Table 1.
Randomised clinical trials examining lifestyle interventions of diet and exercise in adult patients with NAFLD.
| Author | N | Lifestyle intervention (vs. control) | Duration, weeks | Mean weight loss | Hepatic triglyceride | Liver histology | Cardiovascular risk |
|---|---|---|---|---|---|---|---|
| Promrat7 | 31 NASH | Low-fat (25%) diet + 200 min/week moderate-intensity PA + CBT | 48 | -8.7 kg | n.a. | Improved steatosis, NAS | No difference in glucose or HOMA-IR |
| Eckard8 | 41 NAFLD | Low-fat (20%) diet + moderate exercise vs. low-carbohydrate (50%) diet + moderate exercise vs. moderate PA/exercise | 26 | -0.2 lbs vs. -3.0 lbs vs. 0.1 lbs | n.a. | Improved NAS vs. Improved NAS vs. No improvement | n.a. |
| Ueno9 | 25 NAFLD | Low (30%) fat diet + 210 min/week vigorous PA | 12 | n.a. | n.a. | Improved steatosis | Improved cholesterol and triglyceride |
| Wong6 | 145 NAFLD | Low-fat, low GI diet + 210 mins/week moderate PA | 52 | -5.6 kg | -6.7% (MRS) | n.a. | Improved LDL-cholesterol |
| Gepner3 | 278 Obese or dyslipidaemia (53% NAFLD) | Low-fat diet vs. low-carbohydrate/med. diet ± 180 min/week moderate PA | 78 | -3.2%⁎ | -5.8% vs. -7.3% | n.a. | Improved HbA1c |
| Sun5 | 1,024 NAFLD | Low-fat (30%), low-sugar diet + 27 MET/hr/week PA/exercise | 52 | -7 kg | No difference (CT) | n.a. | Improved HOMA-IR and cholesterol |
| St George4 | 152 elevated ALT and HOMA-IR | Low saturated fat, caloric restricted diet + 150 min/week moderate PA + 3 vs. 6 counselling sessions | 12 | -1.9 kg vs. -2.8 kg | n.a. | n.a. | Improved cholesterol and triglyceride |
*
No difference between groups. ALT, alanine aminotransferase; GI, glycaemic index; HbA1c, glycated haemoglobin; HOMA-IR, homeostasis model of assessment - insulin resistance; MET, metabolic equivalent of tasks; NAFLD, non-alcoholic fatty liver disease; n.a., not assessed; NAS, NAFLD activity score; NASH, non-alcoholic steatohepatitis; PA, physical activity.