Background. Associated with epidemics of obesity, nonalcoholic fatty liver disease (NAFLD) is becoming the most prevalent liver disease worldwide. The cornerstone of therapy for NAFLD is lifestyle intervention, mainly focused on weight loss. Significant weight loss results from energy‐restricted diets, regardless of macronutrient distribution. An anti‐inflammatory diet was related to lower odds of NAFLD among daily alcohol drinkers and individuals with metabolic syndrome. This study aims to evaluate the effect of an energy‐reduced anti‐inflammatory diet on liver status in younger adults with obesity after a 6‐month follow‐up. Methods. A two‐arm randomized controlled trial surveyed 81 participants’ (mean age, 43 years) anthropometric and body composition changes. Metabolic status was determined with glycaemic and lipid status, inflammatory status with hs‐CRP, IL‐6, and TNF‐α, and liver status with liver enzymes, NAFLD‐FLS, FLI, and FIB‐4 indices. The inflammatory potential of the diet was assessed by the Dietary Inflammatory Index, DII®. Results. Energy‐restricted anti‐inflammatory diet resulted in significant weight loss (−7.1%, p < 0.001), in reducing the visceral adiposity (−22.3%, p < 0.001), metabolic (HOMA‐IR, −15.5%; total cholesterol, −5.3%; LDL‐C, −4.6%; triglycerides, −12.2%), and inflammatory biomarkers (hs‐CRP, −29.5%; IL‐6, −18.2%; TNF‐α, −34.2%), with significant improvement of liver parameters (NAFLD‐FLS, −143.4%; FLI, −14.3%; FIB‐4, −2.5%). Conclusion. The study showed the effectiveness of the anti‐inflammatory diet with significant improvement of liver parameters in younger adults with obesity, which may reinforce the effectiveness of nutrition‐based lifestyle programs, with an anti‐inflammatory dietary approach for the treatment and resolution of NAFLD.

Numerous factors are involved in the pathogenesis of nonalcoholic fatty liver disease (NAFLD), which are responsible for its development and progression as an independent entity, but also thanks to their simultaneous action. This is explained by the hypothesis of multiple parallel hits. These factors are insulin resistance, lipid metabolism alteration, oxidative stress, endoplasmic reticulum stress, inflammatory cytokine liberation, gut microbiota dysbiosis or gut–liver axis activation. This is a systematic review which has an aim to show the connection between intestinal microbiota and the role of its disbalance in the development of NAFLD. The gut microbiota is made from a wide spectrum of microorganisms that has a systemic impact on human health, with a well-documented role in digestion, energy metabolism, the stimulation of the immune system, synthesis of essential nutrients, etc. It has been shown that dysbiosis is associated with all three stages of chronic liver disease. Thus, the modulation of the gut microbiota has attracted research interest as a novel therapeutic approach for the management of NAFLD patients. The modification of microbiota can be achieved by substantial diet modification and the application of probiotics or prebiotics, while the most radical effects are observed by fecal microbiota transplantation (FMT). Given the results of FMT in the context of metabolic syndrome (MetS) and NAFLD in animal models and scarce pilot studies on humans, FMT seems to be a promising treatment option that could reverse intestinal dysbiosis and thereby influence the course of NAFLD.