Managing NAFLD in Type 2 Diabetes: The Effect of Lifestyle Interventions, a Narrative Review

Siôn A. Parry; Leanne Hodson

doi:10.1007/s12325-020-01281-6

Managing NAFLD in Type 2 Diabetes: The Effect of Lifestyle Interventions, a Narrative Review

Siôn A. Parry^*, Leanne Hodson

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

Abstract

The prevalence of non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D) is increasing. As a strong association between these two diseases exist, it is unsurprising that the number of patients with coexisting NAFLD and T2D is also increasing. These patients display a deleterious metabolic profile (e.g. hypertriglyceridemia), and increased mortality rates relative to those with only NAFLD or T2D in isolation; therefore, effective treatment strategies are required. Here we review the available intervention studies that have investigated the effects of changes in lifestyle (diet and exercise/physical activity) on NAFLD in patients with both NAFLD and T2D. On the basis of the available evidence, it appears that the addition of any kind of exercise (i.e. resistance, aerobic, or high-intensity intermittent exercise) is beneficial for patients with both NAFLD and T2D. These effects appear to occur independently of changes in body weight. Hypocaloric diets leading to weight loss are also effective in improving metabolic parameters in patients with both NAFLD and T2D, with data indicating that ~ 7–10% weight loss is required in order to observe beneficial effects. It is unclear if multidisciplinary interventions incorporating changes in both diet and physical activity levels are a more effective treatment strategy in this population than diet or exercise interventions in isolation. In conclusion, it is clear that lifestyle interventions are an effective treatment strategy in patients with both NAFLD and T2D, although further research is required to optimise these interventions and determine their scalability.

Original language	English
Pages (from-to)	1381-1406
Number of pages	26
Journal	Advances in Therapy
Volume	37
Issue number	4
Early online date	7 Mar 2020
DOIs	https://doi.org/10.1007/s12325-020-01281-6
Publication status	Published - 1 Apr 2020

Bibliographical note

Funding Information:
No Rapid Service Fee or Open Access charge was received by the journal for the publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Leanne Hodson is a British Heart Foundation (BHF) Senior Research Fellow in Basic Science but has nothing else to disclose. Siôn A. Parry has nothing to disclose. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Keywords

Diet
Exercise
Intrahepatic triacylglycerol
Non-alcoholic fatty liver disease
Physical activity
Type 2 diabetes

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10.1007/s12325-020-01281-6Licence: CC BY-NC 4.0

Cite this

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title = "Managing NAFLD in Type 2 Diabetes: The Effect of Lifestyle Interventions, a Narrative Review",

abstract = "The prevalence of non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D) is increasing. As a strong association between these two diseases exist, it is unsurprising that the number of patients with coexisting NAFLD and T2D is also increasing. These patients display a deleterious metabolic profile (e.g. hypertriglyceridemia), and increased mortality rates relative to those with only NAFLD or T2D in isolation; therefore, effective treatment strategies are required. Here we review the available intervention studies that have investigated the effects of changes in lifestyle (diet and exercise/physical activity) on NAFLD in patients with both NAFLD and T2D. On the basis of the available evidence, it appears that the addition of any kind of exercise (i.e. resistance, aerobic, or high-intensity intermittent exercise) is beneficial for patients with both NAFLD and T2D. These effects appear to occur independently of changes in body weight. Hypocaloric diets leading to weight loss are also effective in improving metabolic parameters in patients with both NAFLD and T2D, with data indicating that ~ 7–10% weight loss is required in order to observe beneficial effects. It is unclear if multidisciplinary interventions incorporating changes in both diet and physical activity levels are a more effective treatment strategy in this population than diet or exercise interventions in isolation. In conclusion, it is clear that lifestyle interventions are an effective treatment strategy in patients with both NAFLD and T2D, although further research is required to optimise these interventions and determine their scalability.",

keywords = "Diet, Exercise, Intrahepatic triacylglycerol, Non-alcoholic fatty liver disease, Physical activity, Type 2 diabetes",

author = "Parry, {Si{\^o}n A.} and Leanne Hodson",

note = "Funding Information: No Rapid Service Fee or Open Access charge was received by the journal for the publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Leanne Hodson is a British Heart Foundation (BHF) Senior Research Fellow in Basic Science but has nothing else to disclose. Si{\^o}n A. Parry has nothing to disclose. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. ",

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doi = "10.1007/s12325-020-01281-6",

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N1 - Funding Information: No Rapid Service Fee or Open Access charge was received by the journal for the publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Leanne Hodson is a British Heart Foundation (BHF) Senior Research Fellow in Basic Science but has nothing else to disclose. Siôn A. Parry has nothing to disclose. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

PY - 2020/4/1

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N2 - The prevalence of non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D) is increasing. As a strong association between these two diseases exist, it is unsurprising that the number of patients with coexisting NAFLD and T2D is also increasing. These patients display a deleterious metabolic profile (e.g. hypertriglyceridemia), and increased mortality rates relative to those with only NAFLD or T2D in isolation; therefore, effective treatment strategies are required. Here we review the available intervention studies that have investigated the effects of changes in lifestyle (diet and exercise/physical activity) on NAFLD in patients with both NAFLD and T2D. On the basis of the available evidence, it appears that the addition of any kind of exercise (i.e. resistance, aerobic, or high-intensity intermittent exercise) is beneficial for patients with both NAFLD and T2D. These effects appear to occur independently of changes in body weight. Hypocaloric diets leading to weight loss are also effective in improving metabolic parameters in patients with both NAFLD and T2D, with data indicating that ~ 7–10% weight loss is required in order to observe beneficial effects. It is unclear if multidisciplinary interventions incorporating changes in both diet and physical activity levels are a more effective treatment strategy in this population than diet or exercise interventions in isolation. In conclusion, it is clear that lifestyle interventions are an effective treatment strategy in patients with both NAFLD and T2D, although further research is required to optimise these interventions and determine their scalability.

AB - The prevalence of non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D) is increasing. As a strong association between these two diseases exist, it is unsurprising that the number of patients with coexisting NAFLD and T2D is also increasing. These patients display a deleterious metabolic profile (e.g. hypertriglyceridemia), and increased mortality rates relative to those with only NAFLD or T2D in isolation; therefore, effective treatment strategies are required. Here we review the available intervention studies that have investigated the effects of changes in lifestyle (diet and exercise/physical activity) on NAFLD in patients with both NAFLD and T2D. On the basis of the available evidence, it appears that the addition of any kind of exercise (i.e. resistance, aerobic, or high-intensity intermittent exercise) is beneficial for patients with both NAFLD and T2D. These effects appear to occur independently of changes in body weight. Hypocaloric diets leading to weight loss are also effective in improving metabolic parameters in patients with both NAFLD and T2D, with data indicating that ~ 7–10% weight loss is required in order to observe beneficial effects. It is unclear if multidisciplinary interventions incorporating changes in both diet and physical activity levels are a more effective treatment strategy in this population than diet or exercise interventions in isolation. In conclusion, it is clear that lifestyle interventions are an effective treatment strategy in patients with both NAFLD and T2D, although further research is required to optimise these interventions and determine their scalability.

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KW - Physical activity

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