hagström H, Nasr P, Ekstedt M. et al. Cardiovascular risk factors in non-alcoholic fatty liver disease. Liver Int 2019; 39 (01) 197-204
  • 117 Zelber-Sagi S, Bord S, Dror-Lavi G. et al. Role of illness perception and self-efficacy in lifestyle modification among non-alcoholic fatty liver disease patients. World J Gastroenterol 2017; 23 (10) 1881-1890
  • 118 Haigh L, Bremner S, Houghton D. et al. Barriers and facilitators to Mediterranean diet adoption by patients with nonalcoholic fatty liver disease in northern Europe. Clin Gastroenterol Hepatol 2019; 17 (07) 1364-1371.e3
  • 119 Pimpin L, Cortez-Pinto H, Negro F. et al; EASL HEPAHEALTH Steering Committee. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. J Hepatol 2018; 69 (03) 718-735
  • 120 World Health Organization (WHO), World Economic Forum (WEF). From Burden to “Best Buys”: Reducing the Economic Impact of Non-Communicable Diseases in Low- and Middle-Income Countries. September 18, 2011. Accessed February 17, 2021 at: https://www.who.int/nmh/publications/best_buys_summary/en/
  • 121 Ma Y, Yang W, Li T. et al. Meat intake and risk of hepatocellular carcinoma in two large US prospective cohorts of women and men. Int J Epidemiol 2019; 48 (06) 1863-1871
  • 122 Tran KT, Coleman HG, McMenamin ÚC, Cardwell CR. Coffee consumption by type and risk of digestive cancer: a large prospective cohort study. Br J Cancer 2019; 120 (11) 1059-1066
  • 123 Kennedy OJ, Roderick P, Buchanan R, Fallowfield JA, Hayes PC, Parkes J. Coffee, including caffeinated and decaffeinated coffee, and the risk of hepatocellular carcinoma: a systematic review and dose-response meta-analysis. BMJ Open 2017; 7 (05) e013739
  • 124 Gao M, Sun K, Guo M. et al. Fish consumption and n-3 polyunsaturated fatty acids, and risk of hepatocellular carcinoma: systematic review and meta-analysis. Cancer Causes Control 2015; 26 (03) 367-376
  • 125 Luo J, Yang Y, Liu J. et al. Systematic review with meta-analysis: meat consumption and the risk of hepatocellular carcinoma. Aliment Pharmacol Ther 2014; 39 (09) 913-922
  • 126 Bravi F, Bosetti C, Tavani A, Gallus S, La Vecchia C. Coffee reduces risk for hepatocellular carcinoma: an updated meta-analysis. Clin Gastroenterol Hepatol 2013; 11 (11) 1413-1421.e1