Lifestyle interventions for the treatment of non-alcoholic fatty liver disease in adults: a systematic review
Open accessAbstract
Non-alcoholic fatty liver disease is a serious and growing clinical problem. Despite lifestyle modification, i.e. diet and physical activity, being the recommended therapy, there are currently no systematic evaluations of its efficacy. This review applies a systematic approach to evaluating lifestyle modifications studied to date. Medline (Pubmed), Scopus, and the Cochrane Controlled Trials Register were searched for studies and study groups assessing the effect of diet, physical activity, and/or exercise modification in adult populations with non-alcoholic fatty liver disease. The outcome markers of interest were indicators of steatosis, histological evidence of inflammation and fibrosis, and glucose control/insulin sensitivity. We identified 23 studies for inclusion; seven had control groups, but only six were randomised. Eleven groups received diet-only interventions, two exercise-only, and 19 diet and physical activity/exercise. Studies consistently showed reductions in liver fat and/or liver aminotransferase concentration, with the strongest correlation being with weight reduction. Of the 5 studies reporting changes in histopathology, all showed a trend towards reduction in inflammation, in 2 this was statistically significant. Changes in fibrosis were less consistent with only one study showing a significant reduction. The majority of studies also reported improvements in glucose control/insulin sensitivity following intervention. However, study design, definition of disease, assessment methods, and interventions varied considerably across studies. Lifestyle modifications leading to weight reduction and/or increased physical activity consistently reduced liver fat and improved glucose control/insulin sensitivity. Limited data also suggest that lifestyle interventions may hold benefits for histopathology.
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A meta-analysis of lifestyle interventions in people with MASLD identified weight loss of between 4% and 14% with a corresponding reduction in liver fat of 4-10%.
“A meta-analysis of lifestyle interventions in people with MASLD identified weight loss of between 4% and14% with a corresponding reduction in liver fat of 4–10%.27”
From Randomised trial comparing weight loss through lifestyle and GLP-1 receptor agonist therapy in people with MASLD (2025) · cites this paper as [27]
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- Authors
- Thoma, C., Day, C. P., & Trenell, M. I.
- Affiliations
- Newcastle University (GB)
- Corresponding author
- Trenell, Michael I.
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2012-01
- Volume
- 56
- Issue
- 1
- Pages
- 255-266
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W2010662354
- Cited by
- 523
- References
- 53
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 30 · 2023: 37 · 2022: 35 · 2021: 43 · 2020: 42 · 2019: 36 · 2018: 32 · 2017: 46 · 2016: 46 · 2015: 46 · 2014: 40 · 2013: 32 · 2012: 23
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Hepatology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institute for Health and Care Research (SRF-2011-04-017)
- Medical Research Council (MC_G0802536)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- non-alcoholic fatty liver disease, lifestyle intervention, dietary intervention, physical activity, weight loss, liver fat, hepatic steatosis, liver fibrosis, liver inflammation, insulin sensitivity, glycemic control, transaminases
- MeSH terms
- Adult, Aged, Clinical Trials as Topic, Combined Modality Therapy, Diet Therapy, Exercise Therapy, Fatty Liver, Female, Humans, Life Style, Male, Middle Aged, Motor Activity, Prospective Studies, Lipid Metabolism, Weight Reduction Programs, Non-alcoholic Fatty Liver Disease
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