Endocrinologie et syndrome métabolique
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Nonalcoholic Fatty Liver Disease (NAFLD), a Manifestation of the Metabolic Syndrome: New Perspectives on the Nutritional Therapy

Aline de Piano, Débora Estadella, Lila M. Oyama, Eliane B Ribeiro, Ana R Dâmaso and Claudia M da Penha Oller do Nascimento

Nonalcoholic fatty liver disease (NAFLD) is a multifactorial hepatic disease that develops through complex mechanisms that may be strongly influenced by dietary composition. NAFLD treatment is based on multidisciplinary intervention, which includes nutritional aspects. The objective of this review was to elucidate the influence and role of dietary composition, including fatty acid types, antioxidant nutrients, pre and probiotics and vitamin D in the nutritional treatment and prevention of NAFLD. Increased intake of Monounsaturated fatty acids (MUFAs) and omega-3 polyunsaturated fatty acid (PUFA), particularly as replacements for saturated fat and in a higher proportion than carbohydrates, is beneficial to NAFLD patients, improving insulin resistance; increasing plasma levels of adiponectin and its synthesis by the adipose tissue; and restoring the expression of hepatic peroxisome proliferator-activated receptor alpha (PPAR-α), which in turn reduces cholesterol levels and triacylglycerol accumulation. n-3 PUFAs can reduce lipotoxicity caused by excessive saturated and trans fatty acid ingestion and exert a protective role in inflammatory pathways, promoting resolvins and protectins. Several mechanisms linking gut flora to NAFLD have been proposed, such as inflammation and energy extraction. Studies are often designed to explore the beneficial effects of probiotics, prebiotics and vitamin D in these pathways. The results of this review reveal that the strong positive influence bioactive compounds have on these inflammatory processes must be considered when developing treatment and prevention plans for NAFLD patients.