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

Shira Zelber-Sagi*, Laura Sol Grinshpan, Dana Ivancovsky-Wajcman, Ariela Goldenshluger, Yftach Gepner

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations


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.

Original languageEnglish
Pages (from-to)1731-1750
Number of pages20
JournalLiver International
Issue number8
StatePublished - Aug 2022


  • Mediterranean diet
  • fatty liver
  • ketogenic diet
  • low-carb diet
  • low-fat diet
  • time-restricted eating


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