Efficacy of Lifestyle Intervention Versus Pharmacotherapy in the Progression of Non-alcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis

Abstract

This systematic review and meta-analysis compared the efficacy of lifestyle interventions versus pharmacotherapy for managing Non-Alcoholic Fatty Liver Disease (NAFLD) across 12 studies. Pharmacological agents, particularly pioglitazone and liraglutide, demonstrated greater reductions in liver enzyme levels (standardized mean differences [SMD]: -0.65 for pioglitazone, 95% CI: -0.92 to -0.38; -0.70 for liraglutide, 95% CI: -0.95 to -0.45; both p < 0.001) and weight loss (SMD: -0.55 and -0.62, respectively) compared to lifestyle modifications. Vitamin E showed moderate benefits (SMD: -0.48, 95% CI: -0.70 to -0.26; p = 0.01). Subgroup analyses revealed that younger patients (<50 years) and those with a lower body mass index (BMI) achieved meaningful improvements with lifestyle changes, while pharmacotherapy was more effective for older or higher BMI individuals. Both treatment modalities proved beneficial, but the most favorable outcomes were achieved when pharmacotherapy was combined with lifestyle modifications. This multifaceted approach highlights the need for tailored treatment plans addressing patient-specific factors such as age and BMI. Despite moderate heterogeneity (I² = 45–60%) and slight publication bias, sensitivity analyses confirmed the robustness of findings.