METABOLIC-dysfunction-associated steatotic liver disease (MASLD), formerly termed non-alcoholic fatty liver disease (NAFLD), is a prevalent condition, affecting nearly 30% of adults globally. Closely linked to obesity and type 2 diabetes, MASLD encompasses a spectrum of liver conditions, from simple fat accumulation (steatosis) to severe forms involving inflammation and fibrosis, potentially progressing to cirrhosis and liver cancer.
Lifestyle modifications are the cornerstone of MASLD management. A Mediterranean diet (MD), rich in whole grains, vegetables, fruits, nuts, and olive oil, is proven to improve liver health by reducing inflammation and fat accumulation. Regular physical activity complements these dietary benefits, enhancing insulin sensitivity, lipid metabolism, and overall metabolic health.
Aerobic exercise, such as brisk walking, cycling, and swimming, has shown remarkable effects in reducing liver fat and improving cardiovascular metrics. High-intensity interval training (HIIT) has emerged as a particularly effective strategy, significantly reducing visceral fat and promoting insulin sensitivity. Importantly, HIIT also demonstrates a capacity to modulate cortisol levels, a stress hormone implicated in MASLD progression.
Elevated cortisol contributes to liver fat deposition and insulin resistance. Regular exercise, particularly moderate-intensity aerobic activity, has been found to reduce circulating cortisol levels and improve stress resilience. In a recent study, participants practising HIIT alongside MD showed the most significant reductions in cortisol and improvements in liver health within two months. Moderate aerobic activity, however, yielded the greatest long-term benefits in reducing hepatic fat and improving body composition.
Beyond physiological gains, these interventions positively impact emotional well-being. Group exercise, coupled with psychosocial support, fosters motivation and enhances mental health through the release of mood-boosting endorphins.
Despite these promising findings, further research is needed to refine dietary and exercise protocols tailored to individual needs. By integrating MD and targeted exercise, MASLD management can advance significantly, offering a dual benefit for physical and psychological health.
Katie Wright, EMJ
Reference
Bagnato CB et al. Healthy lifestyle changes improve cortisol levels and liver steatosis in MASLD patients: results from a randomized clinical Trial. Nutrients. 2024;16(23):4225.
