Non-alcoholic fatty liver disease (NAFLD) is an increasing epidemic in the U.S. and the rest of the world. It is the leading cause of abnormal liver enzymes and is associated with diabetes and obesity.

At this time there are few guidelines for diagnostic and follow up methods and limited proven treatment options. Previous research of pharmacological agents to treat nonalcoholic fatty liver disease were performed with poor results.

Insulin resistance is one of the key factors in the development of NAFLD, however, the gut-liver axis plays a significant contribution as well. Gut dysbiosis and intestinal hyperpermeability lead to liver damage by proinflammatory responses.

According to a recent review published in Clinical and Experimental Pharmacology and Physiology, researchers investigated the effect of polyunsaturated fatty acids (PUFAs) in nonalcoholic fatty liver disease.

This meta-analysis included all meta-analyses that examined the effect of PUFAs on liver fat and liver function tests including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT)]. In addition, subgroup analyses and sensitivity analyses were also performed. This review included 8 studies involving 6,561 participants with dosing ranging from 250 mg to 50 grams per day over a 8 to 96 weeks in duration. The subgroup analysis demonstrated a more significant effect in doses equal or less than 4 grams in a duration over 40 weeks. As a result, omega-3 fatty acid supplementation improved ALT, AST, GGT, and liver fat in patients with NAFLD. This review demonstrates that omega-3 fatty acid supplement should be considered as a therapeutic option in the treatment of NAFLD.

Research shows that patients with NAFLD have a considerable shortage of omega-3 fatty acids in their diet compared to that of healthy controls. In addition, the higher the omega-6 to omeaga-3 ratio in patients with NAFLD increases lipogenesis, which leads to the development of hepatic steatosis. It has also been reported that omega-3 fatty acid supplementation decreases hepatic fat accumulation and liver enzyme levels, improves insulin sensitivity, reduces inflammation and fibrosis.

These individuals have established disease and increased demands then what could be obtained from the diet alone and therefore, dietary supplements should be considered to mitigate to help reduce the progression and improve liver function in patients with NAFLD.

Other nutrients to consider include, delta and gamma tocotrienols, probiotics, carnitine, coenzyme Q10, berberine, and milk thistle.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Musazadeh V, Karimi A, et al. Omega-3 polyunsaturated fatty acids in the treatment of non-alcoholic fatty liver disease: An umbrella systematic review and meta-analysis. Clin Exp Pharmacol Physiol. 2023 May;50(5):327-334.

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