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Nonalcoholic fatty liver disease is associated with excessive calorie intake rather than a distinctive dietary pattern

Wehmeyer, Malte H. MD; Zyriax, Birgit-Christiane MD; Jagemann, Bettina PhD; Roth, Ewgenia MSc; Windler, Eberhard MD; Schulze zur Wiesch, Julian MD; Lohse, Ansgar W. MD; Kluwe, Johannes MD

Section Editor(s): Abenavoli., Ludovico

doi: 10.1097/MD.0000000000003887
Research Article: Observational Study

Abstract: We aimed to assess the dietary patterns associated with nonalcoholic fatty liver disease (NAFLD) and the efficacy of dietary interventions in a real-life setting at a tertiary medical center in Northern Germany.

Clinical and laboratory data as well as data obtained by a semiquantitative food frequency questionnaire of 55 consecutive patients diagnosed with NAFLD were compared to an age and gender-matched cohort of 88 healthy individuals by univariate analysis. The efficacy of the dietary intervention was assessed in a subgroup of 24 NAFLD patients 6 months after receiving dietary advice. Macronutritional components of the diet were normalized for absolute daily energy intake.

NAFLD patients consumed more calories per day as compared with healthy controls (P <0.001). The absolute amounts of most nutritional components ingested by NAFLD patients were higher than those of the controls. However, there were no significant differences with regards to the relative consumption of carbohydrates (P = 0.359), fat (P = 0.416), and fructose (P = 0.353) per 1000 kcal energy intake. NAFLD patients displayed a higher intake of glucose/1000 kcal (P = 0.041) and protein/1000 kcal (P = 0.009) but a lower intake of fibers/1000 kcal (P < 0.001) and mineral nutrients/1000 kcal (P = 0.001) than healthy controls. In the longitudinal analysis patients significantly reduced their caloric intake and their ALT levels improved 6 months after the dietary counselling (P < 0.001).

Our data from a German real-life cohort demonstrate that dietary patterns of patients with NAFLD display great variability and little disease specificity, while the most distinctive feature compared with healthy controls was higher energy intake in NAFLD patients.

aI. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

bPreventive Medicine, Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.

Correspondence to Johannes Kluwe, I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany (e-mail:

Abbreviations: ALT = alanine transaminase, AST = aspartate transaminase, BIA = bioelectrical impedance analysis, BMI = body mass index, FFQ = food frequency questionnaire, γGT = gamma-glutamyl transpeptidase, HCC = hepatocellular carcinoma, NAFLD = nonalcoholic fatty liver disease, NASH = nonalcoholic steatohepatitis, ULN = upper limit of normal.

MHW wrote the original manuscript, contributed to the study design, and conducted the statistical analyses. B-CZ cowrote the original manuscript, contributed to the study design, and collected the data of the control group. BJ co-wrote the original manuscript, contributed to the study design, collected the data, conducted the dietary counselling, and evaluated the food frequency questionnaires. ER collected the data, conducted the dietary counselling, and critically revised the manuscript. EW contributed to the study-design, collected the data of the control group, and critically revised the manuscript. JSzW and AWL critically revised the manuscript. JK supervised the study, contributed to study design and cowrote and critically revised the manuscript.

MHW, B-CZ, and BJ contributed equally to this work.

JSzW, AWL, and JK are supported by the Deutsche Forschungsgemeinschaft (DFG), SFB 841.

The authors have no conflicts of interest to disclose.

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Received February 11, 2016

Received in revised form April 13, 2016

Accepted April 17, 2016

Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.