IMPACT OF NUTRITIONAL INTERVENTIONS ON THE PROGRESSION OF NON-ALCOHOLIC STEATOHEPATITIS: A CRITICAL REVIEW

Abstract

Introduction: Nonalcoholic steatohepatitis (NASH) is a progressive liver condition associated with obesity and insulin resistance, which can progress to cirrhosis and hepatocellular carcinoma. Nutritional interventions have been studied as a noninvasive approach to slow disease progression, but evidence on their effectiveness is still scattered. Objective: This critical review aims to analyze the impact of nutritional interventions on the progression of NASH, with an emphasis on dietary changes and their implications for controlling inflammation and liver fibrosis. Methodology: A search was performed in the PubMed, Scopus and Web of Science databases to identify clinical studies and reviews published between 2015 and 2023 that investigated the effect of different nutritional interventions in patients with NASH. Studies that evaluated changes in liver fibrosis score, inflammatory markers and improvement in liver function were included. Results and Discussion: The interventions that demonstrated the most positive results were those based on calorie-restricted diets, low intake of refined carbohydrates and increased consumption of unsaturated fats and fiber. Mediterranean and low-carb diets have shown benefits in reducing inflammation and hepatic steatosis levels. However, results on the reversal of hepatic fibrosis are limited and still inconclusive. Long-term adherence has also been shown to be a critical factor for the efficacy of these interventions, highlighting the need for monitoring and continuous support strategies. Final Considerations: Nutritional interventions have the potential to play a significant role in the management of NASH, especially in the early stages of the disease. However, more longitudinal studies are needed to evaluate the reversal of hepatic fibrosis and to identify which combinations of nutrients are most effective in different patient profiles.