Omega-3 Fatty Acids in NAFLD Management

Guideline Recommendations

The European Society for Clinical Nutrition and Metabolism (ESPEN) guideline explicitly states that omega-3 fatty acids cannot be recommended to treat NAFLD/NASH until further efficacy data are available, representing a grade 0 recommendation with strong consensus (100% agreement) 2
The American Gastroenterological Association (AGA), American Association for the Study of Liver Diseases (AASLD), and American College of Gastroenterology (ACG) joint practice guideline concluded it is premature to recommend omega-3 fatty acids for specific treatment of NAFLD or NASH, though they may be considered as first-line agents for hypertriglyceridemia in these patients 1

A multicenter RCT of 243 patients with biopsy-proven NASH found that ethyl-eicosapentaenoic acid (1,800-2,700 mg/day) had no effect on liver enzymes, insulin resistance, adiponectin, keratin 18, C-reactive protein, hyaluronic acid, or liver histology compared to placebo, which is the most important study to consider when making treatment decisions 2

Omega-3 fatty acids are recommended only as a component of the Mediterranean diet, not as isolated supplements, as this dietary pattern reduces hepatic steatosis even without weight loss 3, 4
The Mediterranean diet's benefits come from the nutraceutical effect of bioactive compounds and phytochemicals, including omega-3 fatty acids as one component among many, according to the 2021 AGA Clinical Practice Update 3

The American Gastroenterological Association (AGA) recommends the Mediterranean diet, which naturally includes omega-3-rich foods (fatty fish 2-3 times weekly, olive oil, nuts, seeds), for NAFLD management 3, 4
Omega-3 supplements should only be used if the patient has hypertriglyceridemia requiring treatment, according to the American Gastroenterological Association (AGA) 1