Diabetes Metab J.  2022 May;46(3):391-401. 10.4093/dmj.2022.0048.

Lifestyle Interventions for Non-Obese Patients Both with, and at Risk, of Non-Alcoholic Fatty Liver Disease

• Zhang XL
• Wang TY
• Targher G
• Byrne CD
• Zheng MH

• KMID: 2530178
• DOI: http://doi.org/10.4093/dmj.2022.0048

Abstract

Non-alcoholic fatty liver disease occurring in non-obese subjects (the so-called non-obese NAFLD) is a highly prevalent but neglected liver condition, which is closely associated with metabolic disorders and suboptimal lifestyles. Landmark studies have shown that lifestyle interventions are potentially beneficial in decreasing the risk of developing non-obese NAFLD and in ameliorating NAFLD in non-obese individuals with pre-existing NAFLD. Lifestyle interventions usually refer to changes in eating habits and physical activity, both of which have a powerful effect on non-obese NAFLD and on risk factors for non-obese NAFLD. However, to date, patients and health-care professionals have a poor awareness and understanding of non-obese NAFLD and the beneficial effects of lifestyle interventions in this patient population. The aim of this narrative review is to briefly discuss the evidence for the effects of lifestyle changes and what changes are needed amongst medical personnel and other stakeholders in order to raise awareness of non-obese NAFLD.

Keyword

Exercise; Feeding behaviors; Fructose; Life style; Non-alcoholic fatty liver disease; Social planning

Figure

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  Fig. 1. Feeding rhythms and non-obese non-alcoholic fatty liver disease (NAFLD). Feeding rhythms can reset peripheral tissue clocks and subsequently leads to non-obese NAFLD without influencing the supra-chiasmatic nuclei (SCN) central clock rhythms. (A with dotted line) Directly cause non-obese NAFLD, possibly via resetting the liver clock; resetting liver clock can not only change the systemic metabolism like glucose, lipid, cholesterol and bile acid metabolism, but also lead to autophagy, endoplasmic reticulum stress and increased oxidative stress in hepatocytes. All these factors have been confirmed to be associated with the occurrence of non-obese NAFLD. (B with solid line) Indirectly cause non-obese NAFLD, possibly via changing the gut microbiome; gut microbiome may be another key factor involved in the development of non-obese NAFLD. When the gut microbiome changes (dysbiosis), secondary metabolites are produced, e.g., short-chain fatty acids and bile acids, which may contribute to development of non-obese NAFLD.

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  Fig. 2. Characteristics of two different types of physical activities. Moderate to vigorous physical activity levels are recommended to decrease the risk of new non-obese non-alcoholic fatty liver disease (NAFLD) and resolve the already present non-obese NAFLD. Two different types of exercise for preventing or treating non-obese NAFLD, i.e., aerobic or resistance exercise, can produce comparable hepato-protective effects with similar frequency, duration, and periods of exercise.

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  Fig. 3. Developing a strategy for non-obese non-alcoholic fatty liver disease (NAFLD). Organizations and governments should develop guidelines and policies for non-obese patients with NAFLD. We propose that developing a strategy for non-obese NAFLD needs to involve the development of guidelines, multidisciplinary cooperation between different types of health-care professionals, establishing a unified ‘one stop shop’ for the completion of care, and improved education of patients, health-care professionals and managers.

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