Non-pharmacological treatment of MASLD.

Non-pharmacological treatment of metabolic dysfunction-associated steatotic liver disease (MASLD) aims at modifying lifestyle patterns that promote metabolic dysfunction and hepatic fat accumulation. These include unhealthy dietary habits, which are characterised by excess energy intake and a qualitatively poor diet that is high in ultra-processed food, saturated fat, free sugar, red and processed meat and/or sweetened beverages, and low in fibre. In addition, sedentary habits, and sleep and circadian rhythm disruption have been identified as detrimental lifestyle factors. Lifestyle interventions act upstream of the main pathophysiological mechanisms driving MASLD and, therefore, provide benefits that extend beyond the liver, also improving cardiometabolic health. Weight loss remains the cornerstone of non-pharmacological strategies, and even modest weight loss has been proven beneficial in individuals with MASLD with or without obesity. To achieve weight loss, energy restriction should be combined with physical activity/exercise, since the effects of the latter are partly independent of weight reduction. Importantly, exercise is associated with a dose-dependent reduction in the risk of hepatic steatosis, fibrosis and hepatocellular carcinoma. Despite lifestyle changes proving highly effective for improving MASLD, their implementation is challenging and requires multidisciplinary efforts. Adherence is suboptimal, particularly in the long term, and the variability in individual response calls for research on biomarkers to achieve a more personalised approach. This review provides an overview of evidence of the impact of lifestyle changes/non-pharmacological interventions on MASLD.