Diet and exercise — the cornerstone of NASH disease management

Losing excess weight together with an active lifestyle remains the best way to help NASH patients

Categories: For Potential Participants, [Nonalcoholic Steatohepatitis (NASH), Diet, Lifestyle changes, Physical activity, Weight loss]

Nonalcoholic steatohepatitis (NASH) is a great example of a silent disease (i.e. no noticeable symptoms) that remained under the radar of big pharmaceutical companies for a long time, but is now a hot area for the development of potential new drugs. However, until new drugs become available, the main line of treatment of NASH remains through lifestyle changes and weight control. This means that a good diet and healthy living could limit NASH progression to cirrhosis or possible liver failure, which may require a liver transplant. But is it that simple? It turns out that this simple approach is rather hard to implement in the day-to-day life of many patients with NASH.

How lifestyle changes can benefit patients with NASH

Evidence supporting the beneficial effects of lifestyle changes is robust and has shown significant reductions in liver fat and a better blood sugar control after short dietary and exercise interventions. Furthermore, a modest weight loss of about 3% of total body weight may be enough to lower abnormal retention of fats within a liver cell. However, up to 10% or more weight loss is required to stop inflammation and to reverse the effect of fibrosis in patients with NASH. Unfortunately, only a small number of patients will achieve and sustain a 10% weight loss. In 2011, a research study found that patients benefit the most and achieve sustainable long-term weight loss when receiving behavioral weight-loss counseling consisting of:

  • education about weight management
  • monthly visits with lifestyle coaches 
  • meal replacement.

Therefore, one of the main goals of disease management should be to develop an approach using face-to-face counseling and online platforms. In addition, the development of effective and simplified lifestyle interventions, such as focusing on a single nutrient like sugar, could make the patient’s diet easier to stick to.

The importance of physical activity 

Another important factor in weight loss is physical activity. Public health guidelines, issued by the UK Department of Health and Social Care and the American College of Sports Medicine, recommend a minimum of 150 minutes per week of moderate to vigorous physical activity. However, most people do not follow this recommendation, and this is likely contributing to obesity. A few research studies assessed the effect of exercising alone, without dieting and slimming down, and concluded that the body can cut back on liver fat by 12%–27% after short programs of resistance exercise, high-intensity training, or traditional aerobic exercise. However, a much better result of up to 51% liver fat reduction can be achieved by combining diet and physical activities. 

The widespread use of smartphones can also be used to advantage by NASH patients. It may be beneficial to use smartphone apps, which will keep track of all physical activities, intensity, and frequency, and will allow doctors to better understand the patient’s motivation and capabilities. Having this information will allow the doctor and patient to work together to set realistic goals that achieve sustainable results.

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