Omega-3 fatty acids and nonalcoholic fatty liver disease in adults and children: where do we stand?

Purpose of review Nonalcoholic fatty liver disease (NAFLD) is the most common chronic fatty liver disease worldwide. The incidence of NAFLD parallels the prevalence of obesity. Moreover, NAFLD can progress to nonalcoholic steatohepatitis (NASH), cirrhosis and primary hepatocellular cancer (HCC). As such, NAFLD has become a major public health concern. We discuss recent clinical trials and meta-analyses evaluating the efficacy of C20-22 omega 3 polyunsaturated fatty acids (PUFA) to attenuate preexisting NAFLD in adults and children. Recent findings Humans with NAFLD and NASH; and preclinical mouse models of NASH, have a high abundance of hepatic saturated (SFA) and monounsaturated (MUFA) fat, but a low abundance of hepatic C20-22 omega 3 PUFA. This change in hepatic fat type and abundance is associated with hepatic lipotoxicity, inflammation, oxidative stress and fibrosis. Recent meta-analyses and clinical trials evaluated the capacity of C20-22 omega 3 PUFA dietary supplementation to improve health outcomes in adults and children with preexisting NAFLD. Diets supplemented with docosahexaenoic acid (DHA, 22:6, omega 3) alone or with eicosapentaenoic acid (EPA, 20:5, omega 3) are tolerated and effective at lowering liver fat in NAFLD patients. However, outcomes are mixed with respect to C20-22 omega 3 PUFA attenuation of more severe NAFLD markers, such as hepatic injury, inflammation and fibrosis. Summary These studies suggest that dietary supplementation with C20-22 omega 3 PUFA should be considered as a viable and effective option to lower liver fat in obese adults and children with NAFLD.