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Carcinogenesis and NAFLD
IMPACT OF LIFESTYLE ON NASH (INCLUSIVE OF HCC)
Ingrid Hickman
Department Nutrition and Dietetics,
Princess Alexandra Hospital,
Brisbane, Australia
Email: i.hickman@uq.edu.au
Take home messages
• At least 7% body weight loss appears necessary to significantly benefit the histological features of
NASH.
• The Mediterranean dietary eating pattern may improve IS and reduce steatosis in NAFLD.
• Inclusion of aerobic and/or resistance exercise in a lifestyle intervention for weight loss is important
to preserve muscle mass. However, the ideal prescription of exercise (type, frequency and intensity)
to reduce NASH and target muscle IR is unknown.
• There have been no studies addressing the effect of lifestyle on recurrence of HCC.
• Emerging evidence suggests a possible anti-fibrotic effect from regular coffee drinking; however,
prospective controlled studies to address the mechanisms and dose effect in NASH are yet to be
undertaken.
Introduction
Lifestyle intervention is a broad term used to describe the application of any number of combinations
of environmental, behavioral, and motivational principles to the management of lifestyle-related health
problems in a clinical setting. In studies targeted to those with NAFLD, the majority have studied obese
patients and used a combination of dietary energy restriction and increased exercise. A 5-7% weight loss
generally leads to improvements in steatosis and glucose control [1]. A Cochrane review of weight loss
in NAFLD highlighted that heterogeneity in diet and exercise prescription (e.g. dietary composition,
type, frequency and intensity of exercise programmes), short term interventions and limited histological
outcome all hamper the translation of research findings into clinical prescriptions [2]. So while weight
reduction through lifestyle modifications is usually recommended as a first-line treatment for NASH,
the effectiveness and optimal treatment approach are yet to be determined. Specific aspects of lifestyle
interventions on features of NASH such as IR, liver injury, and development and recurrence of HCC
will be summarized.
Effect of lifestyle intervention on IR in NASH
Whole body IR is a key element influencing the severity of NASH. IR is identifiable across multiple
tissues in people with NASH including muscle, liver and adipose tissue, with IR at each site contributing
to liver damage through detrimental effects on glucose metabolism or lipid delivery [3]. The design
of lifestyle interventions needs to consider how components of the intervention (diet and exercise)
may independently, or in combination, target the sites and severity of IR in NASH. It has been shown
previously in obesity that daily aerobic exercise (without weight loss), or calorie restriction in isolation
may be ineffective at reducing muscle IR. In contrast, identical doses of exercise combined with the
energy deficit can produce clinically significant (up to 60%) improvement in muscle IS [4].
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 87
IMPACT OF LIFESTYLE ON NASH (INCLUSIVE OF HCC)
Ingrid Hickman
Department Nutrition and Dietetics,
Princess Alexandra Hospital,
Brisbane, Australia
Email: i.hickman@uq.edu.au
Take home messages
• At least 7% body weight loss appears necessary to significantly benefit the histological features of
NASH.
• The Mediterranean dietary eating pattern may improve IS and reduce steatosis in NAFLD.
• Inclusion of aerobic and/or resistance exercise in a lifestyle intervention for weight loss is important
to preserve muscle mass. However, the ideal prescription of exercise (type, frequency and intensity)
to reduce NASH and target muscle IR is unknown.
• There have been no studies addressing the effect of lifestyle on recurrence of HCC.
• Emerging evidence suggests a possible anti-fibrotic effect from regular coffee drinking; however,
prospective controlled studies to address the mechanisms and dose effect in NASH are yet to be
undertaken.
Introduction
Lifestyle intervention is a broad term used to describe the application of any number of combinations
of environmental, behavioral, and motivational principles to the management of lifestyle-related health
problems in a clinical setting. In studies targeted to those with NAFLD, the majority have studied obese
patients and used a combination of dietary energy restriction and increased exercise. A 5-7% weight loss
generally leads to improvements in steatosis and glucose control [1]. A Cochrane review of weight loss
in NAFLD highlighted that heterogeneity in diet and exercise prescription (e.g. dietary composition,
type, frequency and intensity of exercise programmes), short term interventions and limited histological
outcome all hamper the translation of research findings into clinical prescriptions [2]. So while weight
reduction through lifestyle modifications is usually recommended as a first-line treatment for NASH,
the effectiveness and optimal treatment approach are yet to be determined. Specific aspects of lifestyle
interventions on features of NASH such as IR, liver injury, and development and recurrence of HCC
will be summarized.
Effect of lifestyle intervention on IR in NASH
Whole body IR is a key element influencing the severity of NASH. IR is identifiable across multiple
tissues in people with NASH including muscle, liver and adipose tissue, with IR at each site contributing
to liver damage through detrimental effects on glucose metabolism or lipid delivery [3]. The design
of lifestyle interventions needs to consider how components of the intervention (diet and exercise)
may independently, or in combination, target the sites and severity of IR in NASH. It has been shown
previously in obesity that daily aerobic exercise (without weight loss), or calorie restriction in isolation
may be ineffective at reducing muscle IR. In contrast, identical doses of exercise combined with the
energy deficit can produce clinically significant (up to 60%) improvement in muscle IS [4].
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 87
