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Published on September 19, 2023

Exercise can help fatty liver diseaseFatty Liver Disease

There’s good news for people with non-alcoholic fatty liver disease. A new analysis shows moderate exercise can reduce fat in your liver, whether or not you lose weight.

Weight loss is the standard recommendation for non-alcoholic fatty liver disease (NAFLD), according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). In this condition, fat accumulates in the liver. It can progress to non-alcoholic steatohepatitis (NASH), in which the liver becomes inflamed and injured.

“In general, we suggest to our fatty liver patients a goal weight loss of about 5 percent of their body weight,” said Hyannis Gastroenterologist Aaron M. Dickstein, MD.

The analysis, published Jan. 30 in The American Journal of Gastroenterology, examined information on 551 people in 14 studies. It found that exercise equal to 2.5 hours of brisk walking a week resulted in a 30 percent or greater loss of fat in the liver, as measured by MRI (magnetic resonance imaging) scans. This reduction of liver fat occurred whether or not the patients lost weight. Lower amounts of exercise weren’t effective. The analysis described a regular routine of moderate exercise as 3.5 times more effective than standard care for NAFLD.

“Exercising 30 minutes a day, five days a week, improves the fat content (in the liver). We also believe that it reduces the inflammation as well, which is most important,” Dr. Dickstein said. “It’s not high-intensity interval training. Brisk walking or swimming would count.”

Dr. Dickstein said he has been recommending exercise for patients with NAFLD for many years, and the new analysis emphasizes its importance.

“I’ve found this study to be a really helpful one to bring up when I’m speaking with patients- it’s simple. Exercise is really the key,” he said.

Fatty Liver Disease

About 30 percent of Americans have non-alcoholic fatty liver disease, Dr. Dickstein said. It’s more prevalent among people who are obese, have type 2 diabetes or metabolic syndrome, according to the NIDDK. People who are apple-shaped – carry their weight in their abdomen – are more likely to develop NAFLD than pear-shaped people, Dr. Dickstein said.

According to the National Library of Medicine, other risk factors include:

  • Prediabetes
  • High blood pressure (hypertension)
  • High blood levels of triglycerides and cholesterol
  • Being Hispanic
  • Taking certain medicines, including corticosteroids and some cancer drugs

“I see mainly people in their 40s and 50s,” Dr. Dickstein said. “We are starting to see patients in their 20s and 30s, given the increase in obesity in young adults.”

The other form of fatty liver disease is alcoholic fatty liver disease, caused by excessive alcohol consumption, according to the National Library of Medicine. Drinking too much overwhelms the liver’s ability to metabolize alcohol, and some of the breakdown products damage the liver. It can lead to alcoholic hepatitis and cirrhosis.

Often NAFLD causes few or no symptoms, unless it worsens to NASH, in which the liver becomes inflamed, called cirrhosis. Scarring and damage associated with cirrhosis can make the liver stiff, according to the National Liver Foundation. This stiffness can be measured with elastography, an imaging technique available at Cape Cod Hospital, Dr. Dickstein said.

“It’s hard to predict who’s going to develop cirrhosis so we try to recommend lifestyle changes as early as possible,” he said.
Cirrhosis caused by NASH typically takes place over years, according to the National Liver Foundation, which estimates 20 percent of people with NAFLD will develop NASH.

In addition to exercise and weight loss, Dr. Dickstein said treatment for NAFLD includes addressing any co-existing conditions, such as diabetes or viral hepatitis. Some of the drugs used to treat diabetes can help reduce fat in the liver, he said.

“Avoiding alcohol is a big change that makes a difference,” Dr. Dickstein added.

Once a patient is diagnosed with NAFLD, Dr. Dickstein follows up on a regular basis. The goal is to prevent future complications including all those that come along with liver cirrhosis, he said.