Energy balance
Calorie-restricted interventions (CRI) significantly reduce liver enzymes (ALT, AST), hepatic steatosis, and liver stiffness in NAFLD patients, with a dose-response relationship between the degree of calorie restriction and clinical benefit.
For NAFLD management, establishing a consistent calorie deficit is the most effective first-line strategy. This approach reliably lowers liver enzymes (ALT/AST), reduces liver fat, and improves liver stiffness. While specific diet types (like Mediterranean) also help, the degree of calorie restriction directly correlates with liver benefits, making energy balance the primary lever for treatment.
Post-intervention meta-analyses revealed that dietary interventions reduced alanine aminotransferase (ALT) (P < 0.001)... CRI had favourable effects on ALT (P < 0.001), HS (P < 0.001) and liver stiffness (P = 0.009). There was a dose-response relationship between degree of calorie restriction and beneficial effects on liver function and weight loss, suggesting that this approach should remain the cornerstone of NAFLD management.
Why this rating
Based on a systematic review and meta-analysis of 26 RCTs/CCTs, though heterogeneity was noted.
Source
The effectiveness and acceptability of Mediterranean diet and calorie restriction in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis
Laura Haigh et al. · Clinical Nutrition · 2022
DOI 10.1016/j.clnu.2022.06.037
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