Exercise and diet modification in non-obese non-alcoholic fatty liver disease: Analysis of biopsies of living liver donors

Background and Aims: We evaluated efficacy of exercise and diet modification for steatosis improvement of non-obese non-alcoholic fatty liver disease (NAFLD) patients. Methods: We analyzed retrospectively the clinical and histological parameters of consecutive living liver donors, who experienced repeated liver biopsies due to steatosis and were treated using exercise and diet modification. Results: From 1995 to 2009, among a total of 1365 potential living liver donors with NAFLD seen on the initial liver biopsy, 120 consecutive donors with steatosis = 30% or an estimated donor-recipient weight ratio < 0.8, underwent exercise and diet modification and received follow-up liver biopsy at our institution. Median age was 33 years, and median interval between the two consecutive biopsies was 10 weeks (range, 139). At the time of initial biopsy, the number of normal body mass index, overweight, and obese donors was 49 (40.8%), 65 (54.2%), and 6 (5.0%), respectively. After lifestyle modification, weight reduction and steatosis improvement were observed in 92 (76.7%) and 103 (85.8%) donors, respectively, at the time of follow-up biopsy. On multivariate analysis, initially higher steatosis (hazard ratio [HR] 1.03, P = 0.02), total cholesterol reduction = 10% (HR 5.59, P = 0.02), and weight reduction = 5% (HR 6.63, P = 0.03) were significantly associated with = 20% steatosis improvement in 120 donors with NAFLD, after exercise and diet modification. Conclusions: Exercise and diet modification were effective in reducing steatosis in potential living liver donors with non-obese NAFLD. Total cholesterol reduction = 10% could be used as a non-invasive predictor for steatosis improvement in liver donors with NAFLD, after exercise and diet modification.