Vuille-Lessard, Élise; Lange, Franziska; Riebensahm, Carlotta; Dufour, Jean-François; Berzigotti, Annalisa (2021). Dietary Interventions in Liver Diseases: Focus onMAFLD and Cirrhosis. Current hepatology reports, 20(2), pp. 61-76. Springer 10.1007/s11901-021-00563-z
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Vuille-Lessard_et_al._-_2021_-_Dietary_Interventions_in_Liver_Diseases_Focus_on_.pdf - Published Version Available under License Creative Commons: Attribution (CC-BY). Download (893kB) | Preview |
Purpose of Review: Dietary interventions (DI) aimed at improving overweight and metabolic abnormalities in metabolic dysfunction-associated fatty liver disease (MAFLD) and at reducing malnutrition and sarcopenia in cirrhosis should become part of routine care in hepatology. This review focuses on recent advances in this field.
Recent Findings: In patients with MAFLD, a gradual reduction, respectively, of 7–10% of body weight if overweight or of 3–5%if lean, obtained by moderately reducing caloric intake, is effective to improve liver disease. Intermittent energy restriction might be an alternative to continuous energy restriction with higher adherence. Qualitative dietary adjustments should include increased intake of unprocessed foods including fruits and vegetables, whole grains, fiber, and unsaturated fatty acids (FAs), for example, through a Mediterranean diet. Refined carbohydrates (CHOs), saturated FA (SFAs), red meat, and processed meat should be limited. DI studies in HIV-infected subjects with MAFLD are very limited, and this is a field for future research. In patients with cirrhosis, DI should aim at correcting malnutrition and improving skeletal muscle mass. Daily diet contents should aim at achieving 30–35 kcal/kg of body weight, including 1.2–1.5 g/kg proteins, and oral or enteral supplementation might be used in patients unable to achieve these targets. In some studies, branched-chain amino acids (BCAAs) proved to be effective in improving muscle mass and were associated with a lower risk of hepatic encephalopathy. Obesity requires adjustment of the above-mentioned targets, and its management is challenging. Studies looking at the efficacy of DI recommended by the existing guidelines on clinical endpoints are a field for future research.
Summary: Dietary interventions are able to improve MAFLD and show potential to reduce complications in liver disease. Despite its key importance, there are many barriers limiting the implementation of DI in patients with chronic liver disease. Patients’ empowerment is crucial and should be the focus of specific educational programs. In addition, liver clinics would benefit from multidisciplinary teams involving experts innutrition, physical exercise, primary care physicians, and psychologists when needed.
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