Lifestyle changes in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis

Tiziana Fernández, Macarena Viñuela, Catalina Vidal, Francisco Barrera, Tiziana Fernández, Macarena Viñuela, Catalina Vidal, Francisco Barrera

Abstract

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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flowchart of studies selection process.
Fig 1. Flowchart of studies selection process.
Fig 2. Effect of exercise alone compared…
Fig 2. Effect of exercise alone compared to the control group in body weight.
Fig 3. Effect of exercise plus diet…
Fig 3. Effect of exercise plus diet compared to the control group in body weight.
Fig 4. Effect of exercise alone compared…
Fig 4. Effect of exercise alone compared to the control in oxygen consumption.
Fig 5. Effect of exercise alone compared…
Fig 5. Effect of exercise alone compared to the control group in intrahepatic lipids assessed by H-MRS and MRI.
Fig 6. Effect of exercise plus diet…
Fig 6. Effect of exercise plus diet compared to the control group in intrahepatic lipids assessed by NAS score.
Fig 7. Effect of exercise plus diet…
Fig 7. Effect of exercise plus diet compared to the control group in ALT concentration.
Fig 8. Effect of exercise alone compared…
Fig 8. Effect of exercise alone compared to the control group in ALT concentration.
Fig 9. Effect of exercise compared to…
Fig 9. Effect of exercise compared to the control group in AST concentration.
Fig 10. Effect of exercise plus diet…
Fig 10. Effect of exercise plus diet compared to the control group in AST concentration.

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