Possibilities of the influence of lifestyle on the degree of steatosis and liver fibrosis in non-alcoholic fatty liver disease. Review

Non‑alcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver conditions globally, encompassing a spectrum from simple steatosis to non‑alcoholic steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Affecting 25—30% of the world’s population, NAFLD is closely linked to obesity, type 2 diabetes, and metabolic syndrome. This article explores the potential of lifestyle modifications to influence the degree of steatosis and liver fibrosis in NAFLD, given the absence of approved specific pharmacological treatments. Steatosis and fibrosis are critical markers of NAFLD progression, with steatosis being reversible and fibrosis potentially regressing at early stages with timely intervention. The primary focus of management lies in non‑pharmacological approaches, particularly lifestyle changes such as dietary adjustments, increased physical activity, sleep normalization, stress management, and gut microbiota optimization. Studies indicate that a 3—5% body weight reduction mitigates steatosis, while a 10% reduction can reverse inflammation and fibrosis. The Mediterranean diet, rich in fiber, monounsaturated fats, and micronutrients (vitamins D, C, choline, zinc, selenium), is recommended as optimal for NAFLD, while intake of fructose, saturated fats, and alcohol should be restricted. Physical activity reduces fibrosis risk and preserves muscle mass, crucial in countering sarcopenia. Gut microbiota modulation through probiotics, prebiotics, synbiotics, and postbiotics alleviates inflammation and steatosis by enhancing intestinal barrier function. Intermittent fasting aligns circadian rhythms, promoting metabolic flexibility and reducing hepatic fat. Stress management techniques (yoga, meditation, cognitive‑behavioral therapy) and adequate sleep (7—8 hours) mitigate insulin resistance and systemic inflammation. Lifestyle interventions are cost‑effective and accessible tools for modulating NAFLD pathogenesis. However, further research is needed to determine optimal intervention combinations, durations, and underlying molecular mechanisms. Developing strategies for primary and secondary prevention remains a priority to alleviate the global burden of this disease.