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

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Handbook of Behavior, Food and Nutrition

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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.

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Abbreviations

ALT:

Alanine aminotransferase

BMI:

Body mass index

HDL:

High density lipoprotein

HOMA:

Homeostasis model assessment

CBT:

Cognitive-behavioral treatment

NAFLD:

Nonalcoholic fatty liver disease

NAS:

NAFLD activity score

NASH:

Nonalcoholic steatohepatitis

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Authors and Affiliations

  1. Unit of Metabolic Diseases & Clinical Dietetics, “Alma Mater Studiorum” University, University of Bologna, Policlinico S. Orsola, Via Massarenti 9, I-40138, Bologna, Italy

    Giulio Marchesini

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  1. Giulio Marchesini
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  2. Chiara Nuccitelli
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  3. Elena Centis
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  4. Silvia Di Domizio
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  5. Alessandro Suppini
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  6. Rebecca Marzocchi
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  7. Riccardo Dalle Grave
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Correspondence to Giulio Marchesini .

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Editors and Affiliations

  1. Dept. Nutrition & Dietetics, King's College, Stamford St. 150, London, SE1 9NH, United Kingdom

    Victor R. Preedy

  2. Arizona Health Science Center, Mel and Enid Zuckerman College of Public, University of Arizona, 1501 N. Campbell Ave. Room 4335, Tucson, 85724-5155, Arizona, USA

    Ronald Ross Watson

  3. University of the West of Scotland, Ayr Campus, Ayr, KA8 0SR, United Kingdom

    Colin R. Martin

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Marchesini, G. et al. (2011). Behavioral Aspects of Nonalcoholic Fatty Liver Disease: Diet, Causes, and Treatment. In: Preedy, V., Watson, R., Martin, C. (eds) Handbook of Behavior, Food and Nutrition. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92271-3_119

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