Lifestyle interventions for patients with nonalcoholic fatty liver disease: a network meta-analysis

Abstract

Lifestyle interventions remain the first-line therapy for nonalcoholic fatty liver disease (NAFLD). This study aims to evaluate the individual impact of exercise and/or dietary interventions on the level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), homeostasis model of assessment for insulin resistance index (HOMA-IR), and BMI. Randomized-controlled trials from patients diagnosed with NAFLD were included in the meta-analysis if they reported the associations between changes in ALT, AST, HOMA-IR, or BMI and types of lifestyle interventions. Nineteen eligible articles were included. Compared with observation, aerobic exercise training (AEx) plus diet [weighted mean difference (WMD)=-25.85; 95% confidence interval (CI): -43.90 to -7.80], AEx (WMD=-8.81; 95% CI: -20.22-2.60) and diet (WMD=-11.85; 95% CI: -47.65-24.95) showed significant efficacy in the improvement of ALT levels. Also AST, AEx plus diet showed a significant tendency to reduce AST levels. In addition, progressive resistance training (WMD=-1.70; 95% CI: -5.61-2.21) led to the most obvious reduction in HOMA-IR compared with observation, but appeared to show no significant effect in BMI (WMD=0.27; 95% CI: -0.48 to -0.07), whereas AEx plus diet (WMD=-0.96; 95% CI: -1.54 to -0.38 and WMD=-1.96; 95% CI: -2.79 to -1.12) showed great efficacy both in the improvement of HOMA-IR and BMI. AEx plus diet is the most effective intervention in the management of patients with NAFLD. Dietary intervention may be more effective in the improvements of aminotransferases, whereas exercise shows superiority in improving insulin sensitivity and reduction of BMI.

Changes in Alanine Aminotransferase in Adults with Severe and Complicated Obesity during a Milk-Based Meal Replacement Programme

“…There have been contradictory ndings from previous studies on the response of ALT to different types of weight-loss interventions [15][16][17][18][19][20]. Our ndings also suggest that patients with elevated ALT (suggesting a degree of NAFLD) are at higher risk of additional hepatic in ammation, at least during the early stages of dietary restriction-based weight loss interventions.…”

“…Weight loss interventions based on either increased physical activity, dietary restriction or a combination of the two, have been shown to reduce ALT in meta-analyses [18,19]. However, intensive caloric restriction such as with a very low-calorie diet has been associated with increased ALT in one study [20].…”

Nonalcoholic Fatty Liver Disease

“…Apart from dietary changes, lifestyle modification is another way to lose weight, for instance, via physical activity instead of sedentariness (Fabricatore 2007). However, compared to dietary restriction, physical activity is less effective in losing weight due to reduced caloric consumption as compared with dietary restriction (Marchesini et al 2016;Zou et al 2018). While dietary change and lifestyle intervention are able to reduce body weight, many patients cannot adhere to these interventions.…”

Changes in Alanine Aminotransferase in Adults with Severe and Complicated Obesity during a Milk-Based Meal Replacement Programme

“…However it must be emphasised that this assertion is speculative, because ALT is regarded as a "modestly good at best" indicator of hepatocyte damage in patients with NAFLD [13]. There have been contradictory findings from previous studies on the response of ALT to different types of weight-loss interventions [15][16][17][18][19][20]. Our findings also suggest that patients with elevated ALT (suggesting a degree of NAFLD) are at higher risk of additional hepatic inflammation, at least during the early stages of dietary restriction-based weight loss interventions.…”