Non-alcoholic fatty liver (NAFL) – Can Diet and Exercise make a Difference?

Published on September 4, 2021

Fatty liver, a common condition where fat infiltrates the liver cells, could be due to excess alcohol intake or liver disease. If it occurs in the absence of these two factors, it is referred to as non-alcoholic fatty liver (NAFL). NAFL could progress to non-alcoholic steatohepatitis (NASH). Individuals with NAFL are at a higher risk for cardiovascular disease.

NAFL can be treated through exercise and diet.

Currently, no drug is approved to treat NAFL. The good news is, the liver changes are not permanent and can be reversed by introducing simple changes in the diet and physical activity level, with the aim of reducing weight. A weight reduction of even between 5 and 10%, especially in the overweight and the obese, could improve the liver condition.

Physical activity reduces weight and improves the NAFL.

Physical activity of a minimum of 150–200 min/week comprising of moderate intensity aerobic exercises is advised for people with NAFL. It improves the NAFL, though higher levels of activity are associated with more benefit.

A low-calorie, low-fructose, high-fibre diet that is low in saturated fats is advised for people with NAFL.

A low-calorie diet of around 500-1000 kcal/day that can be customized to individual taste can reduce the weight and mobilize the fat from the fatty liver. The intake of refined sugars, particularly of fructose, must be reduced. Fructose is a component of corn syrup and sweetened beverages, which sometimes list it as sugar. Likewise, alcohol intake, especially heavy intake, must be avoided. Coffee is permitted and may even be beneficial.

The fibre from foods such as fruits, oat, barley, beans, peas, lentils, chickpeas, grains and green leafy vegetables, gives a feeling of satiety and slows the absorption of glucose and cholesterol from the digestive tract into the blood. Thus, the inclusion of fibre in the diet could help to reduce the total calorie intake and improve the liver changes.

The intake of saturated fats from lard, milk and coconut must be reduced while the intake of monounsaturated fats from sources such as olive oil, nuts, and avocado, and omega-3 fatty acids from sea food can be increased. The intake of omega-6 polyunsaturated fatty acids (PUFA) obtained from vegetable oils such as corn and sunflower oil must be limited to 5-10% of the total calorie intake.

The Mediterranean diet is ideal for patients with NAFL.

The diet that most fits the definition of an ideal diet for NAFL is the Mediterranean diet. It comprises of vegetarian foods such as whole grains, nuts, legumes, fruits and vegetables. It is low in carbohydrates, particularly simple sugars and refined carbohydrates. The sources of fat include olive oil and sea food. The red meat, poultry and low-fat dairy content is limited.

Individuals with NAFL are prone to cardiovascular disease, and simple lifestyle changes in diet and physical activity will not only reverse the liver changes but will also reduce the cardiovascular risk. The changes could also help to improve conditions such as hypertension, diabetes and obesity, that often affect people with NAFL.


Miller EF. Nutrition Management Strategies for Nonalcoholic Fatty Liver Disease: Treatment and Prevention. Clinical Liver Disease 2020; 15(4): 144-148.

Olivera CP et al. Nutrition and Physical Activity in Nonalcoholic Fatty Liver Disease.  Journal of Diabetes Research, vol. 2016, Article ID 4597246, 12 pages, 2016.

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