Lifestyle changes in patients with non-alcoholic fatty liver disease: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Non-alcoholic fatty liver disease is a liver condition that is increasing worldwide and expected to become the number one cause of cirrhosis and hepatocellular carcinoma in the next 5 years. Currently there are no successful or approved pharmacological treatments. Weight loss is the first-line therapy as a 7 to 10% reduction improves steatosis, inflammation, hepatocyte ballooning, and fibrosis. To achieve this, lifestyle interventions including daily exercise and diet must be encouraged. We aimed to assess the effects of diet, exercise, or a combination of both compared to conventional treatment in patients with non-alcoholic fatty liver disease. METHODS AND FINDING: A literature search was performed in CENTRAL, EMBASE, and PubMed. Randomized controlled trials comparing lifestyle changes with conventional treatment were included, without date restriction. Two authors searched studies according to eligibility criteria, extracted data, and assessed study quality. Subgroup analysis was made by type of intervention, duration of intervention and supervision. We calculated mean differences between the intervention and the control group with their corresponding 95% confidence intervals. Quality of the evidence was assessed using the Cochrane Risk of bias tool. This study is registered in PROSPERO, number CRD42020184241, and checked with the PRISMA checklist. 30 RCTs met the inclusion criteria. Compared to conventional treatment, combined exercise with diet seems to elicit greater reductions in ALT (MD: -13.27 CI 95% -21.39, -5.16), AST (MD: -7.02 CI 95% -11.26, -2.78) and HOMA-IR (MD: -2.07 CI 95% -2.61, -1.46) than diet (ALT MD: -4.48 CI 95% -1.01, -0.21; HOMA-IR MD: -0.61 CI 95% -1.01, -0.21) and exercise (ALT and AST non-significant; HOMA-IR MD = -0.46 CI 95% -0.8, -0.12) alone. Additionally, exercise improved quality of life, cardiorespiratory fitness, and weight (MD: -2.64 CI 95% -5.18, -0.09). CONCLUSION: Lifestyle changes are effective in the treatment of NAFLD. Diet and exercise combined are superior to these interventions alone in improving liver enzymes and HOMA-IR.
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In adults with MASLD, dietary and behavioural therapy-induced weight loss improves liver injury, as assessed histologically or non-invasively.
“It has repeatedly been demonstrated in clinical trials that weight reduction achieved by caloric restriction, either with or without increased physical activity, leads to improvements in MASLD biomarkers, including liver enzymes, steatosis, MASH, and fi brosis 277 -279 (Fig. 3).”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [277]
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- Authors
- Fernández, T., Viñuela, M., Vidal, C., & Barrera, F.
- Affiliations
- Pontificia Universidad Católica de Chile (CL)
- Corresponding author
- Fernández, Tiziana
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2022-02-17
- Volume
- 17
- Issue
- 2
- Pages
- e0263931
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC8853532
- OpenAlex
- W4213043394
- Cited by
- 117
- References
- 95
- Citations by year
- 2026: 18 · 2025: 33 · 2024: 29 · 2023: 29 · 2022: 8
- FWCI
- 3.93
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Fondo Nacional de Desarrollo Científico y Tecnológico (1191183)
- 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, diet, physical activity, weight loss, alanine aminotransferase, aspartate aminotransferase, HOMA-IR, insulin resistance, quality of life, cardiorespiratory fitness, conventional therapy comparison, steatosis, fibrosis, hepatocellular carcinoma risk, cirrhosis risk, hepatocyte ballooning
- MeSH terms
- Humans, Life Style, Quality of Life, Weight Loss, Exercise, Non-alcoholic Fatty Liver Disease
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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