Back to Knowledge Center Results

Nonalcoholic Fatty Liver Disease Nutrition Therapy


What is nonalcoholic fatty liver disease?

Nonalcoholic fatty liver disease (NAFLD) or "fatty liver" is a liver disease that progresses slowly over time. It starts when fat builds up inside the liver. Over time, too much fat stays in the liver and may result in more severe conditions, such as cirrhosis. NAFLD usually develops in children and teenagers who are overweight or gain too much weight. Most of the time, fatty liver occurs with other health problems such as pre- diabetes, insulin resistance or high triglycerides.

How is NAFLD diagnosed?

  • Blood tests (liver enzymes) to see if there is liver damage and to rule out other causes of your child's liver problems
    • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both common liver enzymes. When there is damage or inflammation in the liver, these numbers usually go up.
    • AST and ALT are not specific to one disease and can be high from many different types of liver problems. More testing is usually needed to figure out what caused the elevation in the liver enzymes.
  • Ultrasound of liver to look for fat or other abnormalities in the liver

How is NAFLD treated?

Children with NAFLD benefit the most from stopping their weight gain. We encourage children and their families to follow key health behaviors:

  • Avoid sugary drinks and other sugary/sweet snacks, chips, etc.
  • Drink mostly water and some low-fat milk
  • Aim for at least 60 minutes of physical activity every day
  • Limit TV and screen time to one hour or less per day
  • Make half your plate vegetables at mealtimes
  • Eat breakfast every day
  • Add more lean protein to each meal
  • Lower intake of carbohydrate-heavy food items (bread, rice, pasta, tortillas, etc.) by keeping portions small and opting for whole grain versions

What can I do to help my child?

Work together as a family to improve your healthy habits. Small changes can make a big difference over time.

  • Start one healthy habit today
  • Continue to add healthy changes over the coming weeks and months
  • Follow treatment recommendations

Food Group

Foods to Include Foods to Limit

Fat-free (skim) or low-fat (1%) milk

Fat-free or low-fat yogurt, cheese, cottage cheese, sour cream

Whole milk, yogurt, ice cream

Regular cream cheese, sour cream

Fruits and Vegetables

Fresh, frozen or canned fruit

Fresh, frozen or canned vegetables without added fat or salt

Fried fruits or vegetables

Fruit served with butter or cream

Vegetables prepared with butter, cheese or cream sauce

(limit due to carb content)

Whole-grain breads and cereals, including oats and barley

Pasta made with whole wheat or other whole grains

Brown rice

Low-fat popcorn, whole-grain crackers or pretzels

High-fat bakery products, such as doughnuts, biscuits, croissants, Danish pastries, pies, cookies

Snacks made with added oils, such as chips,  cheese puffs, snack mixes, regular crackers, butter-flavored popcorn


Lean cuts of beef and pork (loin, round, extra-lean ground beef)

Lean deli meats

Skinless poultry


Dried beans and peas

Meat alternatives

Higher-fat cuts of meats (ribs, regular ground beef)

Bacon, sausage, hot dogs

Cold cuts (salami, bologna)

Poultry with skin

Fried meat, poultry, fish

Fats and Oils
use sparingly)

Unsaturated oils (olive, peanut, soy, sunflower, canola)

Soft or liquid margarines and vegetable oil spreads

Salad dressings

Seeds and nuts



Stick margarine


Tropical oils (coconut, palm oil, palm kernel



Calorie-free beverages


High-calorie sauces (alfredo, cheese, hollandaise)

Sugar-sweetened beverages (regular soda, juice, fruit drinks)




North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
Academy of Nutrition and Dietetics
National Institute of Diabetes and Digestive and Kidney Disorders