• The only effective treatment for nonalcoholic fatty liver (NAFL) is weight loss
  • It was found that a gradual weight loss of 5-10% has shown improvement in hepatic insulin resistance, liver histology (eg portal inflammation and fibrosis) and enzyme levels
• Lifestyle modification overall goals are to reduce excess body weight through diet and exercise therapies for a period of 3-12 months
• To improve NAFL/nonalcoholic steatohepatitis (NASH), it is recommended to prioritize the optimization of energy intake and restricting lipids in terms of the proportions of nutrient intake

Diet

• It was found that moderate calorie-restricted diet (500-1000 kcal reduction/day) with modified macronutrient composition produces better results in comparison with a very low-caloric diet
• Avoid beverages and foods that contain fructose and trans-fat
• Increasing intake of omega-3/omega-6 polyunsaturated fatty acids in diet is suggested

Alcohol Intake

• Keep alcohol intake below the risk threshold of 30 g for males and 20 g for females
• Heavy alcohol intake is a risk factor for chronic liver disease and should be avoided by patients with NAFL and NASH

Coffee Drinking

• Found to have protective element in NAFLD and reduces histological severity and liver-related outcomes

Exercise/Physical Activity

• Moderate intensity aerobic physical activities 150-200 minutes/week in 3-5 sessions is recommended
  • Has been shown to improve fatty changes in the liver even without accompanying reduced body weight
• It was also found that resistance training is also effective as it promotes musculoskeletal fitness with effects on metabolic risk factors
• Any increase on previous levels of physical activity is better than continuing inactivity