Shehnaz Hussain, PhD, is an associate professor of Medicine in the Division of Hematology/Oncology at Cedars-Sinai. She studies how and why liver disease can worsen into cancer.

Hussain's recent research focuses on nonalcoholic fatty liver disease, an increasingly common condition that affects about a quarter of adults, many of whom haven't been officially diagnosed.

People with nonalcoholic fatty liver disease have an accumulation of fat in their livers that is not caused by drinking, but can be related to obesity and diabetes. Some individuals with fatty liver will never have symptoms, but others will develop nonalcoholic steatohepatitis (NASH)—which is associated with inflammation and fibrosis that can lead to cirrhosis, liver failure, and even cancer.

"We're trying to understand why some people with liver disease progress to cancer and why others do not," Hussain says.

One study, which is anticipated to begin Fall 2018, aims to test how diet might affect fatty liver. Here, Hussain explains how.

Hussain: In this trial, patients with fatty liver will be randomly assigned to eat one of two low-calorie meal plans for one month.

One group will eat healthy, normal food. The other group will be put on a ketogenic diet, which is also healthy and delicious, but very low in carbohydrates and very high in healthy fat (like avocado, oil, and fish).

Currently, we treat people with fatty liver by asking them to eat less; we want to know if it matters more what they eat.

Hussain: We'll provide patients all the food they need through a meal-delivery service. Three chef-prepared meals a day will be dropped off at their homes.

The food is very good—we taste-tested it all.

Hussain: At the end of the study, we'll measure the fat in patients' livers to see if one group lost more liver fat than another.

We're also looking for links between diet and the gut microbiome, which is the community of healthy and harmful bacteria in your gut. We're curious how the diets might change the microbiome. Right now, we can't recommend what to eat to have healthier bacteria, but we hope that we can soon.

Hussain: We're trying to understand if there's anything we can do to intervene in fatty liver to prevent it from turning into cancer.

If we find that the main way diet affects the liver is through the microbiome, we can start to think about strategies and interventions to change someone's microbiome. We can develop probiotics and prebiotics that help build and maintain good bacteria. This is just the start.

These studies will tell us more about the problem and how we can potentially intervene, and then much more research has to be done to see if it's effective.