Exercise does not independently improve histological outcomes in biopsy-proven non-alcoholic fatty liver disease: a systematic review and meta-analysis
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INTRODUCTION: The independent effect of exercise on liver histology in non-alcoholic fatty liver disease (NAFLD) remains unclear. As such, we conducted a systematic review and meta-analysis of the effect of exercise alone on histological endpoints in biopsy-proven NAFLD. MATERIALS AND METHODS: A systematic literature search was conducted to include controlled clinical trials investigating the effect of exercise alone on liver histology in biopsy-proven NAFLD. Meta-analysis was conducted for histological outcomes with available data from a minimum of three studies. Pooled estimates of the effect of exercise on histological endpoints were calculated using random-effects models. RESULTS: We identified three controlled clinical trials that assessed the independent effect of exercise on histological outcomes in patients with biopsy-proven NAFLD. The studies consisted of 72 total participants, including 40 subjects in the exercise intervention and 32 individuals in the comparison group. Meta-analysis showed that exercise did not significantly improve Brunt grade, NAFLD activity score, and fibrosis in NAFLD. DISCUSSION: Exercise alone may not lead to significant histopathological improvement in NAFLD. Future well-powered randomized controlled trials are needed to better characterize the impact of exercise on histological outcomes and clinical endpoints.
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Owing to limited clinical trial data, it is currently unclear whether exercise training can independently improve liver histology.
“Owing to limited clinical trial data, it is currently unclear whether exercise training can independently improve liver histology. 318,319”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [319]
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Prescribing Exercise in MASLD: From Evidence to a Structured, Measurable Intervention
Rodriguez, L. A. M., Olivera, M. R. G., Espinosa, C. S. G., Velazquez, Y. V., Flores-Lázaro, J. R., & Torre, A. (2026) · Current Hepatology Reports · doi:10.1007/s11901-026-00740-y
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- Authors
- Chen, G., Banini, B. A., Do, A., Gunderson, C., Zaman, S., & Lim, J. K.
- Affiliations
- Yale University (US)
- Corresponding author
- Chen, George
- Venue
- Genes
- Publisher
- MDPI AG
- Published
- 2023-09-17
- Volume
- 14
- Issue
- 9
- Pages
- 1811
- ISSN
- 2073-4425 (ISSN-L)
- PMC
- PMC10531443
- OpenAlex
- W4386814536
- Cited by
- 15
- References
- 11
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 8 · 2023: 2
- FWCI
- 0.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Genes (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR001863)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- non-alcoholic fatty liver disease, physical activity, liver histopathology, NAFLD activity score, liver fibrosis, histological outcomes, exercise therapy
- MeSH terms
- Biopsy, Humans, Exercise, Non-alcoholic Fatty Liver Disease
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