Cited by 1,347Liver Disease Diagnosis and TreatmentAlcohol Consumption and Health EffectsNutritional Studies and Diet

Treatment of NAFLD with diet, physical activity and exercise

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Romero-Gómez, Manuel, Zelber-Sagi, Shira, Trenell, Michael·2017·Journal of Hepatology

Abstract

Lifestyle intervention can be effective when treating non-alcoholic fatty liver diseases (NAFLD) patients. Weight loss decreases cardiovascular and diabetes risk and can also regress liver disease. Weight reductions of ⩾10% can induce a near universal non-alcoholic steatohepatitis resolution and fibrosis improvement by at least one stage. However, modest weight loss (>5%) can also produce important benefits on the components of the NAFLD activity score (NAS). Additionally, we need to explore the role of total calories and type of weight loss diet, micro- and macronutrients, evidence-based benefits of physical activity and exercise and finally support these modifications through established behavioural change models and techniques for long-term maintenance of lifestyle modifications. Following a Mediterranean diet can reduce liver fat even without weight loss and is the most recommended dietary pattern for NAFLD. The Mediterranean diet is characterised by reduced carbohydrate intake, especially sugars and refined carbohydrates (40% of the calories vs. 50-60% in a typical low fat diet), and increased monounsaturated and omega-3 fatty acid intake (40% of the calories as fat vs. up-to 30% in a typical low fat diet). Both TV sitting (a reliable marker of overall sedentary behaviour) and physical activity are associated with cardio-metabolic health, NAFLD and overall mortality. A 'triple hit behavioural phenotype' of: i) sedentary behaviour, ii) low physical activity, and iii) poor diet have been defined. Clinical evidence strongly supports the role of lifestyle modification as a primary therapy for the management of NAFLD and NASH. This should be accompanied by the implementation of strategies to avoid relapse and weight regain.

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Crossref · 10.1016/j.jhep.2017.05.016

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  • Exercise can improve liver lipid content and may also decrease cardiovascular risk, importantly even without changes in body weight.

    “Further, exercise can improve liver lipid content and may also decrease cardiovascular risk, importantly even without changes in body weight [75,76].”

    From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [75]

    The Key point section says exercise without weight loss produces a 20–30% relative reduction in intrahepatic lipid. It also suggests exercise may improve cardiovascular function in people with NAFLD, but does not establish that cardiovascular risk decreases independently of changes in body weight. (LLM, conf=0.82)

    Experimental — accuracy not yet measured
  • For a substantial proportion of affected individuals, lifestyle modification is neither successful nor sustainable.

    “However, for a substantial proportion of affected individuals, lifestyle modification is neither successful nor sustainable [75].”
  • Based on seven protocols from seven studies, a reduction in hepatic steatosis was observed in 85.7% of resistance exercise protocols, including five randomized controlled trials.

    “Based on seven protocols from seven studies, a reduction in hepatic steatosis was observed in 85.7% of the protocols, including five randomized controlled trials (76–82).”
  • The link between fructose and MASLD/insulin resistance is attributed to increased hepatic lipogenesis, alterations in intestinal microflora, heightened intestinal permeability, endotoxemia, elevated hepatic TNF-α production, and lipid peroxidation.

    “attributed to increased hepatic lipogenesis, alterations in intestinal microflora, heightened intestinal permeability, endotoxemia, elevated hepatic Tumor Necrosis Factor-α production, and lipid peroxidation (79).”
  • Fructose, particularly added sugars, has been linked to the development of MASLD and insulin resistance.

    “The latter has been linked to the development of MASLD and insulin resistance”

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Authors
Romero-Gómez, M., Zelber-Sagi, S., & Trenell, M.
Affiliations
Newcastle University (GB)
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2017-10
Volume
67
Issue
4
Pages
829-846
ISSN
0168-8278 (ISSN-L)
OpenAlex
W2619337392
Cited by
1,347
References
195
Citations by year
2026: 114 · 2025: 155 · 2024: 193 · 2023: 193 · 2022: 192 · 2021: 178 · 2020: 171 · 2019: 98 · 2018: 41 · 2017: 11
FWCI
11.64
Type
journal article
Language
en
Open access
Locations
  • Journal of Hepatology (publishedVersion)
  • PubMed (publishedVersion)
  • RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
Funders
  • Ministerio de Economía y Competitividad
  • Instituto de Salud Carlos III
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 › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
non-alcoholic fatty liver disease, nonalcoholic steatohepatitis, lifestyle intervention, weight loss, Mediterranean diet, physical activity, sedentary behavior, dietary macronutrients, omega-3 fatty acids, NAFLD activity score, liver fibrosis, relapse prevention, weight regain
MeSH terms
Behavior Therapy, Clinical Trials as Topic, Carcinoma, Hepatocellular, Humans, Life Style, Liver Neoplasms, Risk Factors, Weight Loss, Exercise, Micronutrients, Caloric Restriction, Diet, Mediterranean, Risk Reduction Behavior, Sedentary Behavior, Non-alcoholic Fatty Liver Disease

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