MLS Health and Nutrition Research
Vol. 1 Núm. 2 (2022)
ISSN: 2952-2471
Suplementación con ácidos grasos poliinsaturados omega 3 frente a una dieta mediterránea como tratamiento para la enfermedad del hígado graso no alcohólico
Publicado May 3, 2023
Resumen
La enfermedad del hígado graso no alcohólico (EHGNA) cada vez es más prevalente y es la principal enfermedad hepática a nivel mundial. Se quiere comparar nuevas estrategias dietético-nutricionales, como la dieta mediterránea y los ácidos grasos poliinsaturados omega-3, para determinar cuál es más efectiva como tratamiento para esta enfermedad. Evaluar que manejo nutricional es más efectivo como tratamiento del hígado graso no alcohólico, si la suplementación con omega 3 o una dieta mediterránea. Se realizó una revisión bibliográfica, para la cual se consultaron y seleccionaron varios artículos científicos de diversas bases de datos, documentos y el servicio de información en línea provisto por la Biblioteca Nacional de Medicina de los Estados Unidos (MedlinePlus), obteniendo asi un total de 17 estudios pertenecientes a la base de datos Pubmed, los cuales fueron analizados en profundidad. Tanto la dieta mediterránea como la suplementación con ácidos grasos poliinsaturados omega-3 promueven beneficios sobre las características clínicas de los pacientes con hígado graso. La realización de una dieta mediterránea parece tener mayores beneficios en el tratamiento de la EHGNA al mejorar las características clínicas de la enfermedad como la esteatosis hepática, la inflamación, la fibrosis y la esteatohepatitis no alcohólica, además, del síndrome metabólico.
Palabras clave:
omega 3, EHGNA, dieta mediterránea, síndrome metabólico, EHNA
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Celis Eguren, A. (2023). Suplementación con ácidos grasos poliinsaturados omega 3 frente a una dieta mediterránea como tratamiento para la enfermedad del hígado graso no alcohólico. MLS Health and Nutrition Research, 1(2). Recuperado a partir de https://www.mlsjournals.com/MLS-Health-Nutrition/article/view/1669
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(1). Hígado graso [Internet]. National Library of Medicine; [citado 19 de febrero de 2022]. Disponible en: https://medlineplus.gov/spanish/fattyliverdisease.html
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(3). Anania C, Perla FM, Olivero F, Pacifico L, Chiesa C. Mediterranean diet and nonalcoholic fatty liver disease. World J Gastroenterol. 21 de mayo de 2018;24(19):2083-94.
(4). Jegatheesan P, De Bandt JP. Fructose and NAFLD: The Multifaceted Aspects of Fructose Metabolism. Nutrients. marzo de 2017;9(3):230.
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(7). George ES, Forsyth A, Itsiopoulos C, Nicoll AJ, Ryan M, Sood S, et al. Practical Dietary Recommendations for the Prevention and Management of Nonalcoholic Fatty Liver Disease in Adults. Adv Nutr. enero de 2018;9(1):30-40.
(8). Análisis metabolómico sérico para la detección del daño hepático preneoplásico en personas con fragilidad
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(10). Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-57.
(11). Aller R, Burgueño Gomez B, Sigüenza R, Fernández-Rodríguez C, Fernández N, Antolín B, et al. Comparative study of overweight and obese patients with nonalcoholic fatty liver disease. Rev Espanola Enfermedades Dig Organo Of Soc Espanola Patol Dig. abril de 2019;111(4):256-63.
(12). Juanola O, Martínez-López S, Francés R, Gómez-Hurtado I. Non-Alcoholic Fatty Liver Disease: Metabolic, Genetic, Epigenetic and Environmental Risk Factors. Int J Environ Res Public Health. 14 de mayo de 2021;18(10):5227.
(13). Duarte SMB, Stefano JT, Oliveira CP. Microbiota and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH). Ann Hepatol. 1 de mayo de 2019;18(3):416-21.
(14). Kasper P, Martin A, Lang S, Kütting F, Goeser T, Demir M, et al. NAFLD and cardiovascular diseases: a clinical review. Clin Res Cardiol. 2021;110(7):921-37.
(15). Gelli C, Tarocchi M, Abenavoli L, Di Renzo L, Galli A, De Lorenzo A. Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease. World J Gastroenterol. 7 de mayo de 2017;23(17):3150-62.
(16). Lee CH, Fu Y, Yang SJ, Chi CC. Effects of Omega-3 Polyunsaturated Fatty Acid Supplementation on Non-Alcoholic Fatty Liver: A Systematic Review and Meta-Analysis. Nutrients. 11 de septiembre de 2020;12(9):E2769.
(17). Saeed N, Nadeau B, Shannon C, Tincopa M. Evaluation of Dietary Approaches for the Treatment of Non-Alcoholic Fatty Liver Disease: A Systematic Review. Nutrients. 16 de diciembre de 2019;11(12):3064.
(18). Trovato FM, Castrogiovanni P, Malatino L, Musumeci G. Nonalcoholic fatty liver disease (NAFLD) prevention: role of Mediterranean diet and physical activity. Hepatobiliary Surg Nutr. abril de 2019;8(2):167-9.
(19). Musa-Veloso K, Venditti C, Lee HY, Darch M, Floyd S, West S, et al. Systematic review and meta-analysis of controlled intervention studies on the effectiveness of long-chain omega-3 fatty acids in patients with nonalcoholic fatty liver disease. Nutr Rev. 1 de agosto de 2018;76(8):581-602.
(20). Lu W, Li S, Li J, Wang J, Zhang R, Zhou Y, et al. Effects of Omega-3 Fatty Acid in Nonalcoholic Fatty Liver Disease: A Meta-Analysis. Gastroenterol Res Pract. 2016;2016:1459790.
(21). Mascaró CM, Bouzas C, Tur JA. Association between Non-Alcoholic Fatty Liver Disease and Mediterranean Lifestyle: A Systematic Review. Nutrients. 23 de diciembre de 2021;14(1):49.
(22). Martínez-González MA, Gea A, Ruiz-Canela M. The Mediterranean Diet and Cardiovascular Health. Circ Res. marzo de 2019;124(5):779-98.
(23). Dieta mediterránea: MedlinePlus enciclopedia médica [Internet]. [citado 19 de febrero de 2022]. Disponible en: https://medlineplus.gov/spanish/ency/patientinstructions/000110.htm
(24). Plaz Torres MC, Aghemo A, Lleo A, Bodini G, Furnari M, Marabotto E, et al. Mediterranean Diet and NAFLD: What We Know and Questions That Still Need to Be Answered. Nutrients. 5 de diciembre de 2019;11(12):2971.
(25). Zhao S, Jang C, Liu J, Uehara K, Gilbert M, Izzo L, et al. Dietary fructose feeds hepatic lipogenesis via microbiota-derived acetate. Nature. marzo de 2020;579(7800):586-91.
(26). Romero-Gómez M, Zelber-Sagi S, Trenell M. Treatment of Nafld with Diet, Physical Activity and Exercise. J Hepatol. octubre de 2017;67(4):829-46.
(27). Ma J, Hennein R, Liu C, Long MT, Hoffmann U, Jacques PF, et al. Improved Diet Quality Associates With Reduction in Liver Fat—Particularly in Individuals With High Genetic Risk Scores for Nonalcoholic Fatty Liver Disease. Gastroenterology. julio de 2018;155(1):107-17.
(28). Akhlaghi M, Ghasemi-Nasab M, Riasatian M. Mediterranean diet for patients with non-alcoholic fatty liver disease, a systematic review and meta-analysis of observational and clinical investigations. J Diabetes Metab Disord. 17 de febrero de 2020;19(1):575-84.
(29). Georgoulis M, Kontogianni MD, Margariti A, Tiniakos D, Fragopoulou E, Zafiropoulou R, et al. Associations between dietary intake and the presence of the metabolic syndrome in patients with non-alcoholic fatty liver disease. J Hum Nutr Diet Off J Br Diet Assoc. agosto de 2015;28(4):409-15.
(30). Sewter R, Heaney S, Patterson A. Coffee Consumption and the Progression of NAFLD: A Systematic Review. Nutrients. 12 de julio de 2021;13(7):2381.
(31). Chen B bing, Han Y, Pan X, Yan J, Liu W, Li Y, et al. Association between nut intake and non-alcoholic fatty liver disease risk: a retrospective case-control study in a sample of Chinese Han adults. BMJ Open. 4 de septiembre de 2019;9(9):e028961.
(32). Bullón-Vela V, Abete I, Tur JA, Pintó X, Corbella E, Martínez-González MA, et al. Influence of lifestyle factors and staple foods from the Mediterranean diet on non-alcoholic fatty liver disease among older individuals with metabolic syndrome features. Nutrition. 1 de marzo de 2020;71:110620.
(33). Abenavoli L, Boccuto L, Federico A, Dallio M, Loguercio C, Di Renzo L, et al. Diet and Non-Alcoholic Fatty Liver Disease: The Mediterranean Way. Int J Environ Res Public Health. septiembre de 2019;16(17):3011.
(34). Esposito K, Maiorino MI, Bellastella G, Panagiotakos DB, Giugliano D. Mediterranean diet for type 2 diabetes: cardiometabolic benefits. Endocrine. 1 de abril de 2017;56(1):27-32.
(35). Plaza-Díaz J, Solís-Urra P, Rodríguez-Rodríguez F, Olivares-Arancibia J, Navarro-Oliveros M, Abadía-Molina F, et al. The Gut Barrier, Intestinal Microbiota, and Liver Disease: Molecular Mechanisms and Strategies to Manage. Int J Mol Sci. 7 de noviembre de 2020;21(21):8351.
(36). Parker HM, Cohn JS, O’Connor HT, Garg ML, Caterson ID, George J, et al. Effect of Fish Oil Supplementation on Hepatic and Visceral Fat in Overweight Men: A Randomized Controlled Trial. Nutrients. 23 de febrero de 2019;11(2):475.
(37). Ácidos grasos Omega 3: MedlinePlus medicinas [Internet]. [citado 19 de febrero de 2022]. Disponible en: https://medlineplus.gov/spanish/druginfo/meds/a607065-es.html
(38). Sangouni AA, Orang Z, Mozaffari-Khosravi H. Effect of omega-3 supplementation on cardiometabolic indices in diabetic patients with non-alcoholic fatty liver disease: a randomized controlled trial. BMC Nutr. 15 de diciembre de 2021;7(1):86.
(39). Shi X yan, Fan S min, Shi G mei, Yao J, Gao Y, Xia Y guo, et al. Efficacy and safety of omega-3 fatty acids on liver-related outcomes in patients with nonalcoholic fatty liver disease. Medicine (Baltimore). 12 de junio de 2020;99(24):e20624.
(40). Tobin D, Brevik-Andersen M, Qin Y, Innes JK, Calder PC. Evaluation of a High Concentrate Omega-3 for Correcting the Omega-3 Fatty Acid Nutritional Deficiency in Non-Alcoholic Fatty Liver Disease (CONDIN). Nutrients. 20 de agosto de 2018;10(8):1126.
(41). Pacifico L, Bonci E, Martino MD, Versacci P, Andreoli G, Silvestri LM, et al. A double-blind, placebo-controlled randomized trial to evaluate the efficacy of docosahexaenoic acid supplementation on hepatic fat and associated cardiovascular risk factors in overweight children with nonalcoholic fatty liver disease. Nutr Metab Cardiovasc Dis. 1 de agosto de 2015;25(8):734-41.
(42). Hodson L, Bhatia L, Scorletti E, Smith DE, Jackson NC, Shojaee-Moradie F, et al. Docosahexaenoic acid enrichment in NAFLD is associated with improvements in hepatic metabolism and hepatic insulin sensitivity: a pilot study. Eur J Clin Nutr. agosto de 2017;71(8):973-9.
(43). Cansanção K, Citelli M, Carvalho Leite N, López de las Hazas MC, Dávalos A, Tavares do Carmo M das G, et al. Impact of Long-Term Supplementation with Fish Oil in Individuals with Non-Alcoholic Fatty Liver Disease: A Double Blind Randomized Placebo Controlled Clinical Trial. Nutrients. 2 de noviembre de 2020;12(11):3372.
(44). Konerman MA, Walden P, Joseph M, Jackson EA, Lok AS, Rubenfire M. Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non-alcoholic fatty liver disease. Aliment Pharmacol Ther. febrero de 2019;49(3):296-307.
(45). Capanni M, Calella F, Biagini MR, Genise S, Raimondi L, Bedogni G, et al. Prolonged n-3 polyunsaturated fatty acid supplementation ameliorates hepatic steatosis in patients with non-alcoholic fatty liver disease: a pilot study. Aliment Pharmacol Ther. 2006;23(8):1143-51.
(46). Scorletti E, Bhatia L, McCormick KG, Clough GF, Nash K, Hodson L, et al. Effects of purified eicosapentaenoic and docosahexaenoic acids in nonalcoholic fatty liver disease: Results from the WELCOME* study. Hepatology. 2014;60(4):1211-21.
(2). Schwabe RF, Greten TF. Gut microbiome in HCC – Mechanisms, diagnosis and therapy. J Hepatol. 1 de febrero de 2020;72(2):230-8.
(3). Anania C, Perla FM, Olivero F, Pacifico L, Chiesa C. Mediterranean diet and nonalcoholic fatty liver disease. World J Gastroenterol. 21 de mayo de 2018;24(19):2083-94.
(4). Jegatheesan P, De Bandt JP. Fructose and NAFLD: The Multifaceted Aspects of Fructose Metabolism. Nutrients. marzo de 2017;9(3):230.
(5). Enfermedad por hígado graso. American College of Gastroenterology. [citado 29 de marzo de 2022]. Disponible en: https://gi.org/patients/recursos-en-espanol/enfermedad-por-higado-graso/
(6). Aller R, Fernández-Rodríguez C, lo Iacono O, Bañares R, Abad J, Carrión JA, et al. Documento de consenso. Manejo de la enfermedad hepática grasa no alcohólica (EHGNA). Guía de práctica clínica. Gastroenterol Hepatol. 1 de mayo de 2018;41(5):328-49.
(7). George ES, Forsyth A, Itsiopoulos C, Nicoll AJ, Ryan M, Sood S, et al. Practical Dietary Recommendations for the Prevention and Management of Nonalcoholic Fatty Liver Disease in Adults. Adv Nutr. enero de 2018;9(1):30-40.
(8). Análisis metabolómico sérico para la detección del daño hepático preneoplásico en personas con fragilidad
aumentada por la edad [Internet]. CENIE. 2019 [citado 28 de marzo de 2022]. Disponible en: https://cenie.eu/es/blogs/old-hepamarker/analisis-metabolomico-serico-para-la-deteccion-del-dano-hepatico-preneoplasico
(9). Augustin S, Graupera I, Caballeria J. Hígado graso no alcohólico: una pandemia poco conocida. Med Clínica. 20 de diciembre de 2017;149(12):542-8.
(10). Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-57.
(11). Aller R, Burgueño Gomez B, Sigüenza R, Fernández-Rodríguez C, Fernández N, Antolín B, et al. Comparative study of overweight and obese patients with nonalcoholic fatty liver disease. Rev Espanola Enfermedades Dig Organo Of Soc Espanola Patol Dig. abril de 2019;111(4):256-63.
(12). Juanola O, Martínez-López S, Francés R, Gómez-Hurtado I. Non-Alcoholic Fatty Liver Disease: Metabolic, Genetic, Epigenetic and Environmental Risk Factors. Int J Environ Res Public Health. 14 de mayo de 2021;18(10):5227.
(13). Duarte SMB, Stefano JT, Oliveira CP. Microbiota and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH). Ann Hepatol. 1 de mayo de 2019;18(3):416-21.
(14). Kasper P, Martin A, Lang S, Kütting F, Goeser T, Demir M, et al. NAFLD and cardiovascular diseases: a clinical review. Clin Res Cardiol. 2021;110(7):921-37.
(15). Gelli C, Tarocchi M, Abenavoli L, Di Renzo L, Galli A, De Lorenzo A. Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease. World J Gastroenterol. 7 de mayo de 2017;23(17):3150-62.
(16). Lee CH, Fu Y, Yang SJ, Chi CC. Effects of Omega-3 Polyunsaturated Fatty Acid Supplementation on Non-Alcoholic Fatty Liver: A Systematic Review and Meta-Analysis. Nutrients. 11 de septiembre de 2020;12(9):E2769.
(17). Saeed N, Nadeau B, Shannon C, Tincopa M. Evaluation of Dietary Approaches for the Treatment of Non-Alcoholic Fatty Liver Disease: A Systematic Review. Nutrients. 16 de diciembre de 2019;11(12):3064.
(18). Trovato FM, Castrogiovanni P, Malatino L, Musumeci G. Nonalcoholic fatty liver disease (NAFLD) prevention: role of Mediterranean diet and physical activity. Hepatobiliary Surg Nutr. abril de 2019;8(2):167-9.
(19). Musa-Veloso K, Venditti C, Lee HY, Darch M, Floyd S, West S, et al. Systematic review and meta-analysis of controlled intervention studies on the effectiveness of long-chain omega-3 fatty acids in patients with nonalcoholic fatty liver disease. Nutr Rev. 1 de agosto de 2018;76(8):581-602.
(20). Lu W, Li S, Li J, Wang J, Zhang R, Zhou Y, et al. Effects of Omega-3 Fatty Acid in Nonalcoholic Fatty Liver Disease: A Meta-Analysis. Gastroenterol Res Pract. 2016;2016:1459790.
(21). Mascaró CM, Bouzas C, Tur JA. Association between Non-Alcoholic Fatty Liver Disease and Mediterranean Lifestyle: A Systematic Review. Nutrients. 23 de diciembre de 2021;14(1):49.
(22). Martínez-González MA, Gea A, Ruiz-Canela M. The Mediterranean Diet and Cardiovascular Health. Circ Res. marzo de 2019;124(5):779-98.
(23). Dieta mediterránea: MedlinePlus enciclopedia médica [Internet]. [citado 19 de febrero de 2022]. Disponible en: https://medlineplus.gov/spanish/ency/patientinstructions/000110.htm
(24). Plaz Torres MC, Aghemo A, Lleo A, Bodini G, Furnari M, Marabotto E, et al. Mediterranean Diet and NAFLD: What We Know and Questions That Still Need to Be Answered. Nutrients. 5 de diciembre de 2019;11(12):2971.
(25). Zhao S, Jang C, Liu J, Uehara K, Gilbert M, Izzo L, et al. Dietary fructose feeds hepatic lipogenesis via microbiota-derived acetate. Nature. marzo de 2020;579(7800):586-91.
(26). Romero-Gómez M, Zelber-Sagi S, Trenell M. Treatment of Nafld with Diet, Physical Activity and Exercise. J Hepatol. octubre de 2017;67(4):829-46.
(27). Ma J, Hennein R, Liu C, Long MT, Hoffmann U, Jacques PF, et al. Improved Diet Quality Associates With Reduction in Liver Fat—Particularly in Individuals With High Genetic Risk Scores for Nonalcoholic Fatty Liver Disease. Gastroenterology. julio de 2018;155(1):107-17.
(28). Akhlaghi M, Ghasemi-Nasab M, Riasatian M. Mediterranean diet for patients with non-alcoholic fatty liver disease, a systematic review and meta-analysis of observational and clinical investigations. J Diabetes Metab Disord. 17 de febrero de 2020;19(1):575-84.
(29). Georgoulis M, Kontogianni MD, Margariti A, Tiniakos D, Fragopoulou E, Zafiropoulou R, et al. Associations between dietary intake and the presence of the metabolic syndrome in patients with non-alcoholic fatty liver disease. J Hum Nutr Diet Off J Br Diet Assoc. agosto de 2015;28(4):409-15.
(30). Sewter R, Heaney S, Patterson A. Coffee Consumption and the Progression of NAFLD: A Systematic Review. Nutrients. 12 de julio de 2021;13(7):2381.
(31). Chen B bing, Han Y, Pan X, Yan J, Liu W, Li Y, et al. Association between nut intake and non-alcoholic fatty liver disease risk: a retrospective case-control study in a sample of Chinese Han adults. BMJ Open. 4 de septiembre de 2019;9(9):e028961.
(32). Bullón-Vela V, Abete I, Tur JA, Pintó X, Corbella E, Martínez-González MA, et al. Influence of lifestyle factors and staple foods from the Mediterranean diet on non-alcoholic fatty liver disease among older individuals with metabolic syndrome features. Nutrition. 1 de marzo de 2020;71:110620.
(33). Abenavoli L, Boccuto L, Federico A, Dallio M, Loguercio C, Di Renzo L, et al. Diet and Non-Alcoholic Fatty Liver Disease: The Mediterranean Way. Int J Environ Res Public Health. septiembre de 2019;16(17):3011.
(34). Esposito K, Maiorino MI, Bellastella G, Panagiotakos DB, Giugliano D. Mediterranean diet for type 2 diabetes: cardiometabolic benefits. Endocrine. 1 de abril de 2017;56(1):27-32.
(35). Plaza-Díaz J, Solís-Urra P, Rodríguez-Rodríguez F, Olivares-Arancibia J, Navarro-Oliveros M, Abadía-Molina F, et al. The Gut Barrier, Intestinal Microbiota, and Liver Disease: Molecular Mechanisms and Strategies to Manage. Int J Mol Sci. 7 de noviembre de 2020;21(21):8351.
(36). Parker HM, Cohn JS, O’Connor HT, Garg ML, Caterson ID, George J, et al. Effect of Fish Oil Supplementation on Hepatic and Visceral Fat in Overweight Men: A Randomized Controlled Trial. Nutrients. 23 de febrero de 2019;11(2):475.
(37). Ácidos grasos Omega 3: MedlinePlus medicinas [Internet]. [citado 19 de febrero de 2022]. Disponible en: https://medlineplus.gov/spanish/druginfo/meds/a607065-es.html
(38). Sangouni AA, Orang Z, Mozaffari-Khosravi H. Effect of omega-3 supplementation on cardiometabolic indices in diabetic patients with non-alcoholic fatty liver disease: a randomized controlled trial. BMC Nutr. 15 de diciembre de 2021;7(1):86.
(39). Shi X yan, Fan S min, Shi G mei, Yao J, Gao Y, Xia Y guo, et al. Efficacy and safety of omega-3 fatty acids on liver-related outcomes in patients with nonalcoholic fatty liver disease. Medicine (Baltimore). 12 de junio de 2020;99(24):e20624.
(40). Tobin D, Brevik-Andersen M, Qin Y, Innes JK, Calder PC. Evaluation of a High Concentrate Omega-3 for Correcting the Omega-3 Fatty Acid Nutritional Deficiency in Non-Alcoholic Fatty Liver Disease (CONDIN). Nutrients. 20 de agosto de 2018;10(8):1126.
(41). Pacifico L, Bonci E, Martino MD, Versacci P, Andreoli G, Silvestri LM, et al. A double-blind, placebo-controlled randomized trial to evaluate the efficacy of docosahexaenoic acid supplementation on hepatic fat and associated cardiovascular risk factors in overweight children with nonalcoholic fatty liver disease. Nutr Metab Cardiovasc Dis. 1 de agosto de 2015;25(8):734-41.
(42). Hodson L, Bhatia L, Scorletti E, Smith DE, Jackson NC, Shojaee-Moradie F, et al. Docosahexaenoic acid enrichment in NAFLD is associated with improvements in hepatic metabolism and hepatic insulin sensitivity: a pilot study. Eur J Clin Nutr. agosto de 2017;71(8):973-9.
(43). Cansanção K, Citelli M, Carvalho Leite N, López de las Hazas MC, Dávalos A, Tavares do Carmo M das G, et al. Impact of Long-Term Supplementation with Fish Oil in Individuals with Non-Alcoholic Fatty Liver Disease: A Double Blind Randomized Placebo Controlled Clinical Trial. Nutrients. 2 de noviembre de 2020;12(11):3372.
(44). Konerman MA, Walden P, Joseph M, Jackson EA, Lok AS, Rubenfire M. Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non-alcoholic fatty liver disease. Aliment Pharmacol Ther. febrero de 2019;49(3):296-307.
(45). Capanni M, Calella F, Biagini MR, Genise S, Raimondi L, Bedogni G, et al. Prolonged n-3 polyunsaturated fatty acid supplementation ameliorates hepatic steatosis in patients with non-alcoholic fatty liver disease: a pilot study. Aliment Pharmacol Ther. 2006;23(8):1143-51.
(46). Scorletti E, Bhatia L, McCormick KG, Clough GF, Nash K, Hodson L, et al. Effects of purified eicosapentaenoic and docosahexaenoic acids in nonalcoholic fatty liver disease: Results from the WELCOME* study. Hepatology. 2014;60(4):1211-21.
