Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this systematic review and meta-analysis, a low carbohydrate diet, aerobic training, and resistance training significantly improved multiple markers in metabolic associated fatty liver disease (MAFLD).

2. Although both aerobic and resistance training were effective interventions in MAFLD, resistance training was more effective in reducing certain metabolic markers.

Evidence Rating Level: 1 (Excellent)

Metabolic associated fatty liver disease (MAFLD) is a form of liver disease that is often treated with lifestyle interventions, such as diet and exercise. However, the efficacy of these interventions is poorly understood, and no systematic review to date has evaluated the impact of lifestyle changes on MAFLD. As a result, the objective of the present study was to synthesize the evidence on the impact of lifestyle interventions on various metabolic indicators in MAFLD.

Of 8469 identified records, 34 (n=2652 patients, 8% had diabetes) studies were included from various databases from inception to May 2021. Studies were included if they were published in English and evaluated the effects of lifestyle interventions on MAFLD. Studies were excluded if participants had non-alcoholic fatty liver disease (NAFLD) unrelated to metabolic dysfunction. The review was performed using PRISMA guidelines. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal tools for RCTs. Statistical analysis was performed using fixed-effects models and random-effects models. The primary outcome was changes in hepatic fat content and blood markers associated with metabolic risk.

The results demonstrated that a low carbohydrate diet, aerobic exercise, and resistance training were effective in improving hepatic fat content and multiple blood markers related to MAFLD, including plasma triglycerides, high-density lipoprotein, and HbA1c. Furthermore, resistance training was more effective than aerobic exercise at improving hepatic fat content and plasma triglycerides. Despite these results, the majority of included studies focused on patients with obesity, and there were insufficient studies to support the influence of lifestyle interventions on lean or normal weight individuals with MAFLD. Nonetheless, the present study was the first review to examine the influence of lifestyle interventions on patients with MAFLD.

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