Clinical approaches to non-alcoholic fatty liver disease

Table 1 Summary of lifestyle intervention studies: diet and/or physical activity

Ref.	Population, Study Design	Intervention	Results
[71]	n = 96, 12-mo intervention on adults with hepatic steatosis and type 2 diabetes	Combination of moderate caloric restriction (1200-1800 kcal/d) and increased moderate physical activity (175 min per week)	Significant decreases in BMI, weight, waist circumference, percent body fat and A1C
[72]	n = 50, longitudinal study with lifestyle intervention in NAFLD adults	10 concealing sessions with a dietitian, and moderate intensity activity 3 h/wk	Significantly decreased body fat and liver fat and increased fitness. NAFLD at baseline resolved in 20 participants
[68]	n = 28, randomized control trial adults with elevated ALT or AST, BMI of 25-40	Combination of diet (1000-1500/d), exercise (10000 steps per day and 200 min/wk of moderate physical activity) and behavior modification	Weight in intervention group decreased by 9.3%, significant improvement of NASH. > 7% weight loss significantly improved steatosis
[73]	n = 152, randomized intervention of adults with elevated liver enzymes, central obesity and metabolic risk factors	Randomized to moderate (6 sessions/10 wk) or low-intensity (3 sessions/4 wk) or control. Physical activity 150 min/wk and low saturated fat and process food diet (1700-2400 kcal/d)	Moderate intensity – improvement in all risk factors, greater reduction in liver enzymes and weight loss than low-intensity
[74]	n = 19, 8 wk exercise intervention in NAFLD adults	8 wk (3 × wk) of resistance exercise (n = 11) vs control (n = 8)	13% reduction in liver lipid. Lipid oxidation, glucose and IR improved. No effect on weight or body fat

BMI: Body mass index; NAFLD: Non-alcoholic fatty liver disease; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; NASH: Nonalcoholic steatohepatitis; IR: Insulin resistance.