Lifestyle Modification Programs for Non-alcoholic Fatty Liver Disease

Introduction

Non-alcoholic fatty liver disease is one of the most common long-term liver disorders in the world, involving multiple causes. However, healthy habits, including dietary adjustments, consistent exercise, and gradual weight reduction, are the cornerstones of managing and treating non-alcoholic fatty liver disease (NAFLD). There are no drugs or medications that are currently licensed for the long-term treatment of NAFLD. Therefore, changing one's lifestyle is regarded as the primary clinical suggestion and the first step in managing non-alcoholic fatty liver disease (NAFLD).

What Is Non-alcoholic Fatty Liver Disease?

The term "non-alcoholic fatty liver disease" covers a broad spectrum of liver diseases, including simple fat accumulation in an organ, inflammation, and hepatocyte (liver cell) expansion. It is often linked to fibrosis that other causes cannot explain. In NAFLD, fat droplets accumulate in the plasma membrane of over five percent of liver cells. Its incidence is rising quickly, with an estimated prevalence of about 25 percent worldwide.

The specific cause of non-alcoholic fatty liver disease (NAFLD) is unknown. Risk factors include heredity, insulin resistance, high cholesterol, overweight, and type 2 diabetes. Most NAFLD patients do not have any symptoms at all. Patients may infrequently experience pain, fatigue, or weight loss. The most serious consequence of non-alcoholic fatty liver disease is significant liver scarring or cirrhosis.

As most non-alcoholic fatty liver disease patients do not have major issues, it is advisable to take action to prevent further worsening of the illness if one gets diagnosed with it. There is presently no specific treatment for non-alcoholic fatty liver disease; however, living a healthy lifestyle can reduce it.

How Lifestyle Modifications Impact NAFLD?

For NAFLD patients, lifestyle modifications are the primary line of treatment. Most therapies aim to reduce body weight by around seven to ten percent to reduce hepatocyte ballooning, inflammation, fibrosis, and steatosis (fat deposition). Exercise and diet modifications are examples of lifestyle modifications. Exercise significantly affects intrahepatic triglycerides (IHL) levels, enzymes, insulin sensitivity, glucose homeostasis, transportation and oxidation of free lipid acids, formation of reactive oxygen species, and inflammation.

The current non-alcoholic fatty liver disease management guidelines include 150 minutes of moderate physical activity per week. Regarding nutrition, the guidelines suggest that lowering daily calorie intake to 750 to 1000 kcal, or 30 percent of the usual intake, improves hepatic steatosis and insulin resistance, fasting glucose and insulin resistance, and lowers free fatty acids. Combining the two therapies has been linked to weight reductions ranging from 4.2 percent to 10.6 percent and has been shown to enhance liver histology and liver enzymes.

What Are Some of the Lifestyle Modifications for Non-alcoholic Fatty Liver Disease?

• Physical Activity and Exercise: Physical activity and exercise are essential metabolic regulators for those with non-alcoholic fatty liver disease. These should be combined with dietary modifications and weight-management strategies. No matter where a patient stands in the NAFLD disease spectrum, exercise and physical activity should be a part of their clinical care because they have been found to reduce hepatic steatosis. Exercise and physical activity provide advantages beyond just helping people lose weight. Resistance and aerobic exercise significantly reduce the risk of cardiovascular diseases in NAFLD patients.

• Dietary Modifications: A diet high in fruits and vegetables is strongly advised to prevent chronic disease and oxidative damage. Herbs and plant-based foods (such as fruit, vegetables, minimally-refined cereal, and medicinal and aromatic herbs) are sustainable antioxidant sources that contain unique physiologically active components such as phenolic compounds and vitamins with recognized positive effects.

It is also highly advised to significantly reduce fructose, trans-fatty acids, saturated fatty acids, and total fat intake. For example, dietary fructose (present in sugar-filled soft drinks) has been linked to the pathophysiology of non-alcoholic fatty liver disease. Excessive sugar consumption is considered the primary cause of obesity. Diets high in fructose are known to reduce insulin sensitivity, which can result in NAFLD. However, despite weight reduction, the Mediterranean diet (foods high in monounsaturated fatty acids or omega-3 fatty acids) reduces liver steatosis. It enhances insulin sensitivity in people with NAFLD.

Dietary interventions for non-alcoholic fatty liver disease patients are highly efficacious as they elevate serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). It is always preferred to combine very low-calorie, low-carbohydrate, and low-fat diets with frequent exercise and behavioral modifications for the management of non-alcoholic fatty liver disease (NAFLD).

• Weight Reduction: A known risk factor for non-alcoholic fatty liver disease (NAFLD) is obesity, which is linked to a disruption in the antioxidant balance that causes inflammation in the liver tissue. Thus, maintaining normal cardiac function and reducing fatty liver are two key weight loss objectives. Even though it can be challenging to achieve and maintain weight loss through energy restrictions, patients are generally advised to lose nearly ten percent of their body weight for significant changes in the cardiovascular risk profile, liver histology, and steatosis. Although from seven to ten percent weight loss is considered moderate, weight loss of more than ten percent is required to produce significant changes in the liver histology of overweight patients with NAFLD.

• Reducing Alcohol Consumption: According to the majority of research, reducing alcohol consumption lowers the risk of fatty liver disease and may even benefit those who already have non-alcoholic fatty liver disease. Patients with non-alcoholic fatty liver disease are not allowed to drink a lot of alcohol. Small doses are permitted; however, typically, it is not over 30 g per day for men and 20 g per day for women. Studies have suggested that alcohol consumption in moderation (less than 20 grams per day) may reduce the risk of liver fibrosis. For NAFLD patients, abstinence from alcohol is typically recommended because of their chance of aggravating liver disease.

Conclusion

Lifestyle modifications provide a comprehensive approach to managing liver and, cardiovascular and metabolic health. Healthy lifestyle changes, including dietary changes, frequent physical activity, gradual weight reduction, and reduced alcohol consumption, are among the most effective interventions that should be implemented holistically as an initial step in the early detection, treatment, and management of non-alcoholic fatty liver disease.