Table 2.

Practical lifestyle recommendations based on current, available evidence for MAFLD

	Recommendations	Impacts	Precautions
Diet
General	Follow healthy dietary patterns (Fig. 1). Most favourable is Mediterranean diet. DASH, TRE, vegetarian/vegan and short-term ketogenic diets may be beneficial	↑MUFA ↓ SFA and free fatty acids ↑Phenolic compounds ↑ dietary fibre, resistant starch, oligosaccharides ↑ ω-3 PUFAs ↑ calcium, phosphorus, magnesium, vitamin D, protein.	Any changes in GI function with dietary changes, should settle after several weeks Eating disorders should be screened and ruled out. Hypoglycaemia management should be provided to those at risk (i) prescribed insulin or sulfonylureas, (ii) those following TRE or Ketogenic diets due to their more restrictive nature. Close monitoring of blood glucose levels due to the rapid and significant dietary changes is recommended. Ketogenic diet should only be followed with recommendation and support from a health care professional and only short term. Conditions that are contraindicated including but not limited to pancreatitis, liver failure, disorders of fat metabolism, primary carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine translocase deficiency, porphyrias, or pyruvate kinase deficiency. Ketogenic diet may cause upset stomach, dizziness, decreased energy, and mood swings. Intermittent fasting may cause headaches, lethargy, mood swings, and constipation.
Daily/weekly	Use extra virgin olive oil as the main culinary fat Choose wholegrains daily Fruits and vegetables daily Nuts, seeds, legumes and pulses daily Fish, especially oily fish 2–3x/week Poultry and game 2–3x/week Coffee consumers should aim for three or more cups daily Reduce red meat intake to weekly Consume moderate dairy, especially fermented varieties
Avoid	Ultra-processed foods Processed meat Soft drinks and processed foods high in fructose High-salt foods and adding salt to meals	↑ SFA ↑ Sodium ↑ Fructose ↑ Sucrose
Exercise
General	Follow recommendation for PA/exercise and sedentary behavior (Fig. 1)	↑ Cardiorespiratory fitness ↑ Cardiometabolic health ↑ Health-related quality of life ↓ Body adiposity (including visceral adipose tissue). ↓ Hepatic steatosis. ↑ Lean mass.	Review and guidance from a medical practitioner and referral to an appropriately qualified exercise professional is strongly recommended prior to initiating an exercise programme, or significantly changing an existing programme. This enables appropriate screening for contraindications and individual tailoring of the programme and behavioural support strategies. Progressive overload (gradual increases of intensity, duration and/or frequency) of exercise is important to prevent musculoskeletal injury.
Daily/weekly	150–240 min per week of aerobic-based exercise. E.g. 30–60 min of moderate-intensity aerobic exercise (e.g. walking, cycling, jogging, swimming, aerobic dancing) 2–3 days per week of muscle strengthening exercises (e.g. body weight exercises, machine-based resistance exercises, hand weights) Flexibility and/or balance exercises may be incorporated for individuals based on individual goals Look for opportunities to be physically active (e.g. take the stairs, take active breaks)
Avoid	Prolonged sitting and/or other sedentary behavior (> 30 min at one time; > 8 h a day)

DASH dietary approaches to stop hypertension diet, TRE time-restricted eating, IF intermittent fasting, MUFA monounsaturated fatty acids, PUFA polyunsaturated fatty acids, GI gastrointestinal, SFA saturated fatty acids