NAFLD is often associated with obesity and/or with diabetes, and insulin resistance is the key causative agent. Four phenotypes of NAFLD are defined: obesity; type II diabetes mellitus; metabolic syndrome; and PNPLA3 is a genetic marker for NAFLD in lean individuals. Talk to you briefly about how diet improves fatty liver. Energy restriction is key Excessive energy intake is a major risk factor for obesity and related complications, and weight gain, even as little as 3-5 kilograms, can develop NAFLD, regardless of baseline weight. Interestingly, not only excessive energy intake but also the way food is consumed affects hepatic fat accumulation. A prospective controlled study demonstrated that even though the same calorie intake was consumed, an increased number of times was an increased risk factor for NAFLD, i.e., snacking is an important contributor to fatty liver. Whether consuming more omega-3 fatty acid-based supplements is beneficial for NAFLD Experimental studies have shown that diets rich in omega-3 polyunsaturated fatty acids (PUFAs) increase insulin sensitivity, reduce intrahepatic triglyceride levels and ameliorate steatohepatitis.Members of the omega-3 fatty acid family, principally alpha-linolenic acid, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), are derived from deep-sea fish or nut-based foods. The use of different types and doses of omega-3 supplements was found to be beneficial in reducing liver fat accumulation in a small sample meta-analysis. In another study of omega-3 supplementation with 10 randomized controls, it was found that although omega-3 reduced liver fat, it did not lower transaminases such as ALT,AST. Recent liver pathology has also shown such seemingly contradictory results, with reduced liver steatosis but no improvement in steatohepatitis or liver fibrosis. It can be simply understood here that supplementation with omega-3 polyunsaturated fatty acids does not require deliberate supplementation, but rather an appropriate increase in the food in question. The Mediterranean Diet is a generalized reference to the dietary style of fruits and vegetables, fish, grains, legumes, and olive oil that is predominant in the southern European countries along the Mediterranean Sea, such as Greece, Spain, France, and southern Italy. Studies have found that the Mediterranean diet reduces the risk of heart disease, protects the brain from blood vessel damage, and reduces the risk of stroke and memory loss. The picture above shows the pyramid diet structure of the Mediterranean diet, which simply tells us that red meat and desserts should be eaten sparingly, and the concept of eating sparingly is understood to be just 1-2 times a month, chicken, eggs, and milk are also eaten only moderately, fish can be eaten regularly, and grains and cereals are the staple food, but of course, the amount should be controlled. In the treatment of nonalcoholic fatty liver disease (NAFLD), lifestyle interventions can be effective in inducing weight loss, reducing cardiovascular and diabetic risk, and also improving liver disease. 10% weight loss induces at least one step (graded staging) of improvement in NAFLD and fibrosis. However, the Mediterranean diet, which reduces liver fat even without weight loss after the diet, is the most recommended dietary pattern for NAFLD. The Mediterranean diet is characterized by a reduction in carbohydrate intake, especially sugar and refined carbohydrates, and an increase in monounsaturated and omega-3 fatty acid intake. The traditional Mediterranean diet is characterized by a high intake of olive oil, an abundance of monounsaturated fats, nuts, fruits and legumes, vegetables and fish, and a low intake of red meat, processed meats, and sweets (wine in moderation). In comparison with a low-fat diet, the Mediterranean diet derives only 40% of its energy from fat, whereas even a strict low-fat diet contains 50-60% of calories, and the Mediterranean diet allows for a greater increase in monounsaturated and omega-3 fatty acid intake. Another feature of the Mediterranean diet is the reduction of sugar and refined carbohydrates. The reduction of these substances can contribute to the reduction of advanced glycosylation end products (AGEs), and AGEs are not a good thing! AGEs can combine with various tissue cells in the human body and destroy these tissue cells, thus causing harm to the human body. Research has proven that AGEs can accelerate aging and cause various chronic degenerative diseases, such as diabetes, Alzheimer’s disease, atherosclerosis and other diseases. Therefore, lowering AGEs can play a role in anti-aging and preventing various chronic degenerative diseases. AGEs are now thought to be elevated in patients with NAFLD. Mediterranean Diet and Alcohol Consumption In the traditional Mediterranean diet 1-2 glasses of wine per day are recommended, and while this recommendation may be beneficial for cardiovascular disease, it is indeed debatable whether it is beneficial for liver disease, and it is clearly not recommended for patients with cirrhosis. The Mediterranean Diet and coffee It is recommended to drink 2-3 cups of coffee per day, as coffee is beneficial for liver disease, see “Coffee, it’s time for your prescription”!