A brief overview of Metabolic Associated Fatty Liver Disease
A certain amount of fat is normally stored in the liver. When the liver cells begin to accumulate more than 5% of its weight as fat, that person is said to have fatty liver disease or 'steatosis'. Simple steatosis or fatty liver can exist without causing symptoms, but in some cases, the excess fat can lead to inflammation of the liver. Over time, the inflamed liver can become scarred (fibrosed) and hardened. This is termed Non-alcoholic steatohepatitis (NASH). In some cases this may lead to more serious complications such as cirrhosis, liver failure or liver cancer. Excessive alcohol intake over many years can also cause fatty liver disease, and this is termed Alcoholic steatohepatitis.
Causes of and risk factors for Metabolic AssociatedFatty Liver disease and Non-alcoholic steatohepatitis
Fatty liver can be caused by alcohol, viral infections, some medications and certain medical disorders. The most common medical disorder associated with MAFLD and NASH are:
- Overweight and Obesity - eating too much, especially of the wrong foods, can cause the liver to stop breaking down fat as it is supposed to, and the fat then builds up and accumulates in the liver.
- Type 2 diabetes
- High cholesterol or triglycerides
- Insulin resistance together with the 'metabolic syndrome'.
Insulin is a hormone that helps regulate the amount of sugar in the blood. When someone has insulin resistance, the cells in the body become resistant to the effects of insulin.
The metabolic syndrome is a group of disorders that includes:
- excess fat around the waist (abdominal obesity)
- high blood triglycerides (a type of fat found in the blood)
- low high density lipoproteins (HDLs) (a type of fat found in the blood)
- raised blood pressure or hypertension
- low levels of high density lipoproteins (the 'good' cholesterol)
It is now thought that insulin resistance together with the metabolic syndrome plays a very important role in the development of fatty liver disease.
It is not completely understood how and why the liver stops being able to process fat and becomes fatty, but the type and amount of food we eat can increase the risk of insulin resistance or type 2 diabetes, which can then affect the way the we break down and store fat in the liver, leading to MAFLD.
Symptoms of fatty liver disease
Having a fatty liver does not usually cause symptoms at all for many years. Often people learn about their fatty liver when having other medical tests. If the disease progresses to cirrhosis or liver failure, you may experience symptoms such as:
- Fatigue
- Weight loss or loss of appetite
- Weakness
- Central or right upper abdominal pain
Treatment of fatty liver disease
There are some things you can do to help prevent further damage to your liver, and even to reverse some of the damage.
1. Gradually Lose Weight
If you are overweight, a moderate reduction in food of approximately 500- 1000kcals/day less than what you normally eat is suggested. Aim to lose 7-10% of your body weight over 6months- 1year and then gradually aim to get to your ideal body weight. Your doctor or dietitian can advise you of your healthy weight. Diets should have a high protein: calorie ratio. The best way to achieve this is to decrease your intake of carbohydrates such as rice, potatoes and pasta, sugar sweetened beverages and snack foods containing lots of sugar. It is not advisable to lose more than a half to 1 kilogram per week as rapid weight loss can make your fatty liver disease worse. Further information can be found on in our exercise advice page.
2. Eat Less sugary foods
You can reduce your intake of sugar by limiting the following foods, which contain lots of sugar:
All types of added sugar, including white, brown, raw or castor sugar and glucose. Instead, why not try an artificial sweetener such as Splenda™, Sugarine™, Equal™or other varieties.
- Honey, treacle and syrups
- Sweetened jams and marmalades. Why not try the diet varieties or 100% fruit spread such as the Monbulk 100% Fruit™ or the St Dalfours 100% Fruit Spread™
- Sweet spreads such as Nutella™, Milky Way Spread™and other similar varieties. These spreads are also high in fat
- Lollies, chocolate and chewing gums. Why not try the sugar free varieties such as the Double D Sugar Free™ sweets, or Extra™ gums
- Cakes and sweet biscuits
- Puddings and other sweet desserts. You can however buy diet jellies in many flavours
- Dessert syrups. Instead, try the diet varieties such as Cottees Diet Toppings™
- Canned fruit in syrup. Choose those in natural juice instead
- Regular soft drinks, or cordials. Only have diet or low joule options
- Sweetened breakfast cereals. Look for more grain based cereals or those sweetened with added fruit. Good examples include Weet Bix™, All Bran™, All Bran with Fruit™, Sultana Bran™ , traditional oats and other similar cereals.
3. Choose healthier fats
- Limit saturated fats such as Cream, Palm oil, Dripping lard, butter, and mayonnaise
- Limit trans fats such as deep fried food, commercial cake and biscuits, pies and pastries. They contain higher levels of trans fats due to the way they are processed. Trans fats are also found in beef, lamb and dairy foods so cut the fat off meat, don't eat the skin of chicken and choose low fat dairy foods
- The best fats to have are polyunsaturated and monounsaturated fats. Polyunsaturated fats contain both Omega 3 and Omega 6 fatty acids.
- Aim to have more Omega 3 fatty acids in your diet:
Foods containing polyunsaturated fats high in omega 3 fatty acids include:
- Fatty fish (salmon, tuna, sardines)
- Oils and margarines (canola and flaxseed oil)
- Nuts and seeds (linseed, walnuts)
Foods containing polyunsaturated fats high in omega 6 fatty acids include:
- Oils and margarines (sunflower, safflower, soybean, sesame, and polyunsaturated margarine) - limit to 1 teaspoon per day
- Nuts (walnuts, pine nuts, Brazil, pecans, almond, pistachios)
- Legumes (soybeans, chickpeas and lentils)
Foods containing monounsaturated fats include:
- Oils and margarines (canola, macadamia and olive) Avocado
- Nuts (macadamias, pecans, cashews, almonds peanuts, walnuts)
- Seeds (pumpkin and sesame)
4. Eat a balanced healthy diet such as the Mediterranean diet - Include foods from each of these groups every day:
- Meat and meat alternatives
- Vegetables
- Dairy Fruit
- Whole grain breads and cereals
Recommended Food Serves
Low Fat Dairy foods - Aim for 2-3 serves daily
1 serve = 250mls Skim or low fat milk (cow or soy)
= 40g low fat cheese
= 1 tub 200g diet yoghurt
Meat and meat alternatives - Aim for at least 2-4 serves daily
1 serve = 1 chicken breast (100g) chicken
= 1 lean beef/lamb/pork fillet (100g) (limit beef to once per week)
= 150g fish fillet/100g canned fish (eat fish at least twice per week)
= 2 eggs
= 1/3 cup cooked legumes e.g baked beans/lentils
= 1/3 cup nuts or seeds (nuts should be raw or dry roasted)
Fruit - Limit to 2 serves per day
1 serve = 1 serve fruit e.g. apple orange small pear
= 3 cups strawberries
= 1/2 banana or 1/2 mango
Vegetables - Aim for at least 5 serves of low carbohydrate vegetables daily
1 serve = 1 cup raw or cooked vegetables.
Some Low Carbohydrate vegetables include such as broccoli, carrots, cauliflower, celery, cucumber, green beans, leek, lettuce, mushrooms, onion, spinach, tomato and zucchini
NOTE: Limit corn, green peas, legumes, potato, pumpkin, sweet potato, as they contain too much carbohydrate
Cereal/grains and bread - aim for whole grain and limit to 4 serves per day
1 serve = 1 slice bread, 1/2 bagel, % bread roll. 1/4 Lebanese bread
= 1/3 cup cooked rice or % cup pasta
= 3/4 cup cooked porridge or breakfast cereal
= 1-2 plain biscuits or crisp bread
Fats - Limit to 2-3 serves per day
1 serve = 1 teaspoon oil
5. Limit alcohol consumption
Try to have a minimum of 4-5 alcohol-free days per week. On the other days, try not to drink more than 2 standard drinks on each occasion.
6. Increase physical activity
A weight loss diet together with exercise, increases muscle mass and increases insulin sensitivity. Improving cardiovascular fitness and weight training may improve fatty liver disease*.
How can I be More Active?
Consult your doctor prior to starting an exercise plan. Check with your Doctor what level of exercise that is right for you. The following guide will help you increase your activity. If you are unfit, ensure you introduce exercise gradually. You may want to ask your doctor for a referral to an exercise physiologist.
Exercise commencement guide
Week 1 & 2 -Be more active each day and use the stairs or walk to thelocal shop.
Week 3 & 4 -Exercise every day for 10 minutes. Go for a brisk walk or swim.
Week 5 & 6 -Increase exercise time to 20 minutes every day.
Week 7 & 8 -Increase your exercise routine to 30 minutes every day.
Finally, try to be more active for at least60 minutes a day
The mention of product names in this resource does not constitute endorsem*nt by dietitians of WSLHD.
Developed by Department of Nutrition and Dietetics and the Storr Liver Unit, Westmead Hospital, Western Sydney LHD, January 2014
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