Eating, diet, and nutrition for the treatment of non-alcoholic fatty liver disease

An umbrella review of the association between dietary factors and hepatocellular carcinoma risk

Background: Several meta-analyses have summarized the associations between dietary factors and the risk of hepatocellular carcinoma (HCC). However, no research has comprehensively assessed the certainty of this evidence. Methods: PubMed, Embase, and the Cochrane Library were searched from inception to August 2024. The credibility of the evidence was assessed using the pre-specified evidence classification criteria, graded as convincing ("class I"), highly suggestive ("class II"), suggestive ("class III"), weak ("class IV"), or no evidence ("class V"). To evaluate the quality of evidence, the GRADE framework was applied, categorized as "high", "moderate", "low", or "very low" quality. This study was registered at PROSPERO (CRD42023417373). Results: In total, 22 meta-analyses describing 33 non-dose-response and 10 dose-response associations were included. In the non-dose-response associations, convincing evidence (class I) supported an inverse association between coffee intake [risk ratio (RR) 0.50, 95% confidence interval 0.42 to 0.59, GRADE = very low] and risk for HCC. Suggestive evidence (class III) supported the effect of fish (RR 0.81, 0.73 to 0.90; very low), fiber (RR 0.71, 0.61 to 0.84; low), and the Mediterranean diet (RR 0.67, 0.56 to 0.80; very low) in lowering the risk for HCC. Weak evidence (class IV) suggested the protective effects of ginseng, selenium, cruciferous vegetables, whole grains, and vegetables, against HCC, and the negative effect of saturated fat in increasing the risk for HCC. In the dose-response association, convincing evidence (class I) supported that an additional two cups of coffee per day (RR 0.71, 0.60 to 0.77; moderate) lowered HCC risk, and suggestive evidence (class III) indicated that an increase of 10 g day-1 in fiber intake (RR 0.83, 0.76 to 0.91; moderate) lowered HCC risk. Weak evidence (class IV) suggests positive associations between HCC risk and a 1% daily increase in energy from saturated fat and a 100 mg day-1 increase in cholesterol. Conclusions: Dietary factors, especially coffee, fish, fiber, and the Mediterranean diet, are associated with HCC risk. These findings provide a theoretical basis for developing and evaluating dietary interventions to reduce HCC risk.

Association between dietary amino acid intake and the risk of metabolic dysfunction-associated steatotic liver disease

INTRODUCTION

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is becoming the major chronic liver disease, and diet plays crucial role in MASLD prevention.

OBJECTIVES

The study aimed to explore the association between dietary amino acids with MASLD risk.

METHODS

Utilizing data from the U.S. NHANES (2017-2020) and UK Biobank (2006-2010), we investigated the association between dietary intake of combined or specific amino acids, and the risk of MASLD, severe MASLD and MASLD-related events. And we identified MASLD-risk amino acid intake patterns and their primary food sources.

RESULTS

The study included 5,568 participants from the U.S. NHANES and 48,261 from the UK Biobank, with MASLD prevalence of 34.3 % and 28.4 %, respectively. In QGC model, each quartile increase in combined amino acid intake was associated with a higher MASLD risk in the U.S. NHANES (aOR = 1.17, 95 % CI: 1.01-1.37, P = 0.035) and UK Biobank (aOR = 1.07, 95 % CI: 1.002-1.15, P = 0.042). Increased lysine intake was particularly linked to elevated MASLD risk in U.S. NHANES (aOR = 1.49, 95 % CI: 1.08-2.05, P = 0.023) and UK Biobank (aOR = 1.12, 95 % CI: 1.01-1.24, P = 0.032). Substituting lysine with other amino acids was associated with reduced MASLD risk. Lysine intake was also associated with a higher risk of severe MASLD (aHR = 1.13, 95 % CI: 1.04-1.23, P = 0.002) but not liver cirrhosis or HCC. The 'Lys-Met' pattern was identified as a MASLD-risk pattern, with red meats being a representative food source.

CONCLUSION

Lysine plays a major role in the association between amino acid intake and risk of MASLD. Dietary patterns rich in lysine, such as red meat, could be key targets for MASLD prevention strategies.

ASS1 is a hub gene and possible therapeutic target for regulating metabolic dysfunction-associated steatotic liver disease modulated by a carbohydrate-restricted diet

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease globally. A low-carbohydrate diet (LCD) offers benefits to MASLD patients, albeit its exact mechanism is not fully understood. Using public liver transcriptome data from MASLD patients before/after LCD intervention, we applied differential expression analysis and machine learning to identify key genes. We initially identified 162 differentially expressed genes in the GSE107650 dataset. Secondly, employing two machine learning algorithms, we found that PRAMENP, LEAP2, LOC105379013, and argininosuccinate synthetase 1 (ASS1) are potential hub genes. Additionally, protein-protein interaction and single-cell RNA location analyses suggested that ASS1 was the most crucial hub gene. Then, L1000CDS2 analysis of the gene-expression signatures was employed for drug repurposing studies. CGP71683, an appetite suppressant, was predicted to improve MASLD and may mimic the ASS1 expression pattern induced by an LCD. Molecular dynamics confirmed spontaneous, stable CGP71683-ASS1 complex formation. Overall, this work based on analysis of machine learning algorithms, essential gene identification, and drug repurposing studies suggested that ASS1 is an essential gene in MASLD and CGP71683 is a potential drug candidate for treating MASLD by targeting ASS1 and mimicking the beneficial effects of an LCD. However, due to the inherent limitations of a purely computational approach, further experimental investigation is necessary to validate the anticipated results.

Sex-Specific Biochemical and Histopathological Effects of Chronic Meat-Based vs. Plant-Based Burger Consumption in a Rodent Model

The growing consumption of processed foods, including meat-based and plant-based burgers (PBM), raises concerns about their long-term health effects. While PBM burgers are marketed as healthier alternatives, their biochemical and histological impacts remain unclear. This study investigates the effects of chronic meat-based and PBM burger consumption on metabolic and organ health, considering sex differences. Thirty-six Wistar rats (18 males and 18 females) were divided into three groups: control (standard chow), meat burger-fed, and PBM burger-fed. Improved chow was prepared using lyophilized burger powder. Over eight weeks, food intake, weight gain, and food efficiency ratio (FER) were monitored. Serum biochemical markers, including AST, ALT, urea, creatinine, lipid profile (TG, CHOL, HDL, LDL), and leptin, were analyzed, alongside histopathological evaluation of the liver, kidneys, and heart. PBM-fed rats exhibited significantly higher FER than the meat group (p < 0.05). AST and ALT levels were slightly elevated in meat-fed rats, while PBM-fed males had increased urea levels. Triglyceride levels were significantly higher in the meat group, but cholesterol levels did not differ significantly. Serum leptin was elevated in both experimental groups, suggesting leptin resistance. Histological findings showed mild hepatic inflammation and microvacuolar changes, with minor cardiac fibrosis. These findings highlight the need for further research on PBM's long-term health effects.

YouTube as a Source of Information for Dietary Guidance and Advisory Content in the Management of Non-Alcoholic Fatty Liver Disease

Background/Objectives: Fatty liver disease (FLD), particularly non-alcoholic fatty liver disease (NAFLD), is a growing global health concern that underscores the need for effective dietary management strategies. With over 25% of patients seeking dietary advice through platforms like YouTube, the quality and reliability of this information remain critical. However, the disparity in educational value and engagement metrics between professional and non-professional content remains underexplored. This study evaluates YouTube's role in disseminating dietary advice for FLD management, focusing on content reliability, engagement metrics, and the educational value of videos. Methods: This cross-sectional study systematically analyzed 183 YouTube videos on FLD and dietary advice. Videos were selected based on relevance, English language, and non-promotional content. Scoring systems, including DISCERN, Global Quality Score (GQS), and the Video Information and Quality Index (VIQI), were employed to assess reliability, quality, and educational value. Engagement metrics such as views, likes, dislikes, and interaction rates were analyzed across uploader categories, including healthcare professionals, patients, and undefined sources. Results: Videos uploaded by healthcare professionals demonstrated significantly higher DISCERN scores (4.2 ± 0.8) and GQS ratings (4.1 ± 0.6) compared to patient-generated content (DISCERN: 2.8 ± 0.9; GQS: 3.0 ± 0.7). However, patient-generated videos achieved higher engagement rates, with median views reaching 340,000 (IQR: 15,000-1,000,000) compared to 450,050 (IQR: 23,000-1,800,000) for professional videos. Nutritional recommendations spanned diverse approaches, including low-carb diets, Mediterranean diets, and guidance to avoid processed foods and sugars. A significant proportion of videos lacked evidence-based content, particularly among non-professional uploads. Conclusions: YouTube represents a widely accessed but inconsistent source of dietary advice for FLD. While healthcare professional videos exhibit higher reliability and educational value, patient-generated content achieves broader engagement, revealing a critical gap in trusted, accessible dietary guidance. These findings highlight the need for clinicians and content creators to collaborate in curating and disseminating evidence-based content, ensuring patients receive accurate, actionable advice for managing FLD.

Dietary and lifestyle indices for hyperinsulinemia and odds of MAFLD in overweight and obese children and adolescents

Lifestyle and dietary intake play a pivotal role in development of metabolic dysfunction-associated fatty liver disease(MAFLD). We performed this cross-sectional study to evaluate the association between lifestyle and dietary insulinemic potential and odds of MAFLD in overweight and obese children and adolescents. The insulinemic potential of the diet and lifestyle was assessed by computing the scores of the empirical dietary index for hyperinsulinemia(EDIH), the empirical lifestyle index for hyperinsulinemia(ELIH), the empirical dietary index for insulin resistance(EDIR), and the empirical lifestyle index for insulin resistance(ELIR). MAFLD was diagnosed according to the consensus definitions. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by logistic regression. A total of 334 (49.1% boys) with mean ± SD age and BMI-for-age-Z-score of 9.3 ± 1.8 and 2.55 ± 0.69, respectively, were enrolled. After adjusting for all potential confounders, participants in the highest quartile of ELIH score had greater odds of developing MAFLD (OR:3.50;95%CI:1.49-8.22) compared with those in the lowest quartile. This association remained significant among boys and pubertal ones. However, no significant association between EDIH, EDIR, or ELIR and odds of MAFLD was found. Our study suggests that the collective insulinemic potential of dietary intake, BMI, and physical activity is associated with increased odds of MAFLD.

Monascus pilosus SWM-008 red mold rice and its components, monascinol and monascin, reduce obesity in a high-fat diet-induced rat model through synergistic modulation of gut microbiota and anti-lipogenesis

This study is the first to explore the effects of the novel yellow pigment monascinol (Msol) from red mold rice (RMR) on reducing body fat and to compare its effects with those of monascin (MS) and ankaflavin (AK). In a high-fat diet-induced rat model, different doses of RMR fermented rice (RL, RM, RH) and purified Msol, MS, and AK were administered over an 8-week period. The results showed that all treatment groups significantly reduced body weight and fat mass. Msol, in particular, activated acetyl-CoA carboxylase (ACC), inhibiting fatty acid synthesis and reducing triglyceride accumulation. All treatments suppressed the differentiation of preadipocytes into mature adipocytes by inhibiting CCAAT/enhancer-binding proteins β (C/EBPβ) and C/EBPα, as well as peroxisome proliferator-activated receptor γ (PPARγ). In the liver, RL, RM, RH, MS, and AK enhanced the expression of AMP-activated protein kinase (AMPK), ACC, peroxisome proliferator-activated receptor α (PPARα), and carnitine palmitoyl transferase-1α (CPT-1α), thereby promoting fatty acid metabolism. Additionally, RMR and its active components, MS and Msol, reduced body fat by modulating gut microbiota. These compounds significantly decreased the abundance of bacteria associated with fat storage, such as Oliverpabstia intestinalis, while increasing the abundance of bacteria linked to energy expenditure and lipid breakdown, such as Akkermansia muciniphila and Ruminococcus callidus. Moreover, MS and Msol upregulated proteins involved in fat degradation, such as UCP1, thereby enhancing fat burning and reducing fat accumulation. These regulatory effects suggest that Monascus and its components have potential in managing metabolic health and reducing obesity.

Treating Metabolic Dysregulation and Senescence by Caloric Restriction: Killing Two Birds with One Stone?

Cellular senescence is a state of permanent cell cycle arrest accompanied by metabolic activity and characteristic phenotypic changes. This process is crucial for developing age-related diseases, where excessive calorie intake accelerates metabolic dysfunction and aging. Overnutrition disturbs key metabolic pathways, including insulin/insulin-like growth factor signaling (IIS), the mammalian target of rapamycin (mTOR), and AMP-activated protein kinase. The dysregulation of these pathways contributes to insulin resistance, impaired autophagy, exacerbated oxidative stress, and mitochondrial dysfunction, further enhancing cellular senescence and systemic metabolic derangements. On the other hand, dysfunctional endothelial cells and adipocytes contribute to systemic inflammation, reduced nitric oxide production, and altered lipid metabolism. Numerous factors, including extracellular vesicles, mediate pathological communication between the vascular system and adipose tissue, amplifying metabolic imbalances. Meanwhile, caloric restriction (CR) emerges as a potent intervention to counteract overnutrition effects, improve mitochondrial function, reduce oxidative stress, and restore metabolic balance. CR modulates pathways such as IIS, mTOR, and sirtuins, enhancing glucose and lipid metabolism, reducing inflammation, and promoting autophagy. CR can extend the health span and mitigate age-related diseases by delaying cellular senescence and improving healthy endothelial-adipocyte interactions. This review highlights the crosstalk between endothelial cells and adipocytes, emphasizing CR potential in counteracting overnutrition-induced senescence and restoring vascular homeostasis.

Effects of Intermittent Calorie Restriction in Nondiabetic Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease

BACKGROUND & AIMS

We compared the effects of a 12-week intermittent calorie restriction (ICR) and standard-of-care (SOC) diet on liver fat content (LFC) in metabolic dysfunction-associated steatotic liver disease patients.

METHODS

This randomized controlled trial included patients with magnetic resonance imaging-proton density fat fraction ≥8%. Patients were randomly assigned to the ICR (5:2 diet) or SOC (80% of the recommended calorie intake) groups and stratified according to the body mass index (≥25 or <25 kg/m2). The primary outcome was the proportion of patients who achieved a relative LFC reduction as measured by magnetic resonance imaging-proton density fat fraction ≥30%.

RESULTS

Seventy-two participants underwent randomization (36 patients with and 36 without obesity), and 63 (34 patients with and 29 without obesity) completed the trial. At week 12, a higher proportion of patients in the ICR arm achieved a relative LFC reduction of ≥30% compared with the SOC arm (72.2% vs 44.4%; P = .033), which was more prominent in the group with obesity (61.1% vs 27.7%; P = .033) than in the group without obesity (83.3% vs 61.1%; P = .352). The relative weight reduction was insignificant between the ICR and SOC arms (-5.3% vs -4.2%; P = .273); however, it was higher in the ICR arm compared with the SOC arm (-5.5% vs -2.9%; P = .039) in the group with obesity. Changes in fibrosis, muscle and fat mass, and liver enzyme levels were similar between the 2 groups (all P > .05).

CONCLUSIONS

The ICR diet reduced LFC more effectively than SOC in patients with metabolic dysfunction-associated steatotic liver disease, particularly in patients with obesity. Additional studies are warranted in larger and more diverse cohorts.

CLINICALTRIALS

gov, Number: NCT05309642.

Total choline intake, liver fibrosis and the progression of metabolic dysfunction-associated steatotic liver disease: Results from 2017 to 2020 NHANES

OBJECTIVES

This study investigated the cross-sectional relationships of total choline intake with the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and its progression to liver fibrosis.

STUDY DESIGN

The study used data on total choline intake, hepatic steatosis, and liver fibrosis from the cross-sectional 2017-2020 National Health and Nutrition Examination Survey, including 24-h dietary recalls and liver ultrasound elastography (FibroScan®).

MAIN OUTCOME MEASURES

Steatosis was defined as a controlled attenuation parameter score ≥ 285dB/m. Fibrosis was defined as median liver stiffness ≥8 kPa. Complex survey-adjusted regression models were used in all analyses. Effect modification by sex, race, and cardiometabolic risk factors was investigated.

RESULT

Total choline intake was not associated with MASLD status (n = 5687; odds ratio per 100 mg/d [95 % confidence interval]: 0.96 [0.85,1.09]; P = 0.55). However, among people with MASLD, a higher total choline intake was associated with higher odds of fibrosis (n = 2019; 1.15 [1.01,1.30]; P = 0.03). This association was observed in men (P-interaction = 0.1; 1.23 [1.02,1.48]; P = 0.03), but not in women (1.05 [0.88,1.24]; P = 1.0). Choline intake also tended to be positively associated with fibrosis in people with MASLD who were overweight or had central obesity (P-interaction = 0.02; 1.15 [1.00,1.34]; P = 0.06).

CONCLUSIONS

Overall, no significant association was observed between total choline intake and the prevalence of MASLD. However, in people with MASLD, a higher choline intake was associated with higher odds of developing liver fibrosis. This association appeared to differ by sex and cardiometabolic risk factors.

Prevalence of Liver Steatosis Among Workers in Ouagadougou and Associated Factors: A Cross-Sectional Study

Aims

Liver steatosis prevalence is growing, linked to the current worldwide epidemics of obesity and Type 2 diabetes. In sub-Saharan Africa, data on apparent healthy workers must still be included. This study aimed to determine the prevalence of hepatic steatosis and its associated factors in the workplace.

Methods and Results

A cross-sectional study was conducted from July to October 2022 in seven selected public and private works places in Ouagadougou, Burkina Faso. Workers still in activity were enrolled by random sampling. Sociodemographic and anthropometric characteristics and blood pressure measurements were performed using standard procedures. Blood samples for fasting blood glucose, cholesterol (total, HDL, LDL), triglycerides, transaminases (AST, ALT), gamma-glutamyl-transferase, C reactive protein, uric acid, surface antigen of hepatitis B (HBsAg), antibody to hepatitis C virus (anti-HCV), and HIV antibodies have been realized. Liver steatosis was assessed by FIBROSCAN with controlled attenuation parameter (CAP). An adjusted logistic regression analysis was performed. A significance level of 5% was applied. A total of 500 workers were included in this study. Among them, 293 (58.6%) were men. The prevalence of hepatic steatosis was 18% (95% CI: 14.7-21.7). Factors associated with hepatic steatosis were age over 50 (p = 0.038), waist circumference (p = 0.0001), body mass index (p = 0.008), and cytolysis (p = 0.001).

Conclusion

Liver steatosis affects almost a fifth of working people. Health policies must step up the fight against obesity and other nutrition-related noncommunicable diseases.

The Interplay Between Depression, Probiotics, Diet, Immunometabolic Health, the Gut, and the Liver-A Secondary Analysis of the Pro-Demet Randomized Clinical Trial

(1) Background: Depression, metabolic alternations, and liver diseases are highly comorbid. Studies have shown that probiotics might be helpful in the treatment of the above-mentioned states. The aim of this secondary analysis was to search for possible predictors of probiotics' efficacy on liver-related outcome measures. (2) Methods: Data from 92 subjects from a randomized clinical trial on the effect of probiotics on depression were analyzed. The shift in liver steatosis and fibrosis indices was assessed in the context of baseline immunometabolic, psychometric, dietary, and intestinal permeability factors. Correlation analysis and linear regression models were used. (3) Results: A total of 30% of the variance of the improvement in the score of the aspartate transferase to platelet ratio index was explained by probiotic use, higher pre-intervention triglycerides, cholesterol, C-reactive protein levels, increased cereal intake, and a lower consumption of sweets. Then, the model of the change in alanine transferase indicated that probiotics were efficient when used by subjects with higher basal levels of intestinal permeability markers. (4) Conclusions: Probiotics being used along with a healthy diet may provide additional benefits, such as decreased cardiovascular risk, for patients with measures consistent with the immunometabolic form of depression. Probiotic augmentation may be useful for liver protection among subjects with a suspected "leaky gut" syndrome. ClinicalTrials.gov: NCT04756544.

Synergistic Effects of Fructose and Food Preservatives on Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): From Gut Microbiome Alterations to Hepatic Gene Expression

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health problem closely linked to dietary habits, particularly high fructose consumption. This study investigates the combined effects of fructose and common food preservatives (sodium benzoate, sodium nitrite, and potassium sorbate) on the development and progression of MASLD. Methods: We utilized a human microbiota-associated mouse model, administering 10% fructose with or without preservatives for 11 weeks. Liver histology, hepatic gene expression (microarray analysis), biochemical markers, cytokine profiles, intestinal permeability, and gut microbiome composition (16S rRNA and Internal Transcribed Spacer (ITS) sequencing) were evaluated. Results: Fructose and potassium sorbate synergistically induced liver pathology characterized by increased steatosis, inflammation and fibrosis. These histological changes were associated with elevated liver function markers and altered lipid profiles. The treatments also induced significant changes in both the bacterial and fungal communities and disrupted intestinal barrier function, leading to increased pro-inflammatory responses in the mesenteric lymph nodes. Liver gene expression analysis revealed a wide range of transcriptional changes induced by fructose and modulated by the preservative. Key genes involved in lipid metabolism, oxidative stress, and inflammatory responses were affected. Conclusions: Our findings highlight the complex interactions between dietary components, gut microbiota, and host metabolism in the development of MASLD. The study identifies potential risks associated with the combined consumption of fructose and preservatives, particularly potassium sorbate. Our data reveal new mechanisms that are involved in the development of MASLD and open up a new avenue for the prevention and treatment of MASLD through dietary interventions and the modulation of the microbiome.

Metformin: Beyond Type 2 Diabetes Mellitus

Metformin was developed from an offshoot of Guanidine. It is known to be the first-line medication for type 2 diabetes mellitus, polycystic ovarian syndrome, and weight reduction. Metformin has also been shown to have effectiveness in the management of non-alcoholic fatty liver disease (NAFLD), liver cirrhosis, and various carcinomas like hepatocellular, colorectal, prostate, breast, urinary bladder, blood, melanoma, bone, skin, lung and so on. This narrative review focuses on the effect of metformin on non-alcoholic fatty liver disease, liver cirrhosis, and hepatocellular carcinoma. The search platforms for the topic were PubMed, Scopus, and Google search engine. Critical words for searching included 'Metformin,' AND 'Indications of Metformin,' AND 'Non-Alcoholic Fatty Liver Disease,' AND 'Metformin mechanism of action,' AND 'NAFLD management,' AND 'NAFLD and inflammation,' AND 'Metformin and insulin,' AND 'Metformin and inflammation,' AND 'Liver cirrhosis,' AND 'Hepatocellular carcinoma.' Lifestyle modification and the use of hypoglycemic agents can help improve liver conditions. Metformin has several mechanisms that enhance liver health, including reducing reactive oxygen species, nuclear factor kappa beta (NF-κB), liver enzymes, improving insulin sensitivity, and improving hepatic cell lipophagy. Long-term use of metformin may cause some adverse effects like lactic acidosis and gastrointestinal disturbance. Metformin long-term overdose may lead to a rise in hydrogen sulfide in liver cells, which calls for pharmacovigilance. Drug regulating authorities should provide approval for further research, and national and international guidelines need to be developed for liver diseases, perhaps with the inclusion of metformin as part of the management regime.

Transcriptomic Landscape Analysis Reveals a Persistent DNA Damage Response in Metabolic Dysfunction-associated Steatohepatitis Post-dietary Intervention

BACKGROUND AND AIMS

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its more advanced form, metabolic dysfunction-associated steatohepatitis, have emerged as the most prevalent liver diseases worldwide. Currently, lifestyle modification is the foremost guideline-recommended management strategy for MASLD. However, it remains unclear which detrimental signals persist in MASLD even after disease remission. Thus, we aimed to examine the persistent changes in liver transcriptomic profiles following this reversal.

METHODS

Male C57BL/6J mice were divided into three groups: Western diet (WD) feeding, chow diet (CD) feeding, or diet reversal from WD to CD. After 16 weeks of feeding, RNA sequencing was performed on the mice's livers to identify persistent alterations characteristic of MASLD. Additionally, RNA sequencing databases containing high-fat diet-fed P53-knockout mice and human MASLD samples were utilized.

RESULTS

WD-induced MASLD triggered persistent activation of the DNA damage response (DDR) and its primary transcription factor, P53, long after the resolution of the hepatic phenotype through dietary reversal. Elevated levels of P53 might promote apoptosis, thereby exacerbating metabolic dysfunction-associated steatohepatitis, as they strongly correlated with hepatocyte ballooning, an indicator of apoptosis activation. Moreover, P53 knockout in mice led to downregulated expression of apoptosis signaling in the liver. Mechanistically, P53 may regulate apoptosis by transcriptionally activating the expression of apoptosis-enhancing nuclease (AEN). Consistently, P53, AEN, and the apoptosis process all exhibited persistently elevated expression and showed a strong inter-correlation in the liver following dietary reversal.

CONCLUSIONS

The liver demonstrated upregulation of DDR signaling and the P53-AEN-apoptosis axis both during and after exposure to WD. Our findings provide new insights into the mechanisms of MASLD relapse, highlighting DDR signaling as a promising target to prevent MASLD recurrence.

Beneficial effects of intermittent fasting on nonalcoholic fatty liver disease: a narrative review

Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, and it is characterized by a series of fatty liver diseases that can lead to severe liver disease. Although no therapeutic drug has been approved as an effective therapy for NAFLD to date, dietary changes and physical activity are thought to be the cornerstone of NAFLD management. For this reason, some articles are available to analyze the studies done so far using various modifications of intermittent fasting (IF) among animals and patients with NAFLD. Data from preclinical and clinical trials suggested that IF positively impacts inflammatory and metabolic markers in both animals and humans. Inflammation and oxidative stress are the major risk factors involved in the pathogenesis of NAFLD. IF has been shown to have positive benefits in alleviating metabolic disorders, promoting the browning of white tissue, resetting circadian rhythm, and activating autophagy of cells. This review is intended to provide a detailed synopsis of the protocols, potential mechanisms of action, and supporting evidence for IF in NAFLD. We will highlight what is currently known about IF approaches in NAFLD treatments in clinical populations with mechanism insight from animal studies, and the safety concerns in certain patient groups.

Graphical Abstract

The protocols of intermittent fasting (IF) are various. Data from trials suggested that IF positively impacts both humans and animals. IF has been shown to have potential treatments for nonalcoholic fatty liver disease.

Dietary modulation of gut microbiota affects susceptibility to drug-induced liver injury

The rising incidence of drug-induced liver injury (DILI) parallels contemporary dietary shifts that have transformed the composition of human gut microbiota. The relationship between these phenomena remains unknown. Here, it is unveiled that a high fiber diet (HFiD) provides substantial protection against DILI, whereas a western style diet (WSD) significantly exacerbates DILI. Gut microbiota transplantation further confirms these differing outcomes are mediated by diet-induced variations in gut microbiota. Mechanistically, Lactobacillus acidophilus, enriched by HFiD, alleviates DILI through its metabolite indole-3-lactic acid (ILA), which activates the AhR/Nrf2 signaling pathway, thus enhancing hepatocellular antioxidant defenses and detoxification capacity. In the clinical intervention of subjects with prediabetes (N = 330), dietary fiber intervention enriches intestinal L. acidophilus, elevates serum ILA levels, and improves liver function. Conversely, WSD induces disturbance in bile acid metabolism and dysbiosis in gut microbiota, which impairs the intestinal barrier and facilitates the translocation of lipopolysaccharides (LPS) to the liver, thus triggering inflammatory responses and exacerbating DILI. These results demonstrate that dietary patterns significantly influence the onset of DILI by modulating gut microbiota. This novel insight expands the understanding of DILI risk factors and highlights the potential of dietary modifications as a preventive strategy against DILI.

Ramadan fasting model exerts hepatoprotective, anti-obesity, and anti-hyperlipidemic effects in an experimentally-induced nonalcoholic fatty liver in rats

BACKGROUND

The epidemic of nonalcoholic fatty liver disease (NAFLD) and its metabolic effects present a serious public health concern. We hypothesized that the Ramadan fasting model (RFM), which involves fasting from dawn to dusk for a month, could provide potential therapeutic benefits and mitigate NAFLD. Accordingly, we aimed to validate this hypothesis using obese male rats.

METHODS

Rats were split into two groups (n = 24 per group), and they were given either a standard (S) or high-fat diet (HFD) for 12 weeks. During the last four weeks of the study period, both S- and HFD-fed rats were subdivided into eight groups to assess the effect of RFM with/without training (T) or glucose administration (G) on the lipid profile, liver enzymes, and liver structure (n = 6/group).

RESULTS

The HFD+RFM group exhibited a significantly lower final body weight than that in the HFDC group. Serum cholesterol, low-density lipoprotein, and triglyceride levels were significantly lower in the HFD+RFM, HFD+RFM+T, and HFD+RFM+G groups than those in the HFDC group. Compared with the HFDC group, all groups had improved serum high-density lipoprotein levels. Furthermore, HFD groups subjected to RFM had reduced serum levels of aspartate transaminase and alanine transaminase compared with those of the HFD-fed group. Moreover, the liver histology improved in rats subjected to RFM compared with that of HFD-fed rats, which exhibited macro- and micro-fat droplet accumulation.

CONCLUSION

RFM can induce positive metabolic changes and improve alterations associated with NAFLD, including weight gain, lipid profile, liver enzymes, and hepatic steatosis.

β-hydroxybutyrate: A crucial therapeutic target for diverse liver diseases

β-hydroxybutyrate (β-HB), the most abundant ketone body, is produced primarily in the liver and acts as a substitute energy fuel to provide energy to extrahepatic tissues in the event of hypoglycemia or glycogen depletion. We now have an improved understanding of β-HB as a signal molecule and epigenetic regulatory factor as a result of intensive research over the last ten years. Because β-HB regulates various physiological and pathological processes, it may have a potential role in the treatment of metabolic diseases. The liver is the most significant metabolic organ, and the part that β-HB plays in liver disorders is receiving increasing attention. In this review, we summarize the therapeutic effects of β-HB on liver diseases and its underlying mechanisms of action. Moreover, we explore the prospects of exogenous supplements and endogenous ketosis including fasting, caloric restriction (CR), ketogenic diet (KD), and exercise as adjuvant nutritional therapies to protect the liver from damage and provide insights and strategies for exploring the treatment of various liver diseases.

Synergistic Effect of Diet and Physical Activity on a NAFLD Cohort: Metabolomics Profile and Clinical Variable Evaluation

Together with its comorbidities, nonalcoholic fatty liver disease (NAFLD) is likely to rise further with the obesity epidemic. However, the literature's evidence shows how its progression can be reduced by the administration of calorie-restrictive dietary interventions and physical activity regimens. The liver function and the gut microbiota have been demonstrated to be closely related. With the aim of ascertaining the impact of a treatment based on the combination of diet and physical activity (versus physical activity alone), we recruited 46 NAFLD patients who were divided into two groups. As a result, we traced the connection between volatile organic compounds (VOCs) from fecal metabolomics and a set of statistically filtered clinical variables. Additionally, we identified the relative abundances of gut microbiota taxa obtained from 16S rRNA gene sequencing. Statistically significant correlations emerged between VOCs and clinical parameters, as well as between VOCs and gut microbiota taxa. In comparison with a physical activity regimen alone, we disclose how ethyl valerate and pentanoic acid butyl ester, methyl valerate, and 5-hepten-2-one, 6-methyl changed because of the positive synergistic effect exerted by the combination of the Mediterranean diet and physical activity regimens. Moreover, 5-hepten-2-one, 6-methyl positively correlated with Sanguinobacteroides, as well as the two genera Oscillospiraceae-UCG002 and Ruminococcaceae UCG010 genera.

Effect of Nut Consumption on Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

Although previous epidemiological studies have been conducted to investigate the relationship between nut consumption and the risk of nonalcoholic fatty liver disease (NAFLD), the evidence remains inconclusive and contentious. The aim of our study was to further conduct a meta-analysis of observational studies to explore the latest evidence of the influence of nut consumption on NAFLD. This meta-analysis included a comprehensive search of all articles published in the PubMed and Web of Science online databases as of April 2023. A total of 11 articles were included, comprising 2 prospective cohort studies, 3 cross-sectional studies, and 7 case-control studies, and a random effects model was used to evaluate the relationship between nuts and NAFLD. Results showed that the odds ratio (OR) of NAFLD was 0.90 (95% CI: 0.81-0.99, p < 0.001) when comparing the highest and lowest total nut intake, indicating a significant negative correlation. Furthermore, subgroup analysis revealed that the protective effect of nuts on NAFLD was more significant in females (OR = 0.88; 95% CI: 0.78-0.98, I² = 76.2%). In summary, our findings provide support for a protective relationship between nut intake and risk of NAFLD. Further exploration of the association between other dietary components and NAFLD is an important avenue for future research.