Prospective histopathologic evaluation of lifestyle modification in nonalcoholic fatty liver disease: a randomized trial

Abstract

Background and aims: Nonalcoholic fatty liver disease (NAFLD) is now recognized as part of the metabolic syndrome, and is specifically related to obesity and insulin resistance. Lifestyle modification is advocated for the treatment of NAFLD, but few studies have evaluated its impact on liver histology. The purpose of this study was to investigate which, if any, specific diet and exercise recommendations are associated with histopathologic changes. Methods: A total of 56 participants were randomly assigned to 1 of 4 lifestyle modification subgroups for 6 months: standard care, low-fat diet and moderate exercise, moderate-fat/lowprocessed-carbohydrate diet and moderate exercise, or moderate exercise only. All subjects had biopsy-proven NAFLD, to include nonalcoholic steatohepatitis (NASH), and received a repeat 6-month biopsy to detect histopathologic changes. Other measures included blood assay of liver enzymes (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase), fasting glucose, serum insulin, lipid panel, body weight, dietary intake, fat mass, and fitness level. Results: Among the 41 participants who completed the study (88% with NASH), a significant change was found in pre-to post-NAFLD activity score in the group as a whole (p < 0.001) with no difference detected between subgroups (p = 0.31). Our results confirm that lifestyle modification is effective in improving NAFLD and NASH. Conclusions: Regardless of intervention group, lifestyle modification improved liver histology, as verified by repeat biopsy, after a 6-month intervention. This study reinforces the importance of lifestyle modification as the primary treatment strategy for patients with NAFLD.

Efficacy of dietary and physical activity intervention in non-alcoholic fatty liver disease: a systematic review

“…Using the ADA quality assessment criteria (figure 2), 13 of the 24 studies were rated as positive, high-quality trials 16–20 24 25 28 29 33 34 37 38. In eight of the trials, insufficient information was provided to make an informed decision regarding the adequacy of randomisation21 22 26 27 30 32 35 36 and one trial was described as ‘semi-random’ 23.…”

“…Weight losses on VLCD are typically greater than the 10% recommended for maximal improvement in NAFLD,5 6 but the risk of recurring weight gain is significant and weight loss maintenance is challenging in the long term 43. A low carbohydrate diet may improve NAFLD more than other forms of dietary restriction;23 however, evidence is mixed and studies comparing different dietary constituents showed no significant difference between low carbohydrate and low fat diets 22 35 37…”

Intensive lifestyle treatment for non-alcoholic fatty liver disease in children with severe obesity: inpatient versus ambulatory treatment

“…29,30 Specific dietary interventions, like a low carbohydrate and fructose diet, could also potentially enhance the effect of conventional lifestyle interventions for NAFLD. 8,9,31 Drug interventions are the main focus of current NAFLD research and effective drugs for NAFLD might be available in the near future. However, improving lifestyle treatments and identifying individual factors for success remains relevant as combining individually optimized lifestyle treatments with drug therapy rather than drug therapy alone is probably the future of NAFLD treatment.…”

“…No pediatric and only a few adult studies compare different lifestyle interventions for NAFLD. 8,9 In addition, few studies evaluate the effect in children with severe obesity who generally are more therapy resistant in weight loss programs. 10 We aimed to evaluate the 6-month and 2-year efficacy of an intensive lifestyle intervention in an obesity institute for treating NAFLD in therapy resistant severely obese non-diabetic children.…”

Liver Histology after Chronic Use of Alcohol and Exercise Training in Rats

“…Regular aerobic exercises can reduce the levels of hepatic fat, and this benefit may occur, although to a lesser extent, with no weight loss. Studies generally address nonalcoholic fatty liver disease and little is known about the effect of exercise on ALD [14][15][16][17][18][19].…”