Lifestyle Intervention is Effective in Reversal of Fibrosis in NAFLD Patients: Results from a Retrospective Real-World Study

Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) is a lifestyle disorder, and lifestyle intervention (LI) remains the cornerstone of NAFLD management. Despite this, in recent years, the focus has been primarily on developing newer drugs and not on LIs, presumably due to a lack of medication adherence. We aimed to investigate the ability of LI to reverse fibrosis in NAFLD patients.

Methods

Seven hundred seventy-six patients were retrospectively included, of which 565 patients were analysed. Anthropometric and biochemical parameters and 2D-SWE measurements of all patients were recorded before and after LI.

Results

Weight reduction was observed in 85.2% of the patients. The mean body mass index (BMI) decreased from 26.08 ± 3.53 kg/m² to 25.06 ± 3.19 kg/m² (P < 0.001) in the cohort. The mean waist and hip circumferences decreased significantly from 98.87 ± 8.72 cm to 94.40 ± 7.67 cm and from 103.63 ± 7.91 cm to 101.98 ± 7.17 cm, respectively (P < 0.001). Significant reductions in serum low-density lipoprotein (112.93 ± 33.23 mg/dL to 104.12 ± 31.10 mg/dL, P < 0.001) and very low-density lipoprotein (34.05 ± 19.43 mg/dL to 30.26 ± 12.58 mg/dL, P < 0.001) levels were also observed post-intervention. Decrease in liver stiffness was observed in 67.9% of the patients, and a one-stage reduction in fibrosis was observed in 40.5% of the patients, while a 2-point reduction in liver stiffness was observed in 52% of the patients; reversal of hepatic steatosis occurred in 16.4% of the patients. A significant reduction in liver stiffness was seen post-intervention (7.21 ± 1.84 kPa to 6.61 ± 1.59 kPa, P < 0.001). BMI reduction correlated positively with a decrease in liver stiffness (r = 0.43, P < 0.001).

Conclusion

LI when sustained over a year can improve liver stiffness in NAFLD, even in a real-world setting. However, prospective case–control studies are required to robustly assess the effectiveness, safety with regard to micronutrient deficiency, and long-term outcomes of LI in NAFLD.