One size does not fit all; practical, personal tailoring of the diet to NAFLD patients

Zelber‐Sagi, Shira; Grinshpan, Laura Sol; Ivancovsky‐Wajcman, Dana; Goldenshluger, Ariela; Gepner, Yftach

doi:10.1111/liv.15335

Cited by 49Liver Disease Diagnosis and TreatmentNutritional Studies and DietDiet and metabolism studies

One size does not fit all; practical, personal tailoring of the diet to NAFLD patients

Zelber‐Sagi, Shira, Grinshpan, Laura Sol, Ivancovsky‐Wajcman, Dana, Goldenshluger, Ariela, Gepner, Yftach·2022·Liver International

DOI 10.1111/liv.15335

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Abstract

Different dietary regimens for weight loss have developed over the years. Since the most evidenced treatment for non-alcoholic fatty liver disease (NAFLD) is weight reduction, it is not surprising that more diets targeting obesity are also utilized for NAFLD treatment. However, beyond the desired weight loss effects, one should not ignore the dietary composition of each diet, which may not necessarily be healthy or safe over the long term for hepatic and extrahepatic outcomes, especially cardiometabolic outcomes. Some of these diets are rich in saturated fat and red meat, are very strict, and require close medical supervision. Some may also be very difficult to adhere to for long periods, thus reducing the patient's motivation. The evidence for a direct benefit to NAFLD by restrictive diets such as very-low-carb, ketogenic, very-low-calorie diets, and intermittent fasting is scarce, and the long-term safety has not been tested. Nowadays, the approach is that the diet should be tailored to the patient's cultural and personal preferences. There is strong evidence for the independent protective association of NAFLD with a diet based on healthy eating patterns of minimally-processed foods, low in sugar and saturated fat, high in polyphenols, and healthy types of fats. This leads to the conclusion that a Mediterranean diet should serve as a basis that can be restructured into other kinds of diets. This review will elaborate on the different diets and their role in NAFLD. It will provide a practical guide to tailor the diet to the patients without compromising its composition and safety.

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There is currently insufficient evidence on the efficacy or safety of very low carbohydrate ketogenic diets in individuals with MASLD.
“There is currently insuf fi cient evidence on the ef fi cacy or safety of very low carbohydrate ketogenic diets -characterised by extreme carbohydrate restriction to < 20-50 g/day (10-25% of total calories) and high fat and protein contents -in individuals with MASLD, 291 taking into consideration potential cardiovascular, kidney and other side effects. 292”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [291]

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Authors: Zelber‐Sagi, S., Grinshpan, L. S., Ivancovsky‐Wajcman, D., Goldenshluger, A., & Gepner, Y.
Affiliations: University of Haifa (IL)
School of Public Health, Faculty of Social Welfare and Health Sciences University of Haifa Haifa Israel
Tel Aviv University (IL)
Corresponding author: Zelber‐Sagi, Shira
ORCID: Zelber‐Sagi, Shira
Grinshpan, Laura Sol
Ivancovsky‐Wajcman, Dana
Goldenshluger, Ariela
Gepner, Yftach
Venue: Liver International
Publisher: Wiley
Published: 2022-06-21
Volume: 42
Issue: 8
Pages: 1731-1750
ISSN: 0106-9543 (ISSN-L)
1478-3223
1478-3231
DOI: 10.1111/liv.15335
OpenAlex: W4282944700
Cited by: 49
References: 149
Citations by year: 2026: 11 · 2025: 13 · 2024: 16 · 2023: 7 · 2022: 2
FWCI: 1.51
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
Locations: Liver International (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Health Sciences › Medicine › Physiology › Diet and metabolism studies
Keywords: non-alcoholic fatty liver disease, dietary intervention, weight loss, personalized nutrition, Mediterranean diet, very low carbohydrate diet, ketogenic diet, very low calorie diet, intermittent fasting, dietary adherence, cardiometabolic outcomes, saturated fat, polyphenols
MeSH terms: Diet, Humans, Obesity, Weight Loss, Diet, Mediterranean, Non-alcoholic Fatty Liver Disease

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One size does not fit all; practical, personal tailoring of the diet to NAFLD patients

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