Volume-dependent effect of supervised exercise training on fatty liver and visceral adiposity index in subjects with type 2 diabetes The Italian Diabetes Exercise Study (IDES). Non-alcoholic fatty liver disease in the Asia-Pacific region: definitions and overview of proposed guidelines. Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population. Decrease of aminotransferase levels in obese women is related to body weight reduction, irrespective of type of diet. Efficacy and safety of very-low-calorie diet in Taiwanese: a multicenter randomized, controlled trial. Effects of Therapeutic Lifestyle Program on Ultrasound‐diagnosed Nonalcoholic Fatty Liver Disease Effect of aerobic exercise training dose on liver fat and visceral adiposity. Effect of two different hypocaloric diets in transaminases and insulin resistance in nonalcoholic fatty liver disease and obese patients. Prospective histopathologic evaluation of lifestyle modification in nonalcoholic fatty liver disease: a randomized trial Effects of a novel therapeutic diet on liver enzymes and coagulating factors in patients with non-alcoholic fatty liver disease: A parallel randomized trial. Effect of a high monounsaturated vs high polyunsaturated fat hypocaloric diets in nonalcoholic fatty liver disease. Both resistance training and aerobic training reduce hepatic fat content in type 2 diabetic subjects with nonalcoholic fatty liver disease (the RAED2 Randomized Trial). Randomized trial of exercise effect on intrahepatic triglyceride content and lipid kinetics in nonalcoholic fatty liver disease. Effect of resistance training on non-alcoholic fatty-liver disease a randomized-clinical trial. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Community-based lifestyle modification programme for non-alcoholic fatty liver disease: a randomized controlled trial. Dissociation between exercise-induced reduction in liver fat and changes in hepatic and peripheral glucose homoeostasis in obese patients with non-alcoholic fatty liver disease.
AIMS This study evaluated the effect of supervised exercise training on liver enzymes and two surrogate measures of non-alcoholic fatty liver disease ( NAFLD ) in subjects with type 2 diabetes . METHODS Sedentary patients from 22 outpatient diabetes clinics were r and omized by center , age and treatment to twice-a-week supervised aerobic and resistance training plus structured exercise counseling ( exercise group , EXE ; n=303 ) versus counseling alone ( control group , CON ; n=303 ) for 12 months . EXE participants were further r and omized to low-to-moderate ( n=142 ) or moderate-to-high ( n=161 ) intensity training of equal energy cost . Baseline and end-of- study levels of liver enzymes , fatty liver index ( FLI ) and visceral adiposity index ( VAI ) were obtained . RESULTS Enzyme levels did not change , whereas FLI and VAI decreased significantly in EXE , but not CON participants . Physical activity ( PA ) volume was an independent predictor of both FLI and VAI reductions , the extent of which increased from the 1st to the 4th quintile of PA volume and baseline to end-of- study changes in fitness parameters . Differences in the effect of LI versus HI training were negligible . CONCLUSIONS Data from this large cohort of subjects with type 2 diabetes indicate that FLI and VAI decrease with supervised training in a volume-dependent manner Non-alcoholic fatty liver disease ( NAFLD ) is the most common liver disorder in Western industrialized countries , affecting 20 - 40 % of the general population . Large population -based surveys in China , Japan , and Korea indicate that the prevalence of NAFLD is now 12 % to 24 % in population subgroups , depending on age , gender , ethnicity , and location ( urban versus rural ) . There is strong evidence that the prevalence of NAFLD has increased recently in parallel with regional trends in obesity , type 2 diabetes , and metabolic syndrome ; and that further increases are likely . The relationship between NAFLD , central obesity , diabetes , and metabolic syndrome is clearly evident in retrospective and prospect i ve Asian studies , but the strength of association with these metabolic risk factors is only appreciated when regional definitions of anthropometry are used . Pathological definition of NAFLD , particularly its activity and the extent of liver fibrosis , requires histological examination , but liver biopsy is often not appropriate in this disorder for logistic reasons . An alternative set of operational definitions is proposed here . Clinicians need guidelines as how best to diagnose and manage NAFLD and its associated metabolic disorders in countries with scant healthcare re sources . The Asia-Pacific Working Party ( APWP ) for NAFLD was convened to collate evidence and deliberate these issues . Draft proposals were presented and discussed at Asia-Pacific Digestive Week at Cebu , Philippines , in late November 2006 , and are published separately in this issue of the Journal as an Executive Summary . The present document review s the reasoning and evidence behind the APWP-NAFLD proposals for definition , assessment , and management of NAFLD in the Asia-Pacific region Despite the increasing prevalence of nonalcoholic fatty liver disease ( NAFLD ) , the criteria used to diagnose the disorder remain poorly defined . Localized proton magnetic resonance spectroscopy ( MRS ) accurately measures hepatic triglyceride content ( HTGC ) but has been used only in small research studies . Here , MRS was used to analyze the distribution of HTGC in 2,349 participants from the Dallas Heart Study ( DHS ) . The reproducibility of the procedure was vali date d by showing that duplicate HTGC measurements were high correlated ( r = 0.99 , P < 0.001 ) and that the coefficient of variation between measurements was low ( 8.5 % ) . Intake of a high-fat meal did not significantly affect the measurements , and values were similar when measurements were made from the right and left hepatic lobes . To determine the " upper limit of normal " for HTGC , the distribution of HTGC was examined in the 345 subjects from the DHS who had no identifiable risk factors for hepatic steatosis ( nonobese , nondiabetic subjects with minimal alcohol consumption , normal liver function tests , and no known liver disease ) . The 95th percentile of HTGC in these subjects was 5.56 % , which corresponds to a hepatic triglyceride level of 55.6 mg/g . With this value as a cutoff , the prevalence of hepatic steatosis in Dallas County was estimated to be 33.6 % . Thus MRS provides a sensitive , quantitative , noninvasive method to measure HTGC and , when applied to a large urban US population , revealed a strikingly high prevalence of hepatic steatosis OBJECTIVE To evaluate the efficacy of low carbohydrate diet ( LCD ) as compared with low fat diet ( LFD ) to decrease aminotransferase levels in obese women with nonalcoholic fatty liver disease . MATERIAL AND METHODS A total of 59 women were r and omly enrolled in a non-controlled clinical intervention study to receive either LCD or LFD during six months . Apparently healthy non-pregnant obese women aged 20 to 65 years were eligible to participate . Previous diagnosis of hepatic disease , serum creatinine level ≥ 1.5 mg/dL , severe life-limiting medical illness , pregnancy , active participation in other dietary program , use of weight loss drugs , or alcohol consumption ≥ 30 g per day were exclusion criteria . RESULTS A total of 31 obese women who received LCD were compared with 28 women allocated in the LFD group . There were 3 ( LCD group ) and 2 ( LFD group ) women with lost of follow-up . No differences in the proportion of type 2 diabetes , hypertension and hyperlipidemia were noted between women in the LCD and LFD groups . At end of follow-up , there were not significant statistical differences in the anthropometric and biochemical characteristics between women in both groups . The weight loss was 5.7 and 5.5 % for women in the LCD LFD groups . Although the decrease of AST ( 31.7 and 22.4 % ) and ALT ( 41 and 33.3 % ) levels was more elevated in the women of LCD group , as compared with the LFD group , there were not significant statistical differences . CONCLUSIONS Our results show that weight loss , irrespective of the type of diet , reduces aminotransferase levels in obese women with NAFLD OBJECTIVE Very-low-calorie diets ( VLCDs ) are an effective method for weight reduction in Caucasians . This study investigated the efficacy and safety of two different VLCDs ( 450 or 800kcal/d ) in obese Taiwanese . METHODS 132 participants with BMI > or = 30kg/m(2 ) were r and omized to two VLCD groups for body weight reduction for 12 weeks . Each group had 66 participants .  Anthropometric and metabolic parameters were measured . RESULTS The intention-to-treat analysis revealed that the percentage change in body weight over the 12-week treatment period was -9.14 % in the VLCD-450 group and -8.98 % in the VLCD-800 group . A total of 27 ( 40.9 % ) participants in the VLCD-450 group and 29 ( 43.9 % ) participants in the VLCD-800 group achieved 10 % or more weight loss at the end of treatment . The body weight , waist circumference , hip circumference , fat mass , blood pressure , triglycerides , and blood glucose were statistically improved from baseline but not between the two groups . The improvement rate of nonalcoholic fatty liver disease ( NAFLD ) was 41.5 % in the VLCD-450 group and 50.0 % in the VLCD-800 group . The incidence of adverse events did not differ significantly between the groups and no serious adverse events were reported in either group . CONCLUSION Both the VLCD-450 and 800kcal/d can effectively and safely reduce body weight and improve NAFLD in 12 weeks in obese Taiwanese participants . However , there is no additional benefit in prescribing the more restrictive diet intervention in Taiwanese Background : To investigate the effects of varied therapeutic lifestyle programs on patients with ultrasound‐diagnosed nonalcoholic fatty liver disease ( NAFLD ) . Methods : A prospect i ve , case‐controlled study was conducted . A total of 54 subjects with NAFLD were subdivided into 3 groups : ( 1 ) diet plus exercise group ( DPE group , n = 16 ) ; ( 2 ) exercise group ( E group , n = 23 ) ; and ( 3 ) control group ( C group , n = 15 ) . The DPE group received a low‐calorie balanced diet and regular high‐intensity stationary bicycle exercise program for 10 weeks , while the E group received the same exercise protocol as the DPE group but without any changes in diet . Anthropometric indices , biochemical data , physical fitness data and liver ultrasound findings were recorded . A generalized estimating equation method was used to determine the differences among groups . Results : Compared with the C group , the DPE group demonstrated significant improvements in anthropometric indices , total cholesterol , insulin sensitivity , liver biochemistry , ultrasound finding and physical fitness , while the E group showed significant improvements in anthropometric indices , insulin sensitivity status , ultrasound finding and physical fitness but not liver biochemistry . Compared with the E group , the DPE group showed greater reduction in anthropometric indices ( body mass index , body weight , abdominal circumference , hip circumference ) , total cholesterol , alanine aminotransferase , and γ‐glutamyltransferase . Conclusion : Our data suggest that both 10‐week diet‐plus‐exercise and exercise‐only therapeutic lifestyle programs are effective for improving anthropometric indices , insulin sensitivity , ultrasound findings and physical fitness in ultrasound‐diagnosed NAFLD patients . However , the range of improvement in patients on the diet‐plus‐exercise program is more obvious than that in patients on the exercise‐only program . Moreover , the diet‐plus‐exercise program result ed in significant improvement in liver biochemistry , but the exercise‐only program did not . In summary , diet plus exercise is more efficacious than exercise alone in the lifestyle modification treatment of NAFLD BACKGROUND & AIMS Aerobic exercise reduces liver fat and visceral adipose tissue ( VAT ) . However , there is limited data from r and omized trials to inform exercise programming recommendations . This study examined the efficacy of commonly prescribed exercise doses for reducing liver fat and VAT using a r and omized placebo-controlled design . METHODS Inactive and overweight/obese adults received 8 weeks of either ; i ) low to moderate intensity , high volume aerobic exercise ( LO : HI , 50 % VO 2peak , 60 min , 4d/week ) ; ii ) high intensity , low volume aerobic exercise ( HI : LO , 70 % VO 2peak , 45 min , 3d/week ) ; iii ) low to moderate intensity , low volume aerobic exercise ( LO : LO , 50 % VO 2peak , 45 min , 3d/week ) ; or iv ) placebo ( PLA ) . Liver fat ( spectroscopy ) and VAT ( magnetic resonance imaging ) were measured before and after intervention . RESULTS Forty-seven of the 48 ( n = 12 in each group ) participants completed the trial . There were no serious adverse events . There was a significant change in group × time interaction in liver fat , which reduced in HI : LO by 2.38 ± 0.73 % , in LO : HI by 2.62 ± 1.00 % , and in LO : LO by 0.84 ± 0.47 % but not in PLA ( increase of 1.10 ± 0.62 % ) ( p = 0.04 ) . There was a significant reduction in VAT in HI : LO ( -258.38 ± 87.78 cm(3 ) ) , in LO : HI ( -386.80 ± 119.5 cm(3 ) ) , and in LO : LO ( -212.96 ± 105.54 cm(3 ) ) , but not in PLA ( 92.64 ± 83.46 cm(3 ) ) ( p = 0.03 ) . There were no significant differences between the dose or intensity of the exercise regimen and reductions in liver fat or VAT ( p > 0.05 ) . CONCLUSION The study found no difference in efficacy of liver fat reduction by either aerobic exercise dose or intensity . All of the aerobic exercise regimens employed reduced liver fat and VAT by a small amount without clinical ly significant weight loss OBJECTIVE The aim of our study was to examine the changes in hypertransaminasemia after weight reduction in obese patients with and without NAFLD and the relation with insulin resistance . RESEARCH METHODS A population of 162 obese patients was r and omly allocated to two groups : a ) diet I ( low fat ) and b ) diet II ( low carbohydrate ) , dieting along 3 months .  Patients were classified as group I ( n=112 ) when serum ALT activity was normal or group II ( NAFLD , n=30 ) when serum ALT activity was ( > or=43 UI/L ) . RESULTS In control group with diet I , BMI , weight , fat mass , waist to hip ratio , waist circumference , systolic pressure , total cholesterol , LDL cholesterol , HOMA and insulin levels decreased . In NAFLD group with diet I improved the same parameters and glucose , triglycerides , ALT , AST , gamaglutamine transferase levels , too . In control group with diet II , BMI , weight , fat mass , waist to hip ratio , waist circumference , systolic pressure , total cholesterol , LDL cholesterol , HOMA and insulin levels decreased . In NAFLD group with diet II improved the same parameters and glucose , triglycerides , ALT and gamaglutamine transferase levels , without statistical changes in AST . CONCLUSION We showed that weight reduction secondary to two hypocaloric diets was associated with improvement in hipertransaminasemia and insulin resistance in NAFLD patients Background and aims : Nonalcoholic fatty liver disease ( NAFLD ) is now recognized as part of the metabolic syndrome , and is specifically related to obesity and insulin resistance . Lifestyle modification is advocated for the treatment of NAFLD , but few studies have evaluated its impact on liver histology . The purpose of this study was to investigate which , if any , specific diet and exercise recommendations are associated with histopathologic changes . Methods : A total of 56 participants were r and omly assigned to 1 of 4 lifestyle modification subgroups for 6 months : st and ard care , low-fat diet and moderate exercise , moderate-fat/low-processed-carbohydrate diet and moderate exercise , or moderate exercise only .  All subjects had biopsy-proven NAFLD , to include nonalcoholic steatohepatitis ( NASH ) , and received a repeat 6-month biopsy to detect histopathologic changes . Other measures included blood assay of liver enzymes ( aspartate aminotransferase , alanine aminotransferase , alkaline phosphatase ) , fasting glucose , serum insulin , lipid panel , body weight , dietary intake , fat mass , and fitness level . Results : Among the 41 participants who completed the study ( 88 % with NASH ) , a significant change was found in pre- to post-NAFLD activity score in the group as a whole ( p < 0.001 ) with no difference detected between subgroups ( p = 0.31 ) . Our results confirm that lifestyle modification is effective in improving NAFLD and NASH . Conclusions : Regardless of intervention group , lifestyle modification improved liver histology , as verified by repeat biopsy , after a 6-month intervention . This study reinforces the importance of lifestyle modification as the primary treatment strategy for patients with NAFLD OBJECTIVE There are several reports regarding the role of therapeutic diets for patients with non-alcoholic fatty liver disease ( NAFLD ) . Therefore , the aim of this study was to determine the effects of a low-calorie , low-carbohydrate soy-containing diet on lipid profiles , liver enzymes , and coagulating factors in patients with NAFLD . METHOD This was a r and omized parallel clinical trial involving 45 patients with NAFLD . The participants consumed three kinds of diets for 8 wk . Patients were r and omly assigned to consume a low-calorie diet ; a low-calorie , low-carbohydrate diet ; or a low-calorie , low-carbohydrate soy-containing diet . Measurements were done according to the st and ard method . RESULTS Changes in weight were not significantly different in the three groups . The low-calorie , low-carbohydrate soy-containing diet could reduce alanine aminotransferase ( -15.2 ± 12.1 versus -6.8 ± 4.6 in the low-calorie , low-carbohydrate diet , and -6.4 ± 4.4 IU/L in the low-calorie diet ; P = 0.02 ) and serum fibrinogen levels ( -49.1 ± 60.1 versus -12.9 ± 8.1 and -17.4 ± 8.4 g/L , respectively ; P = 0.01 ) . Reductions in aspartate aminotransferase were significantly higher in the low-calorie , low-carbohydrate soy-containing group . Changes in lipid profiles did not differ significantly between the groups . The soy-containing diet did reduce malondialdehyde more than the other diets ( P = 0.01 ) . CONCLUSION A low-calorie , low-carbohydrate soy-containing diet could have beneficial effects on liver enzymes , malondialdehyde , and serum fibrinogen levels in patients with NAFLD OBJECTIVE Hyperaminotransferasemia is an important problem in obese patients . We decide to examine the changes in hyperaminotransferasemia after weight reduction in obese patients with and without NAFLD secondary to a high monounsaturated fat vs. a high polyunsaturated fat hypocaloric diets . PATIENTS AND METHODS A population of 306 obese patients was r and omly allocated to two groups : Diet M ( high monounsaturated fat hypocaloric diet ) and Diet P ( high polyunsaturated fat hypocaloric diet ) . Patients were classified as group I ( obese subjects ; n=262 ) when serum ALT activity was normal or group II ( NAFLD patients ; n=44 ) when serum ALT activity was ( ≥ 43 UI/L ) . RESULTS In NAFLD group with diet M , BMI , weight , fat mass , waist circumference , systolic blood pressure , total cholesterol , LDL cholesterol ) , insulin and HOMA-R decreased . In NAFLD group with diet P , BMI , weight , fat mass , waist circumference , systolic blood pressure , total cholesterol , LDL cholesterol ) , insulin and HOMA-R decreased , too . In NAFLD group , alanine aminotransferase [ ( diet M ) -20.3±19.2 UI/L vs. ( diet P ) -14.2±20.1 UI/L ] , aspartate aminotransferase [ ( diet M ) -11.3±12.2 UI/L vs. ( diet P ) -11.1±10.1 UI/L ] , and gammaglutamyl transferase [ ( diet M ) -18.1±12.2 UI/L vs. ( diet P ) -10.9±20.1 UI/L ] improved with both diets . CONCLUSIONS We showed that weight reduction secondary to two hypocaloric diets was associated with improvement in hypertransaminasemia and insulin resistance in NAFLD patients UNLABELLED Although lifestyle interventions are considered the first-line therapy for nonalcoholic fatty liver disease ( NAFLD ) , which is extremely common in people with type 2 diabetes , no intervention studies have compared the effects of aerobic ( AER ) or resistance ( RES ) training on hepatic fat content in type 2 diabetic subjects with NAFLD . In this r and omized controlled trial , we compared the 4-month effects of either AER or RES training on insulin sensitivity ( by hyperinsulinemic euglycemic clamp ) , body composition ( by dual-energy X-ray absorptiometry ) , as well as hepatic fat content and visceral ( VAT ) , superficial ( SSAT ) , and deep ( DSAT ) subcutaneous abdominal adipose tissue ( all quantified by an in-opposed-phase magnetic resonance imaging technique ) in 31 sedentary adults with type 2 diabetes and NAFLD . After training , hepatic fat content was markedly reduced ( P < 0.001 ) , to a similar extent , in both the AER and the RES training groups ( mean relative reduction from baseline [ 95 % confidence interval ] -32.8 % [ -58.20 to -7.52 ] versus -25.9 % [ -50.92 to -0.94 ] , respectively ) . Additionally , hepatic steatosis ( defined as hepatic fat content > 5.56 % ) disappeared in about one-quarter of the patients in each intervention group ( 23.1 % in the AER group and 23.5 % in the RES group ) . Insulin sensitivity during euglycemic clamp was increased , whereas total body fat mass , VAT , SSAT , and hemoglobin A1c were reduced comparably in both intervention groups . CONCLUSION This is the first r and omized controlled study to demonstrate that resistance training and aerobic training are equally effective in reducing hepatic fat content among type 2 diabetic patients with NAFLD UNLABELLED Nonalcoholic fatty liver disease ( NAFLD ) and alterations in hepatic lipoprotein kinetics are common metabolic complications associated with obesity . Lifestyle modification involving diet-induced weight loss and regular exercise decreases intrahepatic triglyceride ( IHTG ) content and very low density lipoprotein ( VLDL ) triglyceride ( TG ) secretion rate . The aim of this study was to evaluate the weight loss-independent effect of following the physical activity guidelines recommended by the Department of Health and Human Services on IHTG content and VLDL kinetics in obese persons with NAFLD . Eighteen obese people ( body mass index [ BMI ] : 38.1 ± 4.6 kg/m(2 ) ) with NAFLD were r and omized to 16 weeks  of exercise training ( 45%-55 % VO(2peak ) , 30 - 60 minutes × 5 days/week ; n = 12 ) or observation ( control ; n = 6 ) . Magnetic resonance spectroscopy and stable isotope tracer infusions in conjunction with compartmental modeling were used to evaluate IHTG content and hepatic VLDL-TG and apolipoprotein B-100 ( apoB-100 ) secretion rates  . Exercise training result ed in a 10.3 % ± 4.6 % decrease in IHTG content ( P < 0.05 ) , but did not change total body weight ( 103.1 ± 4.2 kg before and 102.9 ± 4.2 kg after training ) or percent body fat ( 38.9 % ± 2.1 % before and 39.2 % ± 2.1 % after training ) . Exercise training did not change the hepatic VLDL-TG secretion rate ( 17.7 ± 3.9 μmol/min before and 16.8 ± 5.4 μmol/min after training ) or VLDL-apoB-100 secretion rate ( 1.5 ± 0.5 nmol/min before and 1.6 ± 0.6 nmol/min after training ) . CONCLUSION Following the Department of Health and Human Services recommended physical activity guidelines has small but beneficial effects on IHTG content , but does not improve hepatic lipoprotein kinetics in obese persons with NAFLD AIM To evaluate the effect of resistance training ( RT ) on non alcoholic liver disease ( NAFLD ) patients . METHODS A r and omized clinical trial enrolling NAFLD patients without secondary liver disease ( e.g. , without hepatitis B virus , hepatitis C virus or excessive alcohol consumption ) . Patients were r and omly allocated either to RT , three times weekly , for 3 mo or a control arm consisting of home stretching . The RT included leg press , chest press , seated rowing , latissimus pull down etc . with 8 - 12 repetitions , 3 sets for each exercise , for a total duration of 40 min . Hepatic ultrasound , fasting blood tests , anthropometrics and body composition by dual energy X-ray absorptiometry were assessed . At baseline and follow-up , patients filled out a detailed semi-quantitative food frequency question naire reporting their habitual nutritional intake . Steatosis was quantified by the hepatorenal-ultrasound index ( HRI ) representing the ratio between the brightness level of the liver and the right kidney . The HRI has been previously demonstrated to be highly reproducible and was vali date d against liver biopsy and proton magnetic resonance spectroscopy . RESULTS Eighty two patients with primary NAFLD were r and omized to receive 3 mo of either RT or stretching . After dropout or exclusion from analysis because of protocol violation ( weight change > 3 kg ) , thirty three patients in the RT arm and 31 in the stretching arm completed the study per protocol . All baseline characteristics were similar for the two treatment groups with respect to demographics , anthropometrics and body composition , blood tests and liver steatosis on imaging . HRI score was reduced significantly in the RT arm as compared to the stretching arm ( -0.25 ± 0.37 vs -0.05 ± 0.28 , P = 0.017 ) . The RT arm had a significantly higher reduction in total , trunk and and roid fat with increase in lean body mass . There was no correlation between the reduction in HRI in the RT arm and weight change during the study , but it was positively correlated with the change in trunk fat ( r = 0.37 , P = 0.048 ) . The RT arm had a significant reduction in serum ferritin and total cholesterol . There was no significant difference between arms in dietary changes and these did not correlate with HRI change . CONCLUSION Three months RT  improves hepatic fat content accompanied by favorable changes in body composition and ferritin . RT may serve as a complement to treatment of NAFLD UNLABELLED Nonalcoholic steatohepatitis ( NASH ) is a chronic progressive liver disease that is strongly associated with obesity . Currently , there is no approved therapy for NASH . Weight reduction is typically recommended , but efficacy data are lacking . We performed a r and omized controlled trial to examine the effects of lifestyle intervention using a combination of diet , exercise , and behavior modification , with a goal of 7 % to 10 % weight reduction , on clinical parameters of NASH . The primary outcome measure was the change in NASH histological activity score ( NAS ) after 48 weeks of intervention . Thirty-one overweight or obese individuals ( body mass index [ BMI ] , 25 - 40 kg/m(2 ) ) with biopsy-proven NASH were r and omized in a 2:1 ratio to receive intensive lifestyle intervention ( LS ) or structured education ( control ) . After 48 weeks of intervention , participants assigned to LS  lost an average of 9.3 % of their weight versus 0.2 % in the control group ( P = 0.003 ) . A higher proportion of participants in the LS group had a reduction of NAS of at least 3 points or had posttreatment NAS of 2 or less as compared with the control group ( 72 % versus 30 % , P = 0.03 ) . NAS improved significantly in the LS group ( from 4.4 to 2.0 ) in comparison with the control group ( from 4.9 to 3.5 ) ( P = 0.05 ) . Percent weight reduction correlated significantly with improvement in NAS ( r = 0.497 , P = 0.007 ) . Participants who achieved the study weight loss goal ( > or=7 % ) , compared with those who lost less than 7 % , had significant improvements in steatosis ( -1.36 versus -0.41 , P < 0.001 ) , lobular inflammation ( -0.82 versus -0.24 , P = 0.03 ) , ballooning injury ( -1.27 versus -0.53 , P = 0.03 ) and NAS ( -3.45 versus -1.18 , P < 0.001 ) . CONCLUSION Weight reduction achieved through lifestyle intervention leads to improvements in liver histology in NASH BACKGROUND & AIMS Healthy lifestyle is the most important management of non-alcoholic fatty liver disease ( NAFLD ) . This study aim ed at assessing the efficacy of a community-based lifestyle modification programme in the remission of NAFLD . METHODS This was a parallel group , superiority , r and omized controlled trial . 154 adults with NAFLD identified during population screening were r and omized to participate in a dietitian-led lifestyle modification programme at 2 community centres or receive usual care for 12 months . The primary outcome was remission of NAFLD at month 12 as evidence d by intrahepatic triglyceride content ( IHTG ) of less than 5 % by proton-magnetic resonance spectroscopy . RESULTS 74 patients in the intervention group and 71 patients in the control group completed all study assessment s. In an intention-to-treat analysis of all 154 patients , 64 % of the patients in the intervention group and 20 % in the control group achieved remission of NAFLD ( difference between groups 44 % ; 95 % CI 30 - 58 % ; p<0.001 ) . The mean ( SD ) changes in IHTG from baseline to month 12 were -6.7 % ( 6.1 % ) in the intervention group and -2.1 % ( 6.4 % ) in the control group ( p<0.001 ) . Body weight decreased by 5.6 ( 4.4 ) kg and 0.6 ( 2.5 ) kg in the two groups , respectively ( p<0.001 ) . While 97 % of patients with weight loss of more than 10 % had remission of NAFLD , 41 % of those with weight loss of 3.0 - 4.9 % could also achieve the primary outcome . CONCLUSIONS The community-based lifestyle modification programme is effective in reducing and normalizing liver fat in NAFLD patients Non-alcoholic fatty liver disease ( NAFLD ) is associated with multi-organ ( hepatic , skeletal muscle , adipose tissue ) insulin resistance ( IR ) . Exercise is an effective treatment for lowering liver fat but its effect on IR in NAFLD is unknown . We aim ed to determine whether supervised exercise in NAFLD would reduce liver fat and improve hepatic and peripheral ( skeletal muscle and adipose tissue ) insulin sensitivity .  Sixty nine NAFLD patients were r and omized to 16 weeks exercise supervision  ( n=38 ) or  counselling  ( n=31 ) without dietary modification . All participants underwent MRI/spectroscopy to assess changes in body fat and in liver and skeletal muscle triglyceride , before and following exercise/counselling . To quantify changes in hepatic and peripheral insulin sensitivity , a pre-determined subset ( n=12 per group ) underwent a two-stage hyperinsulinaemic euglycaemic clamp pre- and post-intervention . Results are shown as mean [ 95 % confidence interval ( CI ) ] . Fifty participants ( 30 exercise , 20 counselling ) , 51 years ( IQR 40 , 56 ) , body mass index ( BMI ) 31 kg/m(2 ) ( IQR 29 , 35 ) with baseline liver fat/water % of 18.8 % ( IQR 10.7 , 34.6 ) completed the study ( 12/12 exercise and 7/12 counselling completed the clamp studies ) . Supervised exercise mediated a greater reduction in liver fat/water percentage  than counselling [ Δ mean change 4.7 % ( 0.01 , 9.4 ) ; P<0.05 ] , which correlated with the change in cardiorespiratory fitness ( r=-0.34 , P=0.0173 ) . With exercise , peripheral insulin sensitivity significantly increased ( following high-dose insulin ) despite no significant change in hepatic glucose production ( HGP ; following low-dose insulin ) ; no changes were observed in the control group . Although supervised exercise effectively reduced liver fat , improving peripheral IR in NAFLD , the reduction in liver fat was insufficient to improve hepatic IR
BACKGROUND Non-alcoholic fatty liver disease ( NAFLD ) is the most common cause of chronic liver disease worldwide , with prevalence above 30 % in many adult population s. Strongly associated with obesity , weight loss through diet and physical activity is the mainstay of its management .
Weight loss can be difficult to achieve and maintain however , and uncertainty exists as to which lifestyle changes are most effective .
OBJECTIVE The aim of this work was to systematic ally evaluate r and omised controlled trials assessing diet , exercise or combination interventions aim ed at reducing steatosis or markers of NAFLD activity .