Mixed
Combined diet and exercise interventions produce greater reductions in liver enzymes (ALT, AST) and insulin resistance (HOMA-IR) than either diet or exercise alone in patients with NAFLD.
For NAFLD, doing just one thing (diet OR exercise) is less effective than doing both together. Aim for a caloric deficit (750-1000 kcal/day reduction) combined with at least 150 minutes of moderate-to-vigorous exercise per week. This combination is superior for lowering liver enzymes and improving insulin resistance compared to either intervention alone.
Compared to conventional treatment, combined exercise with diet seems to elicit greater reductions in ALT (MD: -13.27 CI 95% -21.39, -5.16), AST (MD: -7.02 CI 95% -11.26, -2.78) and HOMA-IR (MD: -2.07 CI 95% -2.61, -1.46) than diet (ALT MD: -4.48 CI 95% -1.01, -0.21; HOMA-IR MD: -0.61 CI 95% -1.01, -0.21) and exercise (ALT and AST non-significant; HOMA-IR MD = -0.46 CI 95% -0.8, -0.12) alone.
Why this rating
Based on a systematic review and meta-analysis of 30 RCTs, though heterogeneity prevented meta-analysis for some single interventions.
Source
Lifestyle changes in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis
Tiziana Fernández et al. · PLoS ONE · 2022
DOI 10.1371/journal.pone.0263931
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