ABSTRACT
Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is a growing global health concern characterized by excessive fat accumulation in the liver, not attributable to significant alcohol consumption. It is closely linked to obesity, metabolic syndrome, and type 2 diabetes. While pharmacological therapies have been developed, lifestyle interventions, including dietary modification and physical activity, remain the cornerstone of NAFLD management. However, comparative data on the efficacy of these approaches is limited, particularly in local populations.
Aim: The study aimed to evaluate the comparative efficacy of lifestyle interventions versus pharmacological therapies in improving liver function, reducing hepatic fat content, and addressing metabolic parameters in patients with NAFLD.
Methods: This prospective cohort study was conducted at Mayo Hospital, Lahore, over a 12-month period from October 2023 to September 2024. The study included 50 patients diagnosed with NAFLD using ultrasonography and serum biomarkers. Participants were divided into two groups: the lifestyle intervention group (n=25), which followed a structured program involving dietary modification, increased physical activity, and behavioral counseling, and the pharmacological therapy group (n=25), which received medications such as pioglitazone and vitamin E. Baseline and follow-up assessments at 6 and 12 months included liver function tests (ALT, AST), imaging studies, and metabolic parameters (BMI, fasting glucose, and lipid profile).
Results: Forty-six patients completed the study. Both interventions significantly improved liver function and reduced hepatic fat content. The lifestyle intervention group showed a mean reduction in ALT levels by 30% (p<0.01) and a decrease in hepatic fat grade by 40% on ultrasonography, compared to a 20% reduction in ALT (p=0.02) and a 25% reduction in hepatic fat grade in the pharmacological group. Improvements in metabolic parameters, including BMI (mean reduction of 2.1 kg/m²) and fasting glucose (decrease by 15 mg/dL), were more pronounced in the lifestyle intervention group. The pharmacological group demonstrated better improvement in lipid profile, with LDL cholesterol decreasing by 25% (p<0.05). Patient adherence rates were higher in the pharmacological group (85%) compared to the lifestyle group (72%).
Conclusion: Both lifestyle interventions and pharmacological therapies effectively improved outcomes in patients with NAFLD, though lifestyle modifications were more effective in reducing hepatic fat and improving metabolic parameters. Pharmacological therapies provided better results for lipid profile improvement and had higher adherence rates. A combined approach may offer synergistic benefits, emphasizing the importance of patient-centered management strategies for NAFLD. Further research with larger populations and longer follow-up is recommended.
Keywords: Non-Alcoholic Fatty Liver Disease, NAFLD, lifestyle intervention, pharmacological therapy, liver function, metabolic syndrome, Mayo Hospital Lahore, pioglitazone, vitamin E.