Behavioral Aspects of Nonalcoholic Fatty Liver Disease: Diet, Causes, and Treatment

Abstract

Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized clinical condition associated with features of metabolic syndrome and having insulin resistance as the underlying metabolic defect. Reduced insulin sensitivity favors the accumulation of free fatty acids and triglycerides within the hepatocytes, resulting in hepatocellular damage that may be self-maintaining and progressive. As the disease stems from excess calorie intake and/or low levels of physical activity, the correction of unhealthy lifestyles is the first line of approach to any prevention and treatment strategy. Patients are invited to modify their habits starting a restricted calorie dietary program associated with regular physical exercise, which should be maintained lifelong. Prescriptive diets are effective for short-term weight loss, but making patients increase and maintain their daily physical activity is hard to achieve. Only behavioral treatment can give patients the practical instruments to reach their eating and activity targets, incorporate them into their lifestyle, and maintain the results for long periods and possibly indefinitely. Very few studies have tested the effects of a behavioral approach in NAFLD patients, and adequate long-term trials having histology as an outcome measure have not been carried out so far. Future studies should test the potential of behavior treatment to restrict NAFLD progression to fibrosis, cirrhosis, and eventually hepatocellular carcinoma. Given the difficulties of implementing lifestyle modifications in adults, healthy lifestyle habits should be promoted in children as part of prevention programs to reduce the future burden of liver disease of metabolic origin.