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      Non-pharmacological management options for MAFLD: a practical guide

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          Abstract

          Lifestyle changes should be the main basis for any treatment for metabolic dysfunction–associated fatty liver disease (MAFLD), aiming to increase energy expenditure, reduce energy intake and improve the quality of nutrients consumed. As it is a multifactorial disease, approaches such as physical exercise, a better dietary pattern, and possible pharmacological intervention are shown to be more efficient when used simultaneously to the detriment of their applications. The main treatment for MAFLD is a lifestyle change consisting of diet, activity, exercise, and weight loss. The variables for training prescription such as type of physical exercise (aerobic or strength training), the weekly frequency, and the intensity most indicated for the treatment of MAFLD remain uncertain, that is, the recommendations must be adapted to the clinical conditions comorbidities, and preferences of each subject in a way individual. This review addresses recent management options for MAFLD including diet, nutrients, gut microbiota, and physical exercise.

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          Most cited references152

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          The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases.

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            A new definition for metabolic associated fatty liver disease: an international expert consensus statement

            The exclusion of other chronic liver diseases including "excess" alcohol intake has until now been necessary to establish a diagnosis of metabolic dysfunction-associated fatty liver disease (MAFLD). However, given our current understanding of the pathogenesis of MAFLD and its rising prevalence, "positive criteria" to diagnose the disease are required. In this work, a panel of international experts from 22 countries propose a new definition for the diagnosis of MAFLD that is both comprehensive and simple, and is independent of other liver diseases. The criteria are based on evidence of hepatic steatosis, in addition to one of the following three criteria, namely overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation. We propose that disease assessment and stratification of severity should extend beyond a simple dichotomous classification to steatohepatitis vs. non-steatohepatitis. The group also suggests a set of criteria to define MAFLD-associated cirrhosis and proposes a conceptual framework to consider other causes of fatty liver disease. Finally, we bring clarity to the distinction between diagnostic criteria and inclusion criteria for research studies and clinical trials. Reaching consensus on the criteria for MAFLD will help unify the terminology (e.g. for ICD-coding), enhance the legitimacy of clinical practice and clinical trials, improve clinical care and move the clinical and scientific field of liver research forward.
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              EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease.

              (2016)
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                Author and article information

                Contributors
                Role: Writing - original draftRole: Writing - review & editing
                Role: Writing - original draftRole: Writing - review & editing
                Role: Writing - review & editing
                Role: InvestigationRole: Writing - review & editing
                Journal
                Ther Adv Endocrinol Metab
                Ther Adv Endocrinol Metab
                TAE
                sptae
                Therapeutic Advances in Endocrinology and Metabolism
                SAGE Publications (Sage UK: London, England )
                2042-0188
                2042-0196
                21 March 2023
                2023
                : 14
                : 20420188231160394
                Affiliations
                [1-20420188231160394]Laboratório de Gastroenterologia Clínica e Experimental LIM-07, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas HCFMUSP, Department of Gastroenterology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
                [2-20420188231160394]Laboratório de Gastroenterologia Clínica e Experimental LIM-07, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas HCFMUSP, Department of Gastroenterology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
                [3-20420188231160394]Departament of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
                [4-20420188231160394]Laboratório de Gastroenterologia Clínica e Experimental LIM-07, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas HCFMUSP, Department of Gastroenterology, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar no 255, Instituto Central, # 9159, Sao Paulo 05403-000, Brazil
                [5-20420188231160394]Departament of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
                Author notes
                Author information
                https://orcid.org/0000-0002-2848-417X
                Article
                10.1177_20420188231160394
                10.1177/20420188231160394
                10031614
                36968655
                ddb49675-e83a-4ea4-8bb1-96d586e82e4e
                © The Author(s), 2023

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 6 August 2022
                : 11 February 2023
                Categories
                New Insights in MAFLD
                Review
                Custom metadata
                January-December 2023
                ts1

                dietary pattern,lifestyle changes,metabolic dysfunction–associated fatty liver disease (mafld),nonalcoholic fatty liver disease (nafld),physical exercise

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