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The effects of diet and lifestyle interventions on insulin resistance in patients with nonalcoholic fatty liver disease: a systematic review

Paris, Tonyaa; George, Elena S.a,b; Roberts, Stuart K.c; Tierney, Audrey C.a,b

European Journal of Gastroenterology & Hepatology: August 2017 - Volume 29 - Issue 8 - p 867–878
doi: 10.1097/MEG.0000000000000890
Review Articles

Nonalcoholic fatty liver disease (NAFLD) results from excessive fat accumulation in the liver in the absence of excessive alcohol consumption. Insulin resistance (IR) is proposed to be an underlying pathogenic factor in the development and progression of disease. There are currently no proven pharmacotherapies and weight loss is the only prescribed treatment despite a lack of evidence to support a specific diet or lifestyle therapy. The aim of this review is to evaluate the efficacy of dietary lifestyle interventions on IR measured by Homeostasis model assessment in patients with NAFLD. A systematic electronic search of Medline, Scopus, The Cochrane Library, CINAHL and PubMed databases (1999–2015) was performed by two independent reviewers. Randomized control trials evaluating the efficacy of diet and lifestyle interventions on IR in adults diagnosed with NAFLD were included. A total of 6441 articles were identified; eight randomized control trials fulfilled the inclusion criteria. Three studies involved dietary interventions and five incorporated diet and exercise. The majority of intervention groups resulted in significant reductions in IR, with no significant changes observed in the control groups. Lifestyle interventions compared with controls reduced IR measured by homeostasis model assessment. All diet and diet and lifestyle intervention trials were efficient in reducing IR in participants with NAFLD. A lack of literature and variation across interventions warrants the need for extensive research to establish firm dietary lifestyle recommendations.

aDepartment of Rehabilitation, Nutrition and Sports, La Trobe University

bDepartment of Nutrition and Dietetics

cDepartment of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia

Correspondence to Audrey C. Tierney, PhD, Room 438, Health Sciences Building 3, La Trobe University, 1 Kingsbury Drive Bundoora, Melbourne, VIC 3086, Australia Tel: +61 424 449 854; fax: +61 394 795 768; e-mail:

Received January 8, 2017

Accepted April 7, 2017

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