Abstract
BackgroundNon-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 findingA 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).ConclusionLifestyle 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.
Highlights
NAFLD is a condition that includes a broad spectrum of liver diseases ranging from simple steatosis in which lipid droplets accumulate within the cytoplasm in over 5% of hepatocytes, to non-alcoholic steatohepatitis (NASH), which is characterized by steatosis, inflammation and hepatocyte cell ballooning frequently associated with fibrosis not explained by other factors [1] NAFLD is strongly associated with obesity, insulin resistance (IR), type 2 diabetes mellitus (T2DM) and dyslipidemia [2].Its prevalence is approximately 25% worldwide and its incidence is increasing rapidly
Diet and exercise combined are superior to these interventions alone in improving liver enzymes and HOMA-IR
As secondary outcomes we considered intrahepatic triglycerides (IHL) assessed by MRS, magnetic resonance imaging (MRI), or US; serum liver enzymes concentrations, especially alanine aminotransferase (ALT) and aspartate aminotransferase (AST); changes in body weight, Cardiorespiratory fitness (CRF) evaluated with maximum oxygen consumption or peak oxygen consumption (VO2 ml/kg/min), and HOMA-IR as a parameter of glucose metabolism
Summary
NAFLD is a condition that includes a broad spectrum of liver diseases ranging from simple steatosis in which lipid droplets accumulate within the cytoplasm in over 5% of hepatocytes, to non-alcoholic steatohepatitis (NASH), which is characterized by steatosis, inflammation and hepatocyte cell ballooning frequently associated with fibrosis not explained by other factors [1] NAFLD is strongly associated with obesity, insulin resistance (IR), type 2 diabetes mellitus (T2DM) and dyslipidemia [2].Its prevalence is approximately 25% worldwide and its incidence is increasing rapidly. The AASLD guideline recommends that decreasing caloric intake between 750–1000 kcal/day or 30% of the regular intake improves IR and hepatic steatosis [11], improving fasting glucose, IR, and alanine-transferase [12] and reducing free fatty acids. The combination of both interventions has demonstrated improvements in liver histology and liver enzymes [7] and is associated with weight reductions of 4.2% to 10.6% [13]. 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 5 years. 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
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