What is the role of diet and weight loss in the treatment of alcoholic liver disease (ALD)?

Updated: Apr 12, 2018
  • Author: Emily Tommolino, MD; Chief Editor: BS Anand, MD  more...
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No specific dietary restrictions are needed in patients with simple alcoholic steatosis. Patients with alcoholic fatty liver may have deficiencies of vitamins, minerals, and trace elements. Adequate replacement of these deficiencies should be a part of management. Protein-calorie malnutrition is a common finding in patients with alcoholic liver disease (ALD) and is associated with the major complications observed with cirrhosis. Consequently, it is vital to recognize and understand the significance of malnutrition in these patients.

A low-fat American Diabetes Association (ADA) diet is recommended, and a weight loss goal of 1-2 pounds per week is suggested. Diets associated with improvement include those restricted in rapidly absorbed carbohydrates and those with a high protein-to-calorie ratio. Weight loss should be gradual, moderate, and controlled. [40]

Mounting evidence indicates that high-fructose diets (eg, sodas and preserved foods) are factors for developing fatty liver and that their elimination may reverse fatty liver. [41, 42] The mechanism appears to be related to depletion of adenosine triphosphate (ATP), as well as to increased uric acid production from excess fructose. [43]

In mouse models of NASH, a high-fat diet combined with a high-fructose diet (equivalent to the typical American “fast food diet”) resulted in more liver damage than a high-fat diet alone. [41] In a study of rats on a high-fructose diet, exercise (swimming 1 hour a day, 5 days a week) prevented the development of fatty liver disease. [42]

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