Recent literature suggests that having a higher intake of omega-3 fatty acids, as opposed to omega-6, may have some effect upon the accumulation of fat in the liver, and a recent clinical trial published in the Journal of Nutrition put the evidence accrued so far to the test in a group of 20 participants between the ages of 9 and 19 years old, who were afflicted with both obesity and non-alcoholic fatty liver disease.
 
“Nonalcoholic fatty liver disease (NAFLD) is a common complication of childhood obesity and an ominous marker of the metabolic syndrome. Indeed, children with NAFLD exhibit insulin resistance, glucose intolerance, hypertriglyceridemia, and cardiovascular disease,” the authors of the study wrote. “Although many factors contribute to the development of fatty liver, the composition of the diet plays a pivotal role.”
 
Each of the participants in this study was put on a normocaloric (not altering daily calorie count from baseline) diet, in which the ratio of omega-6 to omega-3s was lowered over a period of 12 weeks. Following the 12-week dietary intervention, hepatic fat fraction, measured by abdominal MRI, was reduced by 25.8%, even though weight remained stable across the participants.
 
Baseline diets were established using a three-day food record for each participant, evaluated by the study’s dietitian. Each diet contained quotas for calories, as well as macronutrients (carbohydrates, fats, and protein), with instructions to eat plenty of fish and nuts, which are high in omega-3s. While no supplements were used in this study, there were a number of foods included which were fortified with omega-3s. Participants were instructed to keep their level of physical activity stable in order to control this variable, also known to impact NAFLD.
 
Additionally, the researchers observed a number of positive secondary outcomes, such as a 34.4% reduction in ALT (alanine aminotransferase), a 21.9% reduction in triglycerides, a 3.28% reduction in LDL cholesterol, and a 26.3% improvement in whole body insulin sensitivity.
 
“This study has shown, to our knowledge for the first time, that a nonpharmacologic, food dietary intervention high in n-3 and low in n-6 PUFA intake improves fatty liver disease in obese adolescents, and restores liver fat content to normal in one-third of participants, in absence of weight loss,” the authors of the study concluded. “This study supports the concept that nutritional interventions might be most effective in ameliorating the metabolic phenotype of youth with NAFLD, providing additional benefits to dyslipidemia and insulin resistance not present in some drugs for treating NAFLD.”
 
Since the study was small in size, it remains to be determined whether this nutritional modification can be generalized to a larger population. However, it is believed that this study suggests improving ratios in fatty acid intakes is a highly feasible type of intervention to ameliorate hepatic steatosis in youths, especially if standardized material is taught by dietitians.