Nonalcoholic fatty liver disease (NAFLD) is a dynamic chronic liver disease that develops in close association with metabolic irregularities. Between 2016 and 2019, the global prevalence among adults was reported as 38% and among children and adolescents it was about 10%. NAFLD can be progressive and is associated with increased mortality from cardiovascular disease, extrahepatic cancers and liver complications. Despite these numerous adverse outcomes, no pharmacological treatments currently exist to treat nonalcoholic steatohepatitis, the progressive form of NAFLD. Therefore, the main treatment is the pursuit of a healthy lifestyle for both children and adults, which includes a diet rich in fruits, nuts, seeds, whole grains, fish and chicken and avoiding overconsumption of ultra-processed food, red meat, sugar-sweetened beverages and foods cooked at high heat. Physical activity at a level where one can talk but not sing is also recommended, including leisure-time activities and structured exercise. Avoidance of smoking and alcohol is also recommended. Policy-makers, community and school leaders need to work together to make their environments healthy by developing walkable and safe spaces with food stores stocked with culturally appropriate and healthy food items at affordable prices as well as providing age-appropriate and safe play areas in both schools and neighbourhoods.
Lifestyle interventions, including diet and physical activity, are the main treatments for nonalcoholic fatty liver disease.
The Mediterranean diet, or a diet similar in its culturally sensitive components, is the most effective diet for losing weight.
The loss of 5–7% of body weight can reverse steatosis, whereas the loss of 10% can help to reverse fibrosis.
In cirrhosis, healthy diet principles like those of the Mediterranean diet are recommended, with emphasis on high protein intake, including adding a late evening snack to shorten the night-time fast.
Physical activity, performed at a high or medium aerobic intensity along with resistance training, might improve the status of elevated liver enzymes, intrahepatic fat, total cholesterol and triglyceride levels.
Using web-based programmes to pursue healthy lifestyle interventions for nonalcoholic fatty liver disease produces results similar to those of in-person programmes for those who complete the programme.
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Z.Y. has received research funding and/or serves as a consultant to Intercept, Cymabay, Boehringer Ingelheim, BMS, GSK, NovoNordisk, AstraZeneca, Siemens, Madridgal, Merck and Abbott. The remaining authors declare no competing interests.
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Younossi, Z.M., Zelber-Sagi, S., Henry, L. et al. Lifestyle interventions in nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol 20, 708–722 (2023). https://doi.org/10.1038/s41575-023-00800-4
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