Impact of lifestyle modifications on liver function, hepatic fat, and metabolic parameters in non-alcoholic fatty liver disease: A culturally adapted intervention study

Objective: This study evaluates the impact of a Mediterranean-style diet and structured physical activity program on liver function, hepatic fat reduction, and metabolic parameters in Non-Alcoholic Fatty Liver Disease (NAFLD) patients in a South Asian population. Material and Methods: This prospective interventional study was conducted over six months in 150 participants, diagnosed with ultrasound-confirmed NAFLD. The sample size was determined using OpenEpi software. Participants were required to adhere to a Mediterranean diet (≥80% compliance based on 24-hour dietary recall) and moderate-intensity exercise (≥150 minutes/week). Dropout reasons included non-compliance (n=61) and loss to follow-up (n=29). Liver function tests (ALT, AST), lipid profile (LDL-C, HDL-C, triglycerides), and hepatic fat grading were assessed at baseline and post-intervention. Statistical analysis was performed using SPSS v26.0. Results: The Median age of the participants was 47 (51 – 41) years and median BMI was 33 (36 – 31) kg/m2. Out of total Patients, 63% were male. Significant reductions were observed in ALT (56 (60 – 52) to 32 (34 – 28) IU/L, p < 0.001) and AST (54 (56 – 52) to 33 (34 – 29) IU/L, p < 0.001). Hepatic fat grades improved significantly, with a 60% reduction in Grade III steatosis, 41.7% reduction in Grade II, and a 115.6% increase in Grade I cases (p < 0.001). Lipid parameters improved, with LDL-C reduced by 28 mg/dL, triglycerides reduced by 30 mg/dL, and HDL-C increased by 10 mg/dL (p < 0.001). Conclusion: This study supports the integration of culturally adapted lifestyle interventions as a first-line strategy for NAFLD management. Keywords: NAFLD, Mediterranean diet, Hepatic steatosis, Liver function, ALT, AST, Lipid profile, lifestyle modification, Metabolic syndrome, Non-pharmacological therapy