Copyright ©The Author(s) 2021.
World J Gastroenterol. May 21, 2021; 27(19): 2281-2298
Published online May 21, 2021. doi: 10.3748/wjg.v27.i19.2281
Table 1 Overview of important studies concerning the management of metabolic dysfunction-associated fatty liver disease/non-alcoholic steatohepatitis patients

Study design
No. of patients
Liver disease
Main findings
Diet/physical exerciseBerzigotti et al[57], 2017 Prospective, uncontrolled60 (50 completed the study)Cirrhosis, BMI ≥ 26 kg/m2, portal hypertensionModerate exercise was safe in patients with compensated cirrhosis
Diet and moderate exercise reduced body weight and portal pressure
Weight loss ≥ 10% is associated with more pronounced portal pressure reduction
Wong et al[55], 2018 Randomized controlled trial154NAFLDRegular exercise associated with significantly more frequent remission of NAFLD (assessed by proton-magnetic MR-spectroscopy)
NAFLD remission in 67% of non-overweight patients (baseline BMI < 25 kg/m2) with lifestyle intervention
DyslipidemiaUnger et al[150], 2019Retrospective1265CLD34.2% of non-advanced and 48.2% of advanced CLD patients did not receive guideline-conform statin therapy
Guideline-conform statin use was associated with improved overall survival in compensated, but not in decompensated CLD patients
Abraldes et al[69], 2009 Randomized controlled trial59Cirrhosis and portal hypertensionSimvastatin reduced portal pressure (-8.3) in both patients, who did and did not also receive beta-blockers
Simvastatin improved liver perfusion
The effects of simvastatin were additive to beta-adrenergic blockade
Nelson et al[72], 2009Randomized controlled trial16NASHSimvastatin reduced low-density lipoprotein by 26%
Simvastatin was well-tolerated
Simvastatin did not histologically improve NASH (but small sample size, only n = 10 follow-up biopsies)
T2DMLavine et al[108], 2011Randomized controlled trial173NAFLDSustained ALT level reduction was similar in the metformin and placebo group
Metformin did not change the NAFLD activity score
Cusi et al[102], 2016Randomized controlled trial101NASH and prediabetes/T2DMSignificantly more patients receiving pioglitazone (59%) resolved NASH compared to placebo (23%)
Pioglitazone improved fibrosis score (-0.9 vs placebo 0.0)
Pioglitazone improved insulin sensitivity in liver, muscle and adipose tissue
Armstrong et al[104], 2016Randomized controlled trial52NASHSignificantly more patients receiving liraglutide (39%) resolved NASH compared to placebo (9%)
Significantly less patients receiving liraglutide (9%) exhibited fibrosis progression compared to placebo (36%)
Liraglutide was safe and well-tolerated
Bariatric surgeryLassailly et al[114], 2015Prospective109NASHNASH was resolved in 85% of patients one year after surgery and even in 94% with mild NASH before surgery (assessed via biopsy)
NASH persistence was higher in patients after gastric banding (30.4%) compared to gastric bypass (7.6%)
Goossens et al[117], 2016Retrospective59NASHNASH is an independent predictor of overall mortality after bariatric surgery
NASH may reduce the overall survival benefit of bariatric surgery
Eilenberg et al[118], 2018Retrospective10NAFLD/NASHLiver dysfunction, liver steatosis/fibrosis and cirrhosis may occur after bariatric surgery
Lengthening of the alimentary or common limb may lead to a clinical improvement in these patients
Post-LTKrasnoff et al[151], 2006 Randomized controlled trial151Post-LTExercise and dietary counseling intervention improved exercise capacity and self-reported general health
Adherence to the intervention was associated with positive trends in exercise capacity and body composition (% body fat)
Zamora-Valdes et al[152], 2018 Prospective29NAFLD/NASH/obese ACLDPatients, who received sleeve gastrectomy at the time of LT had more pronounced and sustained weight loss
They also had a lower prevalences of hepatic steatosis, hypertension and insulin resistance 3 yr after LT
Patel et al[139], 2019Retrospective495Post-LTStatins were underused after LT (54.3% of patients with known coronary artery disease did not receive statin therapy)
Statin use was well-tolerated
Statin therapy was associated with improved overall survival