AGA: Lifestyle modifications ‘cornerstone’ to achieving weight loss in NAFLD
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The AGA Institute Clinical Practice Updates Committee and the Governing Board published evidence-based intervention advice for lifestyle modifications for treating nonalcoholic fatty liver disease in Gastroenterology.
“Lifestyle modifications, which include diet and physical activity to achieve weight loss, are the cornerstone of treatment for NAFLD,” Zobair M. Younossi, MD, from Center for Liver Diseases and department of medicine at Inova Fairfax Medical Campus, Falls Church, Virginia, and colleagues wrote. “Additionally, restriction or elimination of alcohol consumption and optimal management of cardiometabolic comorbidities are also highly important.”
Younossi and colleagues shared the following for best practice advice in treating NAFLD:
- Lifestyle modifications such as diet and exercise to achieve weight loss is beneficial for NAFLD patients.
- Weight loss of 5% of total weight can decrease hepatic steatosis among patients with NASH; 7% of total weight may lead to NASH resolution and 10% of total body weight may lead to fibrosis regression or stability.
- Significant weight loss needs a hypocaloric diet targeting 1200 to 1,500 kcal per day or a decrease from baseline of 500 to 1,000 kcal per day.
- Patients with NAFLD should follow a Mediterranean diet, decrease intake of saturated fatty acid and limit or eliminate commercially produced fructose consumption.
- Patients with lean NAFLD should follow a hypocaloric diet with a lower weight-loss threshold of 3% to 5%.
- There is not adequate research to support the routine use of specific hypocaloric diets, such as low-carbohydrate/high-protein diets, meal replacement protocols, intermittent fasting and vitamin supplementation.
- Regular physical activity should be considered with 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic exercise per week. There may be independent impact on NAFLD with resistance training in combination with aerobic exercise.
- Patients should be assessed for coexisting metabolic conditions. These should be treated aggressively.
- Restrict or eliminate alcohol consumption.
- Patients with sarcopenia may need specialized dietary and activity management.
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