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Challenges in Nutrition: Nutrition in acute and chronic diseases

Fatty acid composition but not quantity is an important indicator of non-alcoholic fatty liver disease: a systematic review

European Journal of Clinical Nutrition volume 77, pages 1113–1129 (2023)Cite this article

Subjects

Abstract

Background

There is still paucity on the effects of dietary and supplemental fatty acid on non-alcoholic fatty liver disease (NAFLD). The aim of this review is to systematically review and summarise the effect of fatty acids intake on liver-related outcomes in adult patients with NAFLD.

Methods

The review was conducted using Cochrane CENTRAL Library, Scopus, Embase, MEDLINE, PubMed, and Web of Science. A total of 2786 records were identified, and of these, 36 studies (31 were randomised control trials (RCTs), and 5 were case-control studies) were included. Quality assessment was conducted using the Revised Cochrane Risk of Bias tool and Joanna Briggs Institute checklists.

Results

Of 36 articles, 79% of RCTs and 66% of case-control studies had a low risk of bias. Potential heterogeneity has been observed in assessment of liver-related outcomes. According to the RCTs, there was moderate evidence (3/6 studies) that a diet characterised by a high MUFA, PUFA and low SFA showed reduced liver fat and stiffness. The using of culinary fats that are high in MUFA (4/6 studies) reduces liver steatosis. n-3 PUFA supplementation in combination with a hypocaloric or heart healthy diet with a low SFA improved liver enzyme level (5/14 studies) and steatosis score (3/14 studies).

Conclusions

Effects on NAFLD parameters, including liver fat content (assessed via magnetic resonance imaging/spectroscopy), stiffness and steatosis score (assessed by ultrasonography), were primarily related to fatty acid composition independent of energy intake. Further investigation is needed to determine the mechanism of specific fatty acid on the accumulation of liver fat.

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Funding

The study was funded by the King Faisal Specialist Hospital & Research Centre. The funders were not involved in the planning, design, implementation, statistical analysis, interpretation or any other aspect of the study including preparation of the paper or knowledge of its contents.

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Authors and Affiliations

  1. Department of Nutrition and Dietetics, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia

    Arpita Das & Yu Lung Malcolm Tang

  2. Sharik Association for Health Research, Riyadh, Saudi Arabia

    Nora A. Althumiri

  3. Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Vanessa Garcia-Larsen

  4. Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre, Mainz, Germany

    Jörn M. Schattenberg

  5. Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA

    Saleh A. Alqahtani

  6. Liver Transplantation Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

    Saleh A. Alqahtani

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AD contributed to conceptualisation, methodology, executed the search, screening, quality assessment, data extraction, data synthesis, writing of original draft, review and editing the manuscript. AD and YLMT contributed to screening, quality assessment and data extraction. All co-authors reviewed and provided critical feedback on the manuscript. All authors approved the final manuscript.

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Das, A., Tang, Y.L.M., Althumiri, N.A. et al. Fatty acid composition but not quantity is an important indicator of non-alcoholic fatty liver disease: a systematic review. Eur J Clin Nutr 77, 1113–1129 (2023). https://doi.org/10.1038/s41430-023-01335-2

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