Table 1.

Therapeutic recommendations related to lifestyle changes and dietary treatment in MAFLD.

5–10% reduction in initial body weight for overweight/obese patients, increasing these targets when there are higher levels of MASH and fibrosis

3–5% reduction in initial body weight for lean MAFLD patients (especially if their excess abdominal fat and is present has been recent weight gain)

Visceral fat reduction (abdominal circumference)

Visceral fat reduction (abdominal circumference) A healthy diet with calorie restriction (daily reduction of 0.5000–1.000 kcal) or total intake between 1.200−1.800 kcal/day adapted to patient preferences

Prioritize consumption of olive oil, nuts, and fish, reduction of saturated fat, and avoid trans fat intake

Avoid foods and drinks that contain added fructose There is no evidence of the harmful effect of fruits in their natural form if consumed in a reasonable amount (generally 1–3 servings/day)

The daily protein intake recommendation should be equal to or more than 1.2–1.5 g/kg/day

The Mediterranean diet is the better dietary strategy to improve steatosis and insulin sensitivity and their adherence should be advised. Partial adherence can be advantageous if it reduced saturated fat, and fructose intake, avoid added refined sugar, and prioritizes homemade food and minimally processed foods

Consumption of coffee in moderate amounts is recommended for patients with MAFLD

The ω-3 PUFAs may be considered to treat hypertriglyceridemia in patients with MAFLD, however, are not recommended for the specific treatment of MAFLD or MASH

Avoiding excessive alcohol consumption and smoking can be beneficial both in preventing the progression of MAFLD and in reducing the risk of hepatocellular carcinoma

Moderate-intensity aerobic exercise (150–200 min/week of 3–5 sessions) Resistance training (weight training) promotes musculoskeletal fitness and is also effective to improve effects on metabolic risk factors. Moderate-intensity exercise is effective to promote 7–10% of total weight loss and sustaining this loss over time

Stimulate fat loss and lean mass increase in lean MAFLD patients with diet and exercise

MAFLD, metabolic dysfunction–associated fatty liver disease; MASH, metabolic associated steatohepatitis; PUFA, polyunsaturated fatty acids.