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1160394
review-article20232023 TAE
0 0 10.1177/20420188231160394Therapeutic Advances in Endocrinology and MetabolismJT Stefano, SMB Duarte

THERAPEUTIC ADVANCES in
Endocrinology and Metabolism Review

Ther Adv Endocrinol

Non-pharmacological management options Metab
2023, Vol. 14: 1–17

for MAFLD: a practical guide DOI: 10.1177/

https://doi.org/10.1177/20420188231160394
https://doi.org/10.1177/20420188231160394
20420188231160394

© The Author(s), 2023.

José Tadeu Stefano, Sebastião Mauro Bezerra Duarte, Article reuse guidelines:
sagepub.com/journals-
Renato Gama Ribeiro Leite Altikes and Claudia P. Oliveira permissions

Abstract: Lifestyle changes should be the main basis for any treatment for metabolic
dysfunction–associated fatty liver disease (MAFLD), aiming to increase energy expenditure,
reduce energy intake and improve the quality of nutrients consumed. As it is a multifactorial
disease, approaches such as physical exercise, a better dietary pattern, and possible
pharmacological intervention are shown to be more efficient when used simultaneously to the
detriment of their applications. The main treatment for MAFLD is a lifestyle change consisting
of diet, activity, exercise, and weight loss. The variables for training prescription such as type
of physical exercise (aerobic or strength training), the weekly frequency, and the intensity
most indicated for the treatment of MAFLD remain uncertain, that is, the recommendations
must be adapted to the clinical conditions comorbidities, and preferences of each subject in a
way individual. This review addresses recent management options for MAFLD including diet,
nutrients, gut microbiota, and physical exercise. Correspondence to:
Claudia P. Oliveira
Laboratório de
Gastroenterologia
Keywords: dietary pattern, lifestyle changes, metabolic dysfunction–associated fatty liver Clínica e Experimental
disease (MAFLD), nonalcoholic fatty liver disease (NAFLD), physical exercise LIM-07, Division of
Clinical Gastroenterology
and Hepatology,
Received: 6 August 2022; revised manuscript accepted: 11 February 2023. Hospital das Clínicas
HCFMUSP, Department
of Gastroenterology,
Faculdade de Medicina,
Universidade de Sao
Introduction rates worldwide, mainly in the western world. Paulo, Av. Dr. Enéas de
Carvalho Aguiar no 255,
Fatty liver is a clinicopathological condition char- However, these values can change significantly Instituto Central, # 9159,
acterized by the accumulation of lipids within according to the diagnostic methods used and the Sao Paulo 05403-000,
Brazil.
hepatocytes and encompasses a wide spectrum of population studied.5
Departament of
diseases. It is one of the most common forms of Gastroenterology,
liver disease primarily related to the progressive A recent meta-analysis support previous studies Faculdade de Medicina,
Universidade de São
increase in obesity in the world.1 Initially, it was and reports that the prevalence of MAFLD has Paulo, São Paulo, Brazil
considered a benign liver disease; however, it is been affecting more than a third of the global [email protected]

currently known that it is a multifactorial disease population,6 while Liu et al.7 estimated a global José Tadeu Stefano
Sebastião Mauro Bezerra
that involves environmental and genetic factors MAFLD prevalence as 50.7% among overweight/ Duarte
and can progress to more severe forms, such as obese adults. Laboratório de
Gastroenterologia
cirrhosis and hepatocellular carcinoma (HCC) in Clínica e Experimental
patients without a history of alcohol consump- The perfect non-pharmacological strategy for the LIM-07, Division of
Clinical Gastroenterology
tion.2 Recently, Eslam et al.3 proposed to redefine management of MAFLD is not yet well defined. and Hepatology,
the diagnostic criteria to cover fatty liver associ- However, there is a consensus that excessive con- Hospital das Clínicas
HCFMUSP, Department
ated with metabolic dysfunction, including sumption of carbohydrates and lipids is harmful.8 of Gastroenterology,
changing the nomenclature to metabolic dysfunc- The high intake of carbohydrates (mainly soft Faculdade de Medicina,
Universidade de Sao
tion–associated fatty liver disease (MAFLD). drinks and products with added fructose syrup) Paulo, Sao Paulo, Brazil
Obesity, overweight, type 2 diabetes mellitus
(T2DM), metabolic syndrome (MetS), and
and a high-fat diet have been identified as respon-
sible for the development of MetS9 and the accu-
Renato Gama Ribeiro
Leite Altikes )
Departament of
genetic predisposition are the main risk factors.4 mulation of fatty acids (FAs) in the liver,10 Gastroenterology,