This recent Non-Alcoholic Fatty Liver Disease (NAFLD) article brings up very interesting thoughts.

• Kenneally Susan, Sier Joanna H, Moore J Bernadette. Efficacy of dietary and physical activity intervention in non-alcoholic fatty liver disease: a systematic review. BMJ Open Gastroenterol. June 1, 2017;4(1). doi:10.1136/bmjgast-2017-000139.

First of all, it repeats the finding that when you look at the literature you see that there is little evidence that one diet is superior to another. In this case, one diet is the same as others in terms of reducing non-alcoholic fatty liver disease. However, it also shows that losing weight (5-10%) is a key component in affecting that condition. The article is also interesting because it looked at the impact of exercise. Here, again, they find what we keep seeing – the effect of exercise is real, but it is less effective than dietary change. And they find that both are more effective than either alone. Different exercise regimens are not superior to another. However, they do note that resistance training is certainly a more viable option.

Most of the intervention protocols in this review involved 30–60 min of exercise on 3–5 days per week. The data demonstrate aerobic and resistance exercise are both effective. This is an important finding because resistance exercise is more readily available to those of the population most at risk of NAFLD, that is, those with overweight/obesity. Low cardiorespiratory fitness and numerous medical conditions are often concomitant with this population and can preclude aerobic exercise. Therefore performing resistance exercises, relying on body weight alone, can be effective first steps in improving NAFLD. 30 However, while statistically significant, the magnitude of the improvement following exercise interventions appears to be less than in dietary interventions.

This article supports my argument that the issue is adherence and that some interventions are likely to be successful, but not in a more population-based intervention. Success in the population is more focused on adherence and tailoring the experience to maximize adherence – not to genetics or toward a specific diet. Adherence is typically quite low despite knowledge of what is a more effective strategy.