ABSTRACT
Nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS), which are influenced by diet and genetics, contribute individually to the increased risk for cardiovascular disease and type 2 diabetes. Understanding the etiology of these diseases is paramount to the development of effective preventive steps and treatments. Here, we focus on NAFLD as MetS has been covered elsewhere. NAFLD is a cluster of diseases that ranges from accumulation of fat in the liver to inflammation and to cirrhosis of the liver. Currently, the worldwide incidence of NAFLD is 24% and affects both adults and children. The specific mechanisms by which the liver accumulates fat are unknown but involve an imbalance in the flow of lipids entering and exiting the liver. Obesity plays a central role, as adipose tissue is involved in many pathways that directly impact the pathology of NAFLD. Interestingly, risk factors for NAFLD and its progression have been linked to specific polymorphisms 276in genes that encode for proteins involved in the metabolism of hepatic lipids. Currently, the primary treatment for NAFLD is weight loss and lifestyle changes. A hypocaloric diet and reductions in carbohydrate intake have been shown to reduce the accumulation of hepatic fat in NAFLD patients. Our recommendations for treating this patient population include not only the restriction of carbohydrates but also a specific reduction in the intake of simple sugars. Pharmacological agents such as vitamins, bile acid analogs, and probiotics and prebiotics are often prescribed in the presence of other comorbidities such as type 2 diabetes.
