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. 2007 Dec;56(12):1760–1769. doi: 10.1136/gut.2006.112094

Table 3 Effects of diet and exercise on metabolic parameters and histopathology.

n Year Diet Exercise Duration Weight loss Results F/U liver bx Histopathology results
Diet + exercise
Baba et al83 65, 28 pts completed study with exercise and diet 2005 25 kcal/kg/day; 60% carbohydrates, 20% fat, 20% protein, 200 mg cholesterol Brisk walking, jogging or rhythmic aerobic exercise 45 min 5 days/week (target heart rate of 60–70% max) Minimum of 3 months Average weight loss of 3.1 kg Improved BMI, waist circumference, WHR, ALT, AST No NA
No controls; all pts with NASH 4–4.5% decrease in weight associated with 50% reduction in ALT
Ueno et al87 25 1997 25 kcal/kg/day of IBW Walking then jogging 20 min twice daily 3 months BMI decrease of 3.0 Liver enzymes, cholesterol, fasting glucose improved Yes Steatosis improved
Randomised; all pts with NAFLD
Kugelmas et al84 23 2003 Step 1 AHA Walking or jogging 30 min/day 3 months ∼5% ALT and AST, cholesterol improved No NA
Randomised, all pts with NASH
Thomas et al86 10 2006 Reduction of 500 kcal/day Walking with goal of “10 000 steps a day” 6 months ∼4% Decreased subcutaneous (−9.9%) and intra‐abdominal (−11.4%) adipose tissue; decreased intramyocellular lipid content in tibialis; decreased HgbA1c No NA
No controls; all pts with NAFLD
Tamura et al79 7 2005 27.9 kcal/kg IBW; 60% carbohydrate, 25% fat, 15% protein Walking 2–3 times/day for 30 min 5–6 days/week (intensity of 50–60% max O2 uptake) 2 weeks BMI decrease of 2.3 Decreased intramyocellular lipids, increased muscle insulin‐mediated glucose uptake, decreased IHL (27%) No NA
Randomised to diet vs diet/exercise; all pts type 2 diabetics
Hickman et al88 31 2004 Individual counselling to achieve 0.5 kg weight loss/week. Diet based on 55% carbohydrate, 15% protein, 30% fat platform 150 min of aerobic exercise/weeks for 3 months, then encouraged to maintain routine for 9 months 12 months 4% Improvement in ALT and insulin resistance Yes: 14 pts 3–6 months after initial 3 months of study Steatosis and fibrosis improved
No controls, chronic liver disease and steatosis
Zelber‐Sagi et al62 44 2006 104.5 kJ/day for IBW, <30% fat and simple carbohydrates 40 min walking at 5–6 km/h 3–4 times/week 6 months 8% Improvement in ALT and AST. Significant improvement in steatosis by US in orlistat group No NA
Double‐blind, randomised, placebo controlled; all pts with NAFLD
Suzuki et al85 348 2005 Brochure encouraged total caloric restriction, especially fat Increase daily activity for 20–30 min/day, 2–3 times/week 12 months 0.1% overall: 6% of cohort lost ⩾5% weit All pts losing ⩾5% weight improved ALT No NA
Longitudinal cohort of pts with suspected NAFLD

AHA, American Heart Association; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; HgbA1C; haemoglobin A1C; IBW, ideal body weight; IHL, intrahepatic lipid; NA, not available; NAFLD, non‐alcoholic fatty liver disease; NASH, non‐alcoholic steatosis; pts, patients; US, ultrasound; WHR, waist to hip ratio.

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