Researchers studied 474 people with obesity and fatty liver disease who followed a low-carbohydrate diet for four months. They found that the diet was effective at reducing deep belly fat in people with moderate fatty liver disease. However, people with severe fatty liver disease didn’t see as much improvement. This suggests that while diet is still an important treatment, people with advanced liver fat buildup may need additional help beyond diet alone to see significant improvements in their liver health.

The Quick Take

  • What they studied: Whether a low-carbohydrate diet could reduce deep belly fat and improve liver health in people with obesity and fatty liver disease
  • Who participated: 474 adults with obesity (BMI of 35 or higher) who had fatty liver disease. Data came from a nutrition clinic between 2017 and 2019
  • Key finding: The low-carb diet significantly reduced deep belly fat in people with moderate fatty liver disease, but showed limited benefits for those with severe fatty liver disease
  • What it means for you: If you have fatty liver disease and excess belly fat, a low-carb diet may help—but results depend on how advanced your liver condition is. People with severe fatty liver disease should talk to their doctor about additional treatment options beyond diet alone

The Research Details

Researchers looked at health records from 2,040 patients at a nutrition clinic and selected 474 who had both obesity and fatty liver disease. These patients followed a specific low-carbohydrate diet plan called the ‘Strong Diet’ for four months. Before and after the diet, doctors measured the amount of deep belly fat and checked their liver health using ultrasound imaging. This approach allowed researchers to see real-world results from actual patients receiving treatment at a clinic rather than in a controlled laboratory setting.

This study design is valuable because it shows how the diet works in real patients with actual fatty liver disease, not just in healthy volunteers. By measuring both belly fat and liver health, researchers could understand whether reducing belly fat also helps the liver recover. The four-month timeframe is long enough to see meaningful changes but short enough to track what happens quickly.

This study used actual patient data from a real clinic, which makes the results more applicable to everyday life. However, because it wasn’t a randomized controlled trial (where some people get the diet and others don’t), we can’t be completely certain the diet alone caused the improvements. The researchers used ultrasound to measure changes, which is a reliable method. The large starting group (2,040 patients) suggests careful selection of the final 474 participants.

What the Results Show

The low-carbohydrate diet successfully reduced deep belly fat in patients with moderate fatty liver disease over the four-month period. This is important because deep belly fat is linked to many health problems, including heart disease and diabetes. The diet appeared to help the liver start healing in these patients with moderate disease. However, the results were quite different for patients with severe fatty liver disease—their deep belly fat didn’t decrease as much, and their liver health didn’t improve significantly. This suggests that once fatty liver disease becomes severe, diet alone may not be enough to reverse the damage.

The researchers also measured liver stiffness, which indicates how much scarring or damage has occurred in the liver. In patients with moderate disease, improvements in belly fat were accompanied by some improvement in liver health markers. The study suggests that the severity of the fatty liver disease at the start of treatment is a major factor in determining whether diet will help. Patients with mild to moderate disease had much better outcomes than those with advanced disease.

Earlier research had shown that belly fat and liver fat are connected—when belly fat increases, liver fat often increases too. This study confirms that connection by showing that reducing belly fat can help improve liver health, at least in people with moderate disease. However, this study adds important new information: the diet’s effectiveness depends heavily on how advanced the liver disease already is. Previous studies hadn’t clearly shown this limitation in severe cases.

The study didn’t include a control group of people who didn’t follow the diet, so we can’t be 100% certain the diet caused all the improvements. Some patients may have made other lifestyle changes (like exercising more) that also helped. The study only lasted four months, so we don’t know if benefits continue longer or if people regain the weight. The study focused on one specific low-carb diet plan, so results might differ with other diet approaches. Finally, the researchers couldn’t fully explain why severe fatty liver disease didn’t respond as well to the diet.

The Bottom Line

If you have fatty liver disease and excess belly fat, a low-carbohydrate diet appears to be a helpful treatment option—especially if your fatty liver disease is mild to moderate. This should be done under medical supervision. For people with severe fatty liver disease, diet alone may not be sufficient, and you should discuss additional treatment options with your doctor. The diet showed benefits within four months, but longer-term follow-up is needed to understand lasting effects.

This research is most relevant for adults with obesity who have been diagnosed with fatty liver disease. It’s especially important for those with moderate disease who are looking for lifestyle-based treatments. People with severe fatty liver disease should pay attention to the finding that diet alone may have limitations. Anyone considering a low-carb diet for liver health should consult their doctor first, especially if they have other health conditions or take medications.

Based on this study, you might expect to see measurable improvements in belly fat within four months of following a low-carb diet. However, individual results vary. Some people may see changes sooner, while others may take longer. Liver health improvements may take longer to appear than belly fat reduction. It’s important to have realistic expectations and work with your healthcare provider to monitor progress.

Want to Apply This Research?

  • Track daily carbohydrate intake (grams per day) and weekly waist circumference measurements. Set a goal to reduce carbs to the recommended level and measure waist circumference every 7 days to monitor belly fat reduction
  • Use the app to log meals and identify high-carb foods to eliminate or reduce. Set daily carb targets and receive reminders to stay on track. Track which low-carb foods you enjoy most to build sustainable eating habits
  • Create a 4-month tracking plan with monthly check-ins. Monitor waist circumference, weight, energy levels, and digestion. Schedule regular doctor visits to measure liver health markers (liver ultrasound or blood tests) at baseline, 2 months, and 4 months to assess progress

This research suggests that low-carbohydrate diets may help reduce belly fat and improve liver health in people with moderate fatty liver disease, but results vary based on disease severity. This information is educational and should not replace professional medical advice. Before starting any new diet, especially if you have fatty liver disease or other health conditions, consult with your doctor or registered dietitian. They can assess your individual situation, monitor your progress, and adjust treatment as needed. People with severe fatty liver disease should be aware that diet alone may have limitations and should discuss all available treatment options with their healthcare provider.