ECU Researchers Uncover Groundbreaking Insights on NAFLD and Diet

Researchers at Edith Cowan University (ECU) in Western Australia have made headlines with a pioneering study that challenges common assumptions about dietary fibre and liver health. Led by Associate Professor Lois Balmer from ECU's School of Medical and Health Sciences, the investigation reveals how everyday foods like berries and walnuts could safeguard the liver, while a widely used fibre supplement might pose risks for those with non-alcoholic fatty liver disease (NAFLD).

Non-alcoholic fatty liver disease, often abbreviated as NAFLD, occurs when excess fat builds up in the liver without heavy alcohol consumption. It's driven by factors such as obesity, type 2 diabetes, and high blood pressure. This condition silently progresses from simple fat accumulation to more severe non-alcoholic steatohepatitis (NASH), potentially leading to fibrosis, cirrhosis, liver failure, or cancer. In Australia, NAFLD affects approximately one in three adults, with projections estimating up to seven million cases by 2030 if trends continue unchecked.

The ECU study, published in Molecular Nutrition and Food Research, is Australia's first to demonstrate a potential dietary reversal of NASH progression, spotlighting the role of university-led innovation in tackling this epidemic.

The Rising Tide of NAFLD in Australia

NAFLD has emerged as Australia's most common liver disorder, surpassing viral hepatitis and alcohol-related damage. Lifestyle factors fuel its spread: sedentary habits, processed diets high in sugars and fats, and metabolic syndrome contribute to fat infiltration in liver cells. Early stages are asymptomatic, earning it the moniker 'silent killer,' but advanced NASH brings fatigue, abdominal pain, and swelling.

Step-by-step, NAFLD develops when calories exceed needs, particularly from fructose-laden drinks and foods, overwhelming the liver's processing capacity. Free fatty acids accumulate, sparking inflammation and oxidative stress. Australian data from the Australian Bureau of Statistics and health surveys underscore the urgency: prevalence has doubled in two decades, disproportionately hitting Indigenous communities and those over 50.

Without interventions, healthcare costs could soar, emphasizing the value of preventive research from institutions like ECU, Curtin University, and the University of Western Australia, which collaborated on this work.

Unmasking the Risks of Inulin Supplements

Inulin, a soluble fermentable fibre extracted from chicory root, is marketed as a prebiotic to nurture beneficial gut bacteria. Popular Australian brands include Morlife Organic Inulin, Wonder Foods Organic Inulin, and Propel Health Organic Inulin, often added to smoothies, baking, or taken as powders for digestive regularity and blood sugar control.

However, the ECU study administered 5% inulin in a Western diet to mice with induced NASH and observed detrimental effects: heightened energy intake, accelerated body weight gain, elevated fasting blood glucose, increased low-density lipoprotein (LDL) cholesterol, and aggravated liver damage markers like aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Histology showed worsened steatosis (fat buildup), hepatocyte ballooning, and inflammation, with fibrosis emerging in some livers.

Researchers attribute this to gut dysbiosis—inulin's rapid fermentation favors certain bacteria, producing short-chain fatty acids that, in diseased states, disrupt lipid metabolism and promote hepatic inflammation rather than repair.

Ellagic Acid: Nature's Liver Guardian

Contrasting inulin's pitfalls, ellagic acid (EA)—a polyphenol abundant in pomegranates, raspberries, blackberries, strawberries, grapes, and walnuts—emerged as protective. At 100 mg/kg daily via oral gavage, EA curbed liver weight gain, normalized liver-to-body weight ratios, lowered AST/ALT and LDL levels, and eased inflammation and ballooning.

EA's mechanisms include antioxidant activity scavenging reactive oxygen species (ROS), anti-inflammatory effects via nuclear factor erythroid 2-related factor 2 (Nrf2) pathway activation, and modulation of lipid metabolism. Gut microbes convert EA to urolithins A, C, and D—postbiotics with enhanced bioavailability that amplify benefits.

In the combo arm, EA neutralized inulin's harms while boosting urolithin production, hinting at synergistic potential when balanced.

Behind the Science: ECU's Rigorous Mouse Model

The seven-month study used C57BL/6J male mice, a standard for metabolic research. After one-week acclimatization, NASH was induced via a Western diet (high fat/sugar) plus fructose-glucose water for 16 weeks, mimicking human obesogenic patterns. Treatments followed for 12 weeks: oral glucose tolerance tests (OGTT), weekly weights, monthly samples, and endpoint liver histology (H&E, picrosirius red for fibrosis), plasma biochemistry, and urinary metabolomics via liquid chromatography-tandem mass spectrometry (LC-QQQ-MS).

• Western diet reliably induced obesity, hyperglycemia, and NASH hallmarks.
• Statistical rigor: ANOVA, post-hoc tests, p<0.05 significance.
• Funding: ECU scholarships and fellowships—no industry ties.

This preclinical design provides mechanistic depth, paving the way for human translation at Australian universities.

Quantitative Breakthroughs from the Data

Key metrics paint a clear picture:

• Inulin alone: +energy intake (p<0.001), body weight gain from week 3 (p<0.001), fasting glucose up (p<0.05), LDL/TG rise (p<0.05), AST/ALT peak (p<0.001).
• EA alone: Liver weight down (p<0.05), AST/ALT reduced (p<0.001), LDL lowered (p<0.05), urolithins elevated (p<0.001).
• Combo: Steatosis/ballooning scores halved (p<0.05), highest urolithins (A/C/D p<0.0001).

Fibrosis appeared in 23% of inulin mice, absent elsewhere. These shifts underscore nutrient interactions' complexity.

Gut-Liver Axis: The Microbiome Mediator

The gut microbiome bridges diet and liver health. Inulin, as a prebiotic, selectively feeds Bifidobacteria and Lactobacilli, but in NASH, it may overfeed proteobacteria, yielding lipopolysaccharides (LPS) that trigger Toll-like receptor 4 (TLR4), fueling inflammation via portal vein transit.

EA modulates this by fostering urolithin producers (Gordonibacter, etc.), whose metabolites inhibit NF-κB and activate Nrf2, curbing oxidative stress. Prior studies show mixed inulin effects—beneficial prevention, risky treatment—aligning with ECU's findings.

Australian unis like ECU advance microbiome-liver research, vital for personalized nutrition.

Practical Advice: Supplements vs Whole Foods

While inulin aids healthy guts, NAFLD patients should consult doctors before use—opt for psyllium (e.g., Metamucil) if supplementing. Prioritize EA-rich foods: handful walnuts daily, pomegranate seeds, berry smoothies. Australian Dietary Guidelines endorse 30g fibre/day from diverse sources, not isolates.

Australian Liver Foundation urges screening for at-risk groups: BMI>30, diabetes, via FibroScan or blood tests (FIB-4 score).

Voices from the Lab: ECU's Lois Balmer

"This research reinforces that diet matters—not just what we eat, but how nutrients interact," says Assoc Prof Balmer, whose Centre for Precision Health at ECU targets metabolic diseases. PhD candidate Tharani Senavirathna led experiments, with Curtin's Dr Ricky Lareu and ECU's Dr Armaghan Shafaei contributing expertise.

Balmer notes human trials next: "EA holds great promise... first study proving reversal potential." This underscores Australian higher ed's role in translational research.

Looking Ahead: From Mice to Clinic

ECU plans human studies dosing EA equivalents (e.g., 200-500mg/day from foods/supplements). Broader implications: rethink prebiotics in liver patients; personalised diets via microbiome testing. Funding via NHMRC could scale this, positioning WA unis as NAFLD leaders.

Globally, NAFLD burdens healthcare—Australia's proactive uni research offers hope.

Photo by Luke White on Unsplash

A Call to Action for Liver Health

Monitor via GP: ALT/AST, ultrasound. Lifestyle pillars: 150min weekly exercise, Mediterranean diet (veggies, nuts, fish), limit sugars/fructose. Unis like ECU drive evidence-based change—stay informed on emerging findings.Read the full ECU study here.

• Aim 25-30g fibre/day from whole foods.
• Incorporate EA sources 3-5x/week.
• Pause inulin if NAFLD risk; seek alternatives.
• Annual checks if overweight/diabetic.