4. Discussion
NAFLD, obesity, fatty liver disease, inflammation, cirrhosis, liver fibrosis, fibrosis, liver disease, NASH, overweight, skeletal muscle mass functioning, steatosis
OBESITY, OBESE, INFLAMMATION, CIRRHOSIS, LIVER FIBROSIS, FIBROSIS, LIVER DISEASE, INSULIN RESISTANCE, ASSOCIATED CONDITIONS, HEPATIC STEATOSIS, OXIDATIVE STRESS, STEATOSIS
Being overweight or obese promotes the development of NAFLD, a progressive liver disease that could include simple steatosis, NASH, fibrosis, and cirrhosis without excessive alcohol consumption (<20 g dayRecently, fibrosis of adipose tissue has been shown to occur in obesity, along with inflammation [Many studies have shown the crucial role of lifestyle changes in the management of NAFLD, in particular on the degree of liver fibrosis [In the LGIMD arm, kPa tended to decrease gradually up to 90 days without ever increasing from baseline. Myrian et al. confirmed in their study that adhering to a Mediterranean diet program reduces the risk of fibrosis in subjects with NAFLD [MD limits the consumption of processed [The LGIMD satisfies these requirements and it has shown to be effective against fibrosis at 90 days compared with the control diet arm.Nevertheless, the relationship between the MD and fibrosis is still to be clarified and there is no evidence that diet itself could improve liver fibrosis; moreover, it is necessary to adopt a sustainable dietary program in the long term to obtain excellent benefits [In our study, both aerobic and combined PA programs improved kPa at 90 days although this effect did not reach statistical significance. However, these results are supported by some studies which evidenced that PA alone in the management of NAFLD is not sufficient, as it produces only a minimal reduction in body weight [Junichi et al. reported that using PA as therapy slowed the progression of fibrosis in NAFLD patients by improving glucose metabolism, reducing oxidative stress, and keeping skeletal muscle mass functioning [A few studies have probed the effects of the combination of a diet and PA on fibrosis, but there is little evidence about the beneficial effects of PA and diet intervention on NAFLD, in terms of a suppression of fatty liver disease and its associated mechanisms [Visceral fat is directly related to liver inflammatory status and fibrosis, independent of insulin resistance and hepatic steatosis [Aerobic PA improves NAFLD by activating lipolysis in various tissues and altering adipokine levels [Overall, a valid approach indicates that the beneficial effects of PA on NAFLD and associated conditions are greater when exercise is combined with a dietary regimen [Several methodologic issues need to be considered. In this study, interventions were allotted under supervision by trained personnel both in nutrition and physical activity. Furthermore, PA programs were built following specific FITT parameters as recommended, and adherence to the nutritional program was evaluated with a valid instrument. Limitations include the small number of patients treated and the short intervention time, especially to revealing evident changes in the fibrotic markers. However, the estimates obtained are reliable because we implemented an intention-to-treat strategy.