Lifestyle modification in NAFLD/NASH: Facts and figures

Abstract

The development of non-alcoholic fatty liver disease is closely linked to lifestyle factors, namely excessive caloric intake coupled with reduced physical activity and exercise. This review aims to examine the evidence behind lifestyle change as a tool to improve hepatic steatosis and liver histology in patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. Furthermore, potential barriers to adopting lifestyle changes and strategies to overcome these barriers in the clinical setting are discussed.

Review article: the impact of liver‐directed therapies on the atherogenic risk profile in non‐alcoholic steatohepatitis

“…46 At present, there are no drug therapies that have been approved for the treatment of NAFLD or NASH, therefore lifestyle recommendations remain the standard of care. [47][48][49] Improvements in nutrition with or without weight loss can have a positive impact on fatty liver. 49 For example, a short-term isocaloric diet that was low in carbohydrates and high in protein in subjects with NAFLD led to a dramatic reduction in liver fat content, decreased hepatic de novo lipogenesis, and increased fatty acid oxidation reflected by increased circulating β-hydroxybutyrate concentrations.…”

“…[47][48][49] Improvements in nutrition with or without weight loss can have a positive impact on fatty liver. 49 For example, a short-term isocaloric diet that was low in carbohydrates and high in protein in subjects with NAFLD led to a dramatic reduction in liver fat content, decreased hepatic de novo lipogenesis, and increased fatty acid oxidation reflected by increased circulating β-hydroxybutyrate concentrations. 50 In another F I G U R E 1 Comparison of aspects of normal lipoprotein metabolism and atherogenic dyslipidaemia.…”

“…51 Hypocaloric diets, especially those that elicit weight loss, have shown beneficial effects on hepatic and metabolic end points in subjects with NAFLD/NASH. 49 Hypocaloric very low carbohydrate diets in particular tend to increase ketone bodies (ketogenic diets) and decrease liver fat content, insulin resistance and features of metabolic syndrome. 52 In a recent study of 262 subjects who were placed on a diet that restricted carbohydrates and allowed for the consumption of protein and fat to satiety, subjects had reduced liver fat content and exhibited lipoprotein changes that were reminiscent of a reduction in insulin resistance and a reversal of atherogenic dyslipidaemia ( Figure 1).…”

“…57,58 Combining weight loss with an exercise regimen is the most beneficial in terms of improving the histological features of NASH. [47][48][49] A systematic review and a recent meta-analysis of a number of interventions suggested that weight loss of 5% in NAFLD or 7%-10% in NASH was beneficial and could be achieved by a combination of a hypocaloric diet and 30-60 minutes of moderate intensity exercise for 3-5 days per week. 47,49 Combined diet and exercise interventions tended to show improvements in serum levels of liver enzymes as well as liver histology.…”

“…[47][48][49] A systematic review and a recent meta-analysis of a number of interventions suggested that weight loss of 5% in NAFLD or 7%-10% in NASH was beneficial and could be achieved by a combination of a hypocaloric diet and 30-60 minutes of moderate intensity exercise for 3-5 days per week. 47,49 Combined diet and exercise interventions tended to show improvements in serum levels of liver enzymes as well as liver histology. 48 Dietary modifications such as reduction in carbohydrate intake as well as increased physical activity may lead to improvements in liver fat content, however, lifestyle changes including both diet and exercise are necessary to show improvement in hepatic inflammation and fibrosis.…”