Non-Alcoholic Fatty Liver Disease

A build-up of fat in the liver not caused by alcohol, now the most common liver condition in Western countries and tightly linked to insulin resistance, obesity, and type 2 diabetes. Most people have no symptoms and discover it on a routine scan or blood test — and the condition is largely reversible with lifestyle change, especially if caught before scarring develops.

Evidence synthesis: Weight loss is the best-evidenced intervention: trials and meta-analyses show 5% body weight loss reduces liver fat, 7-10% can resolve steatohepatitis, and 10%+ can reverse early fibrosis. Omega-3 fatty acids (EPA/DHA, 2-4 g/day) reduce liver fat content and triglycerides in randomised trials, though effects on inflammation and fibrosis endpoints are inconsistent — hence guideline support as adjuncts for hypertriglyceridaemia rather than NAFLD treatment per se. Vitamin E (800 IU) improved liver histology in the PIVENS trial in non-diabetic NASH, but long-term safety concerns (haemorrhagic stroke, prostate cancer signal) limit its use. Coffee consumption has consistent observational associations with reduced fibrosis. No supplement substitutes for weight, glucose, and alcohol management.