Kenneally Susan, Sier Joanna H, Moore J Bernadette
Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK.
BMJ Open Gastroenterol. 2017 Jun 1;4(1):e000139. doi: 10.1136/bmjgast-2017-000139. eCollection 2017.
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, with prevalence above 30% in many adult populations. Strongly associated with obesity, weight loss through diet and physical activity is the mainstay of its management. Weight loss can be difficult to achieve and maintain however, and uncertainty exists as to which lifestyle changes are most effective.
The aim of this work was to systematically evaluate randomised controlled trials assessing diet, exercise or combination interventions aimed at reducing steatosis or markers of NAFLD activity.
Medline, Scopus and Cochrane databases were searched from 1 January 1980 through to 31 July 2016, for intervention trials assessing the effects of diet, weight loss, exercise or any combination thereof, on NAFLD disease markers in human adults. Risk of publication bias and study quality was assessed using the American Dietetic Association Quality Criteria Checklist.
From a total of 1710 identified records, 24 articles met the inclusion and exclusion criteria; 6 assessed weight loss using dietary restriction, 10 assessed exercise and 8 were combination interventions. While all of the trials demonstrated significant reduction in steatosis and/or markers of NAFLD activity, combination interventions appear to be the most effective at improving NAFLD. Results suggest that 5-10% weight loss using a modestly hypocaloric diet of 500 kcal less per day than calculated energy requirement, in combination with 30-60 min exercise on 3-5 days per week should be recommended.
We conclude this amount of weight loss is achievable in the trial setting but is challenging in the clinical environment. High-intensity, multidisciplinary intervention in specialist clinics is likely to be required in order to manage NAFLD by lifestyle modification alone. This systematic review protocol was registered prospectively at PROSPERO as CRD42016032764.
非酒精性脂肪性肝病（NAFLD）是全球慢性肝病最常见的病因，在许多成年人群中的患病率超过30%。NAFLD与肥胖密切相关，通过饮食和体育活动减轻体重是其主要治疗方法。然而，体重减轻可能难以实现和维持，并且对于哪种生活方式改变最有效存在不确定性。
本研究旨在系统评价评估饮食、运动或联合干预以减少脂肪变性或NAFLD活动标志物的随机对照试验。
检索1980年1月1日至2016年7月31日的Medline、Scopus和Cochrane数据库，查找评估饮食、体重减轻、运动或其任何组合对成人NAFLD疾病标志物影响的干预试验。使用美国饮食协会质量标准清单评估发表偏倚风险和研究质量。
在总共1710条检索记录中，24篇文章符合纳入和排除标准；6篇评估饮食限制减轻体重，10篇评估运动，8篇为联合干预。虽然所有试验均显示脂肪变性和/或NAFLD活动标志物显著降低，但联合干预似乎对改善NAFLD最有效。结果表明，建议采用每天比计算的能量需求少500千卡的适度低热量饮食减轻5 - 10%的体重，同时每周3 - 5天进行30 - 60分钟的运动。
我们得出结论，在试验环境中可以实现这种程度的体重减轻，但在临床环境中具有挑战性。仅通过生活方式改变来管理NAFLD可能需要在专科诊所进行高强度、多学科干预。本系统评价方案已在PROSPERO前瞻性注册，注册号为CRD42016032764。
