Exercise, Mediterranean diet remain key against MASLD

A 12-week lifestyle intervention comprising a moderate-intensity physical activity (PA) programme and a hypocaloric Mediterranean diet (MD) promoted fat removal and liver fibrosis improvement in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD), findings from the EHmet-DIA study suggest.

“Our primary aim was to evaluate liver disease (fibrosis and steatosis) improvement by proton density fat fraction (PDFF) and MR elastography (MRE) in patients with biopsy-proven MASLD undergoing lifestyle intervention with MD enriched with extra virgin olive oil (EVOO) and randomized to PA at home or structured exercise,” said Dr Carmen Lara-Romero from the University of Sevilla in Spain, at EASL 2024.

The team instructed 96 participants (mean age 61 years, 53 percent women, 79 percent with metabolic syndrome) to adhere to the MD and augment their regimen with either structured exercises at the gym (n=48) or home exercises (n=48) for 3 months. [EASL 2024, abstract OS-116]

Diet-wise, weekly menus and grocery guides were provided. Participants were specifically instructed to incorporate EVOO into their regimen.

The structured PA group performed moderate-intensity walking (30 min) plus weight training (30 min) at the gym for 3 days and moderate-intensity walking at home 1 day/week. Alternatively, they could do the gym routine for 1 day/week only and then do virtually-guided home exercises for 3 days.

The home exercise group were to follow general recommendations of moderate-intensity exercise (150–300 min/week) split in three to five sessions.

The structured PA and home exercise groups had similar liver responses* (58 percent vs 52 percent; p=0.644). A similar trend was seen in the individual components of the outcome (30 percent vs 31 percent; p=0.952 [PDFF] and 38 percent vs 38 percent; p=0.972 [MRE]). “Hence, there were no differences in hepatic responses between participants who did their PA at the gym and those at home,” said Lana-Romero.

Anthropometrics

Month 3 saw significant drops in weight (from 96.7 to 93.3 kg; p<0.001), muscle mass (from 53 to 51.2 kg; p=0.048), and fat mass (from 35.28 to 32.9 kg; p=0.001) from baseline among responders. This was not the case among nonresponders, as they exhibited minimal or no reductions in the three variables between the two timepoints (from 95.6 to 94.4 kg; p=0.174, from 54.5 to 53.3 kg; p=0.79, and from 33.6 to 33.8 kg; p=1, respectively).

When comparing between responders and nonresponders, the former had significantly better results than the latter across parameters (p=0.013, p=0.004, and p=0.008 for weight, muscle mass, and fat mass, respectively).

Diet, PA

By month 3, the benefit of EVOO intake was evident in both responders and nonresponders (p<0.001 for both), but the former fared better than the latter in the mixed model analysis (p<0.001).

All PA variables (weekly steps, energy expenditure, 6-minute walking test, MET/min/week, and kCal/week) improved from baseline to month 3 in responders (p<0.001 for all). Again, responders fared significantly better than nonresponders across all parameters, noted Lana-Romero.

However, diet and PA adherence dropped post intervention, hence the numerical decline in hepatic (from 60 percent to 43 percent) and MRE responses (from 38 percent to 25 percent) from month 3 to 6. For PDFF response, the difference between months 3 and 6 was significant (from 31 percent to 26 percent; p<0.001).

Looking at total energy expenditure (EE) at month 3, those who had high EE had a better response rate than those who had low-moderate EE (65 percent vs 29 percent; p<0.001 [liver response] and 62 percent vs 6 percent; p=0.05 [MRE response]).

Cornerstone of treatment

Taken together, the findings underpin the importance of ditching the sedentary lifestyle and adhering to a hypocaloric diet focused on plant-based food and healthy fats, especially when done simultaneously, for MASLD management.

“Lifestyle intervention is the cornerstone of treatment for MASLD patients, and this shall remain even with the emergence of drugs to combat the disease,” said Lara-Romero.