Are Sardines Good for Fatty Liver?

Sardines are good for fatty liver disease, offering a practical and affordable source of omega-3 fatty acids, high-quality protein and key micronutrients that support liver health. Metabolic dysfunction-associated steatotic liver disease (MASLD), also known as non-alcoholic fatty liver disease (NAFLD), is strongly influenced by diet, and oily fish such as sardines feature prominently in evidence-based dietary patterns recommended by bodies including EASL and NICE. This article explains the nutritional science behind sardines and liver health, how often to eat them, which other foods help or harm a fatty liver, and when to seek medical advice.

Why does diet matter so much if you have a fatty liver?

Diet directly influences liver fat accumulation, inflammation and disease progression in MASLD. NICE guideline NG49 identifies lifestyle modification, including dietary change, as the cornerstone of management, as no medicine currently holds UK authorisation specifically for MASLD.

Diet is one of the most powerful tools for managing metabolic dysfunction-associated steatotic liver disease (MASLD), the term increasingly used in UK clinical practice alongside the older label non-alcoholic fatty liver disease (NAFLD).^[1][3] Many NHS and NICE documents, including NICE guideline NG49, still use NAFLD and NASH terminology, so readers may encounter both. The liver processes everything absorbed from the gut, so the quality and quantity of what you eat directly influences how much fat accumulates in liver cells, how much inflammation develops, and whether the condition progresses to more serious stages such as fibrosis or cirrhosis.

NICE guidance (NG49) emphasises that lifestyle modification, including dietary change and increased physical activity, is the cornerstone of management for MASLD. At the time of writing, no medicine holds a UK marketing authorisation specifically for MASLD, though this is an active area of drug development and readers should check current MHRA guidance for the latest position.^[6][7] This makes dietary choices particularly important. Clinical studies have shown that even a modest reduction in body weight of 5 to 10 per cent, achieved largely through diet, can reduce liver fat measurably, with greater histological improvement seen at weight losses of 10 per cent or more.^[16]

Beyond calorie balance, the type of fat and carbohydrate consumed matters considerably. Diets high in ultra-processed foods, added sugars (particularly fructose), saturated fat and alcohol are consistently associated with worsening liver fat accumulation. Conversely, dietary patterns rich in oily fish, vegetables, wholegrains and unsaturated fats, such as the Mediterranean diet, are associated with improved liver outcomes in systematic reviews and clinical guidelines including those from the European Association for the Study of the Liver (EASL).^[18] Understanding which specific foods support liver health, and why, helps people make sustainable, evidence-informed choices.

Are sardines actually good for fatty liver disease?

Sardines are consistent with a liver-supportive diet due to their high omega-3 content (EPA and DHA), which is associated with reduced liver fat and improved liver enzyme levels. They are not a standalone treatment but support liver health as part of a broader dietary pattern.

Sardines are consistent with a liver-supportive diet for people with fatty liver disease, based on their nutritional profile. Sardines are a rich source of long-chain omega-3 polyunsaturated fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have well-documented anti-inflammatory and lipid-modulating properties relevant to liver health.

Clinical research, including systematic reviews and meta-analyses, has found that omega-3 supplementation and dietary intake from oily fish are associated with reductions in liver fat content, improvements in liver enzyme levels (particularly alanine aminotransferase, ALT), and reductions in triglyceride concentrations. A systematic review published in the Journal of Hepatology found that omega-3 fatty acids reduced liver fat in people with NAFLD compared with control groups, though the authors noted that larger trials were needed to confirm effects on fibrosis endpoints.^[8] The evidence is moderate in quality and should be interpreted with appropriate caution: oily fish such as sardines can support liver health as part of a broader dietary pattern, but are not a standalone treatment.

Sardines also provide high-quality protein, which supports satiety and helps preserve lean muscle mass during weight management, an important consideration given that weight loss is a primary treatment goal. They are low in saturated fat. Canned sardines in spring water or in olive oil are generally preferable to those in sunflower or vegetable oil, as the latter adds omega-6 fatty acids that may partially offset the omega-3 benefit, though this is a pragmatic suggestion rather than a firmly evidenced rule. Sardines in tomato sauce are also acceptable. Canned sardines are affordable, widely available in UK supermarkets, and require no preparation, making them a practical dietary choice.

Bolt Pharmacy is a GPhC-registered online pharmacy in Great Britain offering online weight-management consultations, with prescriber review and pharmacist support, for those seeking broader support alongside dietary changes.

Which nutrients in sardines support liver health?

Sardines contain omega-3 fatty acids, vitamin D, selenium, vitamin B12 and high-quality protein, all of which are relevant to liver function and protection against oxidative stress in MASLD. This combination makes sardines one of the more liver-supportive whole foods in a typical UK diet.

Sardines contain several nutrients that are directly relevant to liver function and the management of fatty liver disease. The most clinically significant are:

• Omega-3 fatty acids (EPA and DHA): These are associated with reductions in hepatic fat production, lower circulating triglycerides, and dampening of inflammatory signalling pathways, including those involving nuclear factor kappa B (NF-kB), which contributes to liver inflammation in MASLD.^[8] These mechanisms are supported by experimental and clinical research, though the full picture in humans remains an active area of study.

• Vitamin D: Sardines are one of the few dietary sources of vitamin D in the UK diet. Low vitamin D status has been associated with greater severity of MASLD in observational studies, though a causal relationship is not firmly established.^[11]

• Selenium: This trace mineral acts as a cofactor for glutathione peroxidase, an antioxidant enzyme that helps protect liver cells from oxidative stress, a key driver of progression from simple steatosis to steatohepatitis.^[13][12] Evidence in MASLD specifically is largely observational.

• Vitamin B12: Sardines are an excellent source of B12, which supports one-carbon metabolism and methylation reactions important for liver function.

• Coenzyme Q10: Present in small amounts, this antioxidant has been studied in the context of liver protection, though evidence in MASLD specifically remains preliminary and it is not a primary reason to eat sardines.

• High-quality protein: Adequate protein intake supports overall liver function. VLDL assembly and fat export from the liver are multifactorial processes; protein is one contributing factor among several.

Taken together, this nutrient combination makes sardines one of the more liver-supportive whole foods available in a typical UK diet, rather than a single-nutrient supplement.

How often should you eat sardines if you have a fatty liver?

Eating one to two portions of oily fish such as sardines per week is a reasonable, evidence-consistent target for people with fatty liver disease. NHS guidance advises most adults not to exceed four portions of oily fish per week due to environmental pollutant accumulation.

Current UK dietary guidance from the NHS and the Scientific Advisory Committee on Nutrition (SACN) recommends eating at least two portions of fish per week, of which one should be oily fish such as sardines, mackerel, salmon or trout.^[5][10] For people with fatty liver disease, aiming for one to two portions of oily fish per week is a reasonable and evidence-consistent target, though no specific clinical guideline sets a precise frequency solely for MASLD management.

A standard portion is approximately 140 g of cooked fish. Canned sardines vary in drained weight by brand and tin size, so it is worth checking the label; many standard UK tins contain around 90 to 120 g drained, meaning a single tin may be slightly less than a full portion. Canned sardines in spring water or in olive oil are generally preferable to those in sunflower or vegetable oil, as the latter adds omega-6 fatty acids that may partially offset the omega-3 benefit. Sardines in tomato sauce are also acceptable, though they may contain added salt, which is worth noting for anyone managing blood pressure alongside liver disease.

There is an upper limit to consider. NHS guidance advises that oily fish intake should not exceed four portions per week for most adults, due to the accumulation of environmental pollutants such as dioxins and polychlorinated biphenyls (PCBs).^[5][11] Pregnant women and those planning pregnancy are advised to limit oily fish to two portions per week, in line with NHS and Food Standards Agency (FSA) advice.^[5][10] People with fatty liver disease who are also managing other conditions, such as gout (as sardines are moderately high in purines) or chronic kidney disease, should discuss portion frequency with their GP or dietitian, as individual circumstances vary.

What other foods help or harm a fatty liver alongside sardines?

A Mediterranean dietary pattern, including extra virgin olive oil, vegetables, wholegrains, legumes and oily fish, is the most robustly evidenced approach for MASLD. Alcohol, added sugars, ultra-processed foods and excess fructose are consistently associated with worsening liver fat and inflammation.

Sardines work best as part of a broader dietary pattern rather than as a standalone remedy for fatty liver disease. The Mediterranean dietary pattern, which is the most robustly evidenced dietary approach for MASLD in published literature including EASL clinical practice guidelines, emphasises:

Foods that support liver health:

• Oily fish (sardines, mackerel, salmon, herring)

• Extra virgin olive oil, which provides oleocanthal and oleic acid with anti-inflammatory properties

• Vegetables and legumes, which provide fibre, folate and antioxidants

• Wholegrains (oats, brown rice, wholemeal bread) rather than refined carbohydrates

• Nuts and seeds, particularly walnuts, which are a plant source of alpha-linolenic acid (ALA)

• Coffee, which observational data consistently associates with lower liver enzyme levels and reduced fibrosis risk, as noted in EASL guidance and systematic reviews on coffee and chronic liver disease^[18]

Foods and substances that harm a fatty liver:

• Alcohol: even moderate intake can worsen liver fat and inflammation; NHS guidance recommends people with MASLD discuss alcohol limits with their GP

• Added sugars and sugary drinks, including those containing glucose-fructose syrup, which drives hepatic fat production (de novo lipogenesis)

• Ultra-processed foods high in saturated fat, refined starch and additives

• Red and processed meat in large quantities, associated with higher liver fat in some cohort studies

• Excess fructose from fruit juice (whole fruit in moderate amounts is generally acceptable due to its fibre content, in line with SACN guidance on free sugars)

A registered dietitian can provide personalised guidance, and GP referral to a dietitian is appropriate for people with confirmed MASLD who are struggling to make dietary changes independently.

When should you see a GP about fatty liver disease?

See your GP if you have been diagnosed with fatty liver or have risk factors such as obesity, type 2 diabetes or high triglycerides, as MASLD is often silent but can progress. Seek urgent care for symptoms such as jaundice, severe abdominal pain or vomiting blood.

You should see your GP if you have been told you have a fatty liver, or if you have risk factors such as obesity, type 2 diabetes, high triglycerides or metabolic syndrome, as MASLD is frequently silent in its early stages and can progress without obvious symptoms. Many people are diagnosed incidentally through a liver ultrasound or abnormal liver blood tests requested for another reason.

Contact your GP promptly if you experience any of the following, as these may indicate more advanced liver disease:

• Persistent fatigue or unexplained weight loss

• Abdominal discomfort or swelling, particularly in the upper right abdomen

• Yellowing of the skin or whites of the eyes (jaundice)

• Itching without an obvious cause

• Dark urine or pale stools

• Easy bruising or bleeding

For urgent symptoms such as sudden severe abdominal pain, vomiting blood, or confusion, call 999 or go to A&E immediately, as these may indicate acute liver decompensation. For non-emergency concerns outside GP hours, NHS 111 can provide advice.

Your GP may arrange liver function tests, a FibroScan (transient elastography) or referral to a hepatologist depending on the degree of suspected fibrosis. NICE guideline NG49 supports the use of the FIB-4 score in primary care to stratify risk, and NICE diagnostics guidance supports the Enhanced Liver Fibrosis (ELF) test for further assessment.^[1][9] FibroScan availability through GP referral varies by locality, so your GP can advise on what is accessible in your area. Dietary changes, including incorporating oily fish such as sardines, are most effective when combined with regular monitoring and professional support. Suspected side effects from any medicines you are taking for related conditions can be reported to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk.

Scientific References

1. Metabolic dysfunction-associated steatotic liver disease (formerly NAFLD) [NG49].
2. Non-alcoholic fatty liver disease (NAFLD) – short version of draft guideline [NG49].
3. GID-TA11477 draft scope post-referral – MASLD nomenclature.
4. Non-alcoholic fatty liver disease (NAFLD).
5. Fish and shellfish nutrition.
6. Resmetirom (Rezdiffra) authorised to treat metabolic dysfunction-associated steatohepatitis (MASH) in adults.
7. First treatment against liver scarring caused by a type of fatty liver disease.
8. Omega-3 supplementation and non-alcoholic fatty liver disease: a systematic review and meta-analysis.
9. Using the ELF test, FIB-4 and NAFLD fibrosis score to assess liver fibrosis.
10. Omega-3 fatty acids.
11. Levels of omega-3 fatty acids, vitamin D, dioxins and dioxin-like PCBs in oily fish; tolerable weekly intake.
12. Serum glutathione peroxidase is associated with nonalcoholic fatty liver disease in children and adolescents.
13. Selenium and selenoprotein P in nonalcoholic fatty liver disease.
14. Selenoneine ameliorates hepatocellular injury and hepatic steatosis in a mouse model of NAFLD.
15. Fructose drives de novo lipogenesis affecting metabolic health.
16. Diet, weight loss, and liver health in nonalcoholic fatty liver disease: pathophysiology, evidence, and practice.
17. Fructose, high-fructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: a systematic review and meta-analysis.
18. The impact of dietary interventions on liver health biomarkers in individuals with MASLD: a systematic literature review and meta-analysis of randomised controlled trials.
19. Global epidemiological patterns and disease burden of MASLD, MetALD, and ALD.

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