This review examines the evidence for non-pharmacological (lifestyle) interventions in MASLD, covering dietary modification, physical activity/exercise, sleep, and circadian rhythm changes, with a focus on weight loss strategies and their effects on hepatic and cardiometabolic outcomes.
Combined diet and exercise yields the largest improvements: ALT reduction (MD −13.27), HOMA-IR reduction (MD −2.07), and ~50% intrahepatic lipid (IHL) reduction vs ~30% with exercise alone. Aerobic exercise alone reduced IHL (SMD −0.98). Exercise shows a dose-dependent reduction in risk of hepatic steatosis, fibrosis, and hepatocellular carcinoma.
- Long-term adherence to lifestyle changes is suboptimal, limiting durability of benefits. - Significant individual variability in treatment response; validated biomarkers for personalised approaches are lacking. - Evidence is largely based on prior systematic reviews and meta-analyses of heterogeneous trials (many using older NAFLD nomenclature), which may affect precision of effect estimates.
Combine energy-restricted diet with regular exercise for the greatest liver and metabolic benefit in MASLD — even modest weight loss helps. Exercise reduces liver fat partly independent of weight loss, so it should be prescribed regardless of scale results.
