Personalised Nutrition in Non-Alcoholic Fatty Liver Disease (NAFLD): Feasibility of a Nutrigenomic Therapeutic Approach
NAFLD is a metabolic liver disease that poses a considerable challenge for 21st century healthcare. This increasingly common cause of liver dysfunction and multi-morbidity demands effective dietetic input to provide clinically-beneficial treatments and prevent ageing syndromes.
Non-alcoholic fatty liver disease (NAFLD) affects 1 in every 3 people and represents a spectrum of liver conditions from simple fatty liver through steatohepatitis (liver fat and inflammation) to cirrhosis (liver fat, inflammation and cell damage). The number of people that have more serious NAFLD is rising; as a result it has become a main reason for liver transplantation. Having high levels of liver fat also increases the risk of diabetes, heart attacks and strokes.
A major challenge is to understand how the disease changes in different people over time, but recent research might help. People with NAFLD who are overweight and carry a gene called PNPLA3 are more likely to develop inflammation and fibrosis, which are two later stages of the disease.
Currently, there are no effective drugs in the treatment of NAFLD and the main advice relates to weight control and healthy diet. The Mediterranean diet has been shown to help to reduce the amount of fat in the liver and stop it from getting worse. More research on how this diet works in the liver to bring about its benefits would be useful. To move forward, we also need to understand how the PNPLA3 gene responds to different types of diet treatments.
In the future we hope to perform a randomised controlled trial to investigate the influence of PNPLA3 on Mediterranean diet response and NAFLD severity. To prepare for the trial, important information will be gathered, including a summary of evidence, which demonstrates the impact of the Mediterranean diet across the full NAFLD spectrum. A survey of clinicians to evaluate the nutritional care provided across the country. And finally, to develop and test different parts of the future trial to make sure they work together. The methods used to attract patients to undertake the research and complete tasks such as recording food intake are assessed. Two different diet treatments will be designed and tested.
60 participants will be asked to follow the two different diet treatments, in random order, within three months. Information on how easy it is to follow diets and procedures is recorded. Early data on PNPLA3 gene in terms of response to the diets is measured. To capture diet adherence and effects on NAFLD, novel biological markers (biomarkers) are tested. Biomarkers found in urine and blood, accurately measure food and drink consumption and provide a complete picture of fats in the liver. A group of patients and members of the public will help guide how the research is done.
The research findings will be shared widely to benefit both patients and the NHS;
To develop diet treatments that are more tailored to the individual for greater health benefits.
To improve patients experiences of nutritional care and diet adherence.
To reduce the number of people needing more intensive medical treatment.
To guide future recommendations for NAFLD services.
The results will also help to inform a decision about whether to complete the full future trial and how to make it more suitable for potential participants.