Lifestyle changes in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis

Abstract

Background Non-alcoholic fatty liver disease is a liver condition that is increasing worldwide and expected to become the number one cause of cirrhosis and hepatocellular carcinoma in the next 5 years. Currently there are no successful or approved pharmacological treatments. Weight loss is the first-line therapy as a 7 to 10% reduction improves steatosis, inflammation, hepatocyte ballooning, and fibrosis. To achieve this, lifestyle interventions including daily exercise and diet must be encouraged. We aimed to assess the effects of diet, exercise, or a combination of both compared to conventional treatment in patients with non-alcoholic fatty liver disease. Methods and finding A literature search was performed in CENTRAL, EMBASE, and PubMed. Randomized controlled trials comparing lifestyle changes with conventional treatment were included, without date restriction. Two authors searched studies according to eligibility criteria, extracted data, and assessed study quality. Subgroup analysis was made by type of intervention, duration of intervention and supervision. We calculated mean differences between the intervention and the control group with their corresponding 95% confidence intervals. Quality of the evidence was assessed using the Cochrane Risk of bias tool. This study is registered in PROSPERO, number CRD42020184241, and checked with the PRISMA checklist. 30 RCTs met the inclusion criteria. Compared to conventional treatment, combined exercise with diet seems to elicit greater reductions in ALT (MD: -13.27 CI 95% -21.39, -5.16), AST (MD: -7.02 CI 95% -11.26, -2.78) and HOMA-IR (MD: -2.07 CI 95% -2.61, -1.46) than diet (ALT MD: -4.48 CI 95% -1.01, -0.21; HOMA-IR MD: -0.61 CI 95% -1.01, -0.21) and exercise (ALT and AST non-significant; HOMA-IR MD = -0.46 CI 95% -0.8, -0.12) alone. Additionally, exercise improved quality of life, cardiorespiratory fitness, and weight (MD: -2.64 CI 95% -5.18, -0.09). Conclusion Lifestyle changes are effective in the treatment of NAFLD. Diet and exercise combined are superior to these interventions alone in improving liver enzymes and HOMA-IR.

One size does not fit all; practical, personal tailoring of the diet to NAFLD patients

“…In NAFLD treatment, exercise is recommended by clinicalpractice guidelines. 13,15 The recommendations are established upon the findings that exercise overall, without weight loss, produces a 20%-30% relative reduction in hepatic fat content, 128,129 with similar effects of different modalities of exercise (aerobic exercise, resistance exercise, or high-intensity intermittent exercise).…”

“…130 A recent meta-analysis using 16 RCTs of exercise intervention showed that exercise significantly reduced liver fat compared to the control group. 129 Studies reporting the effects of exercise in people with fibrosis are limited. A 12-week aerobic exercise non-controlled intervention led to reduced fibrosis by one stage, according to repeated liver biopsy, in about 60% of patients.…”

“…In NAFLD treatment, exercise is recommended by clinical‐practice guidelines 13,15 . The recommendations are established upon the findings that exercise overall, without weight loss, produces a 20%–30% relative reduction in hepatic fat content, 128,129 with similar effects of different modalities of exercise (aerobic exercise, resistance exercise, or high‐intensity intermittent exercise). Although most exercise trials among NAFLD patients to date were relatively small and based on short‐term interventions, between 8 and 12 weeks, the positive effects on liver fat reduction are consistent 130,131 .…”

“…Even low‐volume, low‐intensity aerobic exercise can decrease liver fat without clinically significant weight loss 130 . A recent meta‐analysis using 16 RCTs of exercise intervention showed that exercise significantly reduced liver fat compared to the control group 129 . Studies reporting the effects of exercise in people with fibrosis are limited.…”

Cinnabarinic Acid Provides Hepatoprotection Against Nonalcoholic Fatty Liver Disease

“…Therefore, the findings presented here strongly indicate that the anti-steatotic and hepatoprotective effects against lipotoxicity exerted by CA are absolutely dependent upon AhR-mediated Stc2 signaling. (Fernández et al, 2022).…”