2Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
Keywords: Nonalcoholic Fatty Liver Disease; Nutrition Assessment; Energy Restriction; Whole Grain; N-3 Polyunsaturated Fatty Acids;
Class (DP*) |
Subgroup |
Principal components |
Sugars |
Monosaccharides |
Glucose, fructose, galactose |
Disaccharides |
Sucrose, lactose, maltose, trehalose |
|
Polyols (sugar alcohols) |
Sorbitol, mannitol, lactitol, xylitol, |
|
Oligosaccharides (3-9): short-chain carbohydrates |
Malto-oligosaccharides (α-glucans) |
Maltodextrins |
Non-α-glucan oligosaccharides |
Raffinose, stachyose, fructo and galacto oligosaccharides, polydextrose, inulin |
|
Polysaccharides (≥10) |
Starch (α-glucans) |
Amylose, amylopectin, modified starches |
Non-starch polysaccharides |
Cellulose, hemicellulose, pectin, arabinoxylans, β-glucan, glucomannans, plant gums and mucilages, |
Recently, soft drinks are the main cause of sugar overconsumption and deeply related with NAFLD. NAFLD patients have been reported to consume over twice as much soft drinks daily compared with the general population, as well as the drinking frequency also significantly high [29-31]. In addition, the study by Abid et al. showed that an increase in number of consumed soft drink bottles correlates with the severeness of fatty liver evaluated by abdominal ultrasonography. This shows soft drink consumption is a strong predictive factor of fatty liver [31].
On the other hand, compiling evidence showed that appropriate consumption of non-processed whole grain, consisting of dietary fiber and vitamins or minerals with anti-oxidizing function, is beneficial for NAFLD [32]. An epidemiological study showed nonprocessed whole grain consumption reduces abdominal fat, a risk factor of NAFLD [33], and a randomized intervention study showed that it improves obesity, lipid disorders, and metabolic syndrome [34]. A meta-analysis study that investigated the effect of whole grain showed decreased risks of heart disease [35, 36], and type 2 diabetes mellitus [35, 37] with a decrease in fasting insulin level [35, 38], blood serum lipid level [35], and body weight [39], indicating improved effect on these NAFLDrelated features. These reports imply the advantages of adequate everyday consumption of whole grain in preventing or improving the disease status in NAFLD patients.
In summary, NAFLD has a deep relationship with carbohydrates, and we should be aware that specific carbohydrates cause development or progression of the disease, while others may improve the pathophysiological features.
Class |
Subgroup |
Principal components |
Simple lipids |
Triacylglycerol |
Fatty acid, glycerol |
Wax |
Fatty acid, higher aliphatic alcohol |
|
Sterol ester |
Sterol, fatty acid |
|
Compound lipids |
Phospholipid Glycerophospholipid |
Fatty acid, glycerol, phosphate, base |
Fatty acid, sphingosine, phosphate, base |
||
Glycolipid |
Fatty acid, glycerol, saccharide |
|
Fatty acid, sphingosine, saccharide |
||
Derived lipids |
Fatty acid |
|
Fat-soluble vitamin |
Lowering fat energy intake would mean to proportionally increase the energy level or percentage of carbohydrate or protein intake. Especially, the increase of carbohydrate level or percentage is known as a risk-factor for NAFLD. If fat is restricted, the n-3 PUFA that may improve NAFLD may also become of shortage. Nonetheless, the present consensus is that the effect of fat restriction on NAFLD is limited, and it should be noted that many issues are left to be answered such as the effective level or percentage of fat, or whether level or percentage is more important.
We propose that before mechanically conducting a choice between carbohydrate or fat restriction, a “nutritional diagnosis” based upon nutritional assessment of each patient should be made. Then, restriction of the excess nutrient should be corrected by this “nutritional diagnosis”. The speed of eating [79, 80], the extent of mastication [81, 82], and the order of eating [83, 84] have also been shown to change bodyweight and metabolism, making the effect of a specific nutrient or active ingredient not the sole issue of argument. In addition, restricting carbohydrates or fat should concern the subjects’ eating habits, dietary culture, local tradition, dietary environment or accessibility to purchased food (how easily the subject can purchase food). According to the “Nutrition Therapy Recommendations for the Management of Adults with Diabetes” of 2013 [85], personal and cultural preferences, lifestyle, therapeutic goals are different between patients, and thus nutrition therapy must also be conducted differentially, and that no standard evidence-based meal plan exists. The importance of nutrition therapy is that it fits with each lifestyle of personal habitual preferences. This applies to all diseases including diabetes where nutritional and dietary therapy is necessary. Taken together, nutritional and dietary therapy of NAFLD should be based upon assessment, nutritional diagnosis, and understandings of personal preferences, with concomitant settings of a nutritional care plan where energy intake can easily be decreased.
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