Comparative Effectiveness of Lifestyle Versus Pharmacologic Therapy in Non-alcoholic Fatty Liver Disease (NAFLD): A 12-Month Multicenter Observational Study.

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is a growing global health concern linked to metabolic syndrome (MetS) and insulin resistance.

OBJECTIVE

The objective of the study is to compare the effectiveness of lifestyle interventions versus pharmacological therapy in the management of NAFLD across multiple healthcare centers using a real-world observational cohort design.

METHODOLOGY: This multicentric observational cohort study was conducted from January 2023 to December 2024 at the Lady Reading Hospital (LRH), Peshawar, and Hayatabad Medical Complex (HMC), Peshawar. The 12-month follow-up was completed by 367 (90.84%) of the 404 patients who were recruited. Participants were split into two groups: one for pharmaceutical treatment (n = 179) and another for lifestyle intervention (n = 188). At baseline and after a year, clinical, biochemical, and radiological data were evaluated. Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY, US) was used for data analysis.

RESULTS

The lifestyle group showed significantly greater reductions in weight (-4.52 ± 2.10 kg vs. -1.65 ± 1.44 kg; p < 0.001), body mass index (BMI) (-1.43 ± 0.65 vs. -0.52 ± 0.48 kg/m²; p < 0.001), alanine aminotransferase (ALT) (-18.77 ± 10.84 vs. -15.23 ± 9.45 U/L; p = 0.004), and FibroScan (transient elastography) scores (-1.98 ± 0.84 vs. -1.47 ± 0.78 kPa; p < 0.001) compared to the pharmacological group. ALT reduction > 30% was observed in 112 (59.57%) lifestyle patients versus 89 (49.72%) pharmacological patients (p = 0.048), and BMI reduction ≥ 5% in 106 (56.38%) vs. 41 (22.91%), respectively (p < 0.001).

CONCLUSION

Lifestyle intervention is more effective than pharmacological therapy in improving metabolic and liver-related outcomes in NAFLD patients.