Non-alcoholic fatty liver disease and diabetes: From physiopathological interplay to diagnosis and treatment

Table 2 Current data on non-pharmacological treatments of non-alcoholic fatty liver disease

Ref.	Sample size	Type 2 diabetes	Type of intervention	Study design/duration	Liver enzymes	Imaging	Histology
Kistler et al[111]	813 adults	25%	Inactive or moderate or vigorous exercise	Retrospective analysis of biopsy-proven NAFLD	Vigorous recommendations was associated with ↓ GGT levels compared with being inactive		Vigorous exercise was associated with a ↓ adjusted odds of NASH
Hallsworth et al[112]	19 adults		Resistance exercise	Randomly assigned to either exercise or standard care. 8 wk	No significant changes in ALT levels	Resistance exercise: 13% relative ↓ in liver lipid by 1H-MRS
Bacchi et al[113]	31 adults	100%	Aerobic (AER) or resistance (RES) training	Randomized controlled study. 4 mo		Hepatic fat content was ↓ in both by in-opposed-phase MR imaging
Mathurin et al[114]	381 adults	25%	Bariatric surgery	Prospective study. Follow-up of 5 yr	Significant ↓ in ALT and GGT levels 1 and 5 yr after bariatric surgery		Significant ↓ in NASH
							Fibrosis ↑, 96% with F1
Mummadi et al[115]	766 paired liver biopsies		Bariatric surgery	Systematic review and meta-analysis (15 studies)			↓ or resolution 81.3% in NASH and 65.5% in fibrosis

↓: Decrease; ↑: Increase. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gammaglutamyl transferase; AP: Alkaline phosphatase; NAFLD: Non-alcoholic fatty liver disease; NASH: Non-alcoholic steatohepatitis;

¹H-MRS: Proton magnetic resonance spectroscopy; F1: Stage 1 of fibrosis.