Nutrition and Fatty Liver Disease (NAFLD): Who Benefits Most from Dietary Changes?

‍

Non-alcoholic fatty liver disease (NAFLD) is becoming one of the most common liver conditions in New Zealand. It’s closely linked with obesity, type 2 diabetes, high cholesterol, and metabolic syndrome. Left unmanaged, NAFLD can progress to more serious conditions such as non-alcoholic steatohepatitis (NASH), advanced fibrosis, or cirrhosis.

‍

The good news? Nutrition and lifestyle changes make a measurable difference at every stage of the disease, even for people who are not overweight.

‍

Who benefits most from dietary intervention?

1. Adults with NAFLD (all body sizes)

You don’t have to be overweight to have fatty liver disease. Research shows that both lean and overweight people with NAFLD benefit from nutrition changes, particularly when following a Mediterranean-style diet or reducing overall calorie intake. These diets improve insulin sensitivity and reduce fat in the liver, even without significant weight loss.

• Overweight or obese NAFLD: Aiming for 7–10% body weight loss brings the greatest improvement in liver health.
• Lean NAFLD: Even a 3–5% reduction in weight can reduce liver fat and improve blood tests.

‍

2. People with type 2 diabetes or metabolic syndrome

New Zealanders living with type 2 diabetes, high blood pressure, or high cholesterol often see the greatest absolute benefit from diet changes for NAFLD. That’s because these conditions share common pathways with fatty liver disease, including insulin resistance.

Clinical trials show that Mediterranean-style or hypocaloric diets can:

• Improve blood sugar control
• Lower liver enzymes
• Reduce cardiovascular risk

‍

3. Children and adolescents

NAFLD is no longer just an adult problem. With childhood obesity on the rise in New Zealand, more young people are being diagnosed. Early dietary intervention can help reverse fatty liver changes and protect long-term liver health.

‍

4. People at risk of progression

Those with advanced fibrosis, cirrhosis, or strong family histories of liver disease need tailored advice. Avoiding alcohol completely, reducing sugar-sweetened drinks, and prioritising heart health are key.

‍

What does the science say?

The American Gastroenterological Association and the American Association for the Study of Liver Diseases both recommend:

• A Mediterranean diet rich in vegetables, fruit, wholegrains, legumes, nuts, olive oil, and fish.
• Cutting back on sugar-sweetened drinks and highly processed foods.
• Combining nutrition with regular physical activity for best results.

These recommendations apply whether you are overweight, lean, or somewhere in between.

‍

Some simple practical tips for New Zealanders with NAFLD:

• Swap butter and cream for olive oil or avocado
• Choose wholegrain bread (like Vogel’s or Burgen) over white bread
• Enjoy fresh or canned fish (salmon, tuna, sardines) twice a week
• Replace sugary drinks with water, soda water, or unsweetened tea
• Build meals around vegetables and legumes, with moderate amounts of lean protein

‍

Why work with a dietitian?

Every case of fatty liver disease is different. Some people also live with diabetes, heart disease, gut conditions, or cancer, which can complicate nutrition management. As a clinical dietitian, Kylie provides evidence-based, tailored plans that help you:

• Reduce liver fat safely
• Improve blood tests and metabolic health
• Manage other conditions at the same time

‍

If you’ve been diagnosed with fatty liver disease, or if you’re worried about your liver health, Kylie can help.

👉 Book an appointment today to get personalised advice that works in real life.

‍

References

1. AGA Clinical Practice Update on Lifestyle Modification Using Diet and Exercise to Achieve Weight Loss in the Management of Nonalcoholic Fatty Liver Disease: Expert Review. Younossi ZM, Corey KE, Lim JK. Gastroenterology. 2021;160(3):912-918. doi:10.1053/j.gastro.2020.11.051. Practice Guideline Leading Journal

2. Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease. Kanwal F, Shubrook JH, Adams LA, et al. Gastroenterology. 2021;161(5):1657-1669. doi:10.1053/j.gastro.2021.07.049. Practice Guideline Leading Journal

3. AGA Clinical Practice Update: Diagnosis and Management Of Nonalcoholic Fatty Liver Disease in Lean Individuals: Expert Review. Long MT, Noureddin M, Lim JK. Gastroenterology. 2022;163(3):764-774.e1. doi:10.1053/j.gastro.2022.06.023. Practice Guideline Leading Journal

4. AASLD Practice Guidance on the Clinical Assessment and Management of Nonalcoholic Fatty Liver Disease. Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. Hepatology (Baltimore, Md.). 2023;77(5):1797-1835. doi:10.1097/HEP.0000000000000323. Leading Journal

5. Nonalcoholic Fatty Liver Disease and Cardiovascular Risk: A Scientific Statement From the American Heart Association. Duell PB, Welty FK, Miller M, et al. Arteriosclerosis, Thrombosis, and Vascular Biology. 2022;42(6):e168-e185. doi:10.1161/ATV.0000000000000153. Leading Journal

6. Treatment of NAFLD With Diet, Physical Activity and Exercise. Romero-Gómez M, Zelber-Sagi S, Trenell M. Journal of Hepatology. 2017;67(4):829-846. doi:10.1016/j.jhep.2017.05.016. Leading Journal

7. Lifestyle Interventions in Nonalcoholic Fatty Liver Disease. Younossi ZM, Zelber-Sagi S, Henry L, Gerber LH. Nature Reviews. Gastroenterology & Hepatology. 2023;20(11):708-722. doi:10.1038/s41575-023-00800-4. Leading Journal

8. Evaluation of Dietary Approaches for the Treatment of Non-Alcoholic Fatty Liver Disease: A Systematic Review. Saeed N, Nadeau B, Shannon C, Tincopa M. Nutrients. 2019;11(12):E3064. doi:10.3390/nu11123064.

‍