Non-Alcoholic Fatty Liver Disease (NAFLD) is a common condition affecting around 10-25% of the general adult population, 15% of children, and even > 50% of individuals who have type 2 diabetes mellitus. It is a major cause of liver-related morbidity, and cardiovascular (CV) mortality is a common cause of death. In addition to being the initial step of irreversible alterations of the liver parenchyma causing cirrhosis, about 1/6 of those who develop NASH are at risk also developing CV disease (CVD). More recently the acronym MAFLD (Metabolic Associated Fatty Liver Disease) has been preferred by many European and US specialists, providing a clearer message on the metabolic etiology of the disease. The suggestions for the management of NAFLD are like those recommended by guidelines for CVD prevention. In this context, the general approach is to prescribe physical activity and dietary changes the effect weight loss. Lifestyle change in the NAFLD patient has been supplemented in some by the use of nutraceuticals, but the evidence based for these remains uncertain. The aim of this Position Paper was to summarize the clinical evidence relating to the effect of nutraceuticals on NAFLD-related parameters. Our reading of the data is that whilst many nutraceuticals have been studied in relation to NAFLD, none have sufficient evidence to recommend their routine use; robust trials are required to appropriately address efficacy and safety.

Biotechnology Research Center Pharmaceutical Technology Institute Mashhad University of Medical Sciences Mashhad Iran

Cardiology Department University and Emergency Hospital Bucharest Romania University of Medicine and Pharmacy Carol Davila Bucharest Romania

Cardiovascular Research Centre University of Zielona Gora Zielona Gora Poland

Chemical Pathology Division of the Department of Pathology University of Cape Town Health Science Faculty Cape Town South Africa

Department of Clinical Biochemistry Royal Free Campus Medical School University College London London UK

Department of Endocrinology Diabetes and Preventive Medicine University of Cologne Germany

Department of Health Promotion Mother and Child Care Internal Medicine and Medical Specialties University of Palermo Via del Vespro 141 90127 Palermo Italy

Department of Medicine Division of Cardiology University of British Columbia Vancouver British Columbia Canada

Department of Nutritional Sciences and Dietetics International Hellenic University Thessaloniki Greece

Department of Pharmacological and Biomolecular Sciences University of Milan Milan Italy

Department of Preventive Cardiology and Lipidology Medical University of Lodz Poland

Department of Science and Drug Technology University of Turin Turin Italy

Division of Clinical Pharmacology Division of Internal Medicine University of Kansas Medical Center Kansas City KS USA

Hypertension and Cardiovascular disease risk research center Medical and Surgical Sciences Department University of Bologna Bologna Italy

IRCCS Policlinico S Orsola Malpighi Bologna Italy

Liverpool Centre for Cardiovascular Science Liverpool UK

Polish Mother's Memorial Hospital Research Institute Lodz Poland

School of Medicine European University Cyprus Nicosia Cyprus

School of Pharmacy and Biomolecular Sciences Liverpool John Moores University Liverpool UK;

The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore MD USA; Preventive Cardiology CGH Medical Center Sterling IL USA

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