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From NAFLD to MAFLD: The Role of Diet and Lifestyle in Its Pathophysiology and Treatment

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (15 January 2023) | Viewed by 12688

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Special Issue Editor

Prof. Dr. Daniel Cuthbertson

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Guest Editor

Institute of Life Course and Medical Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
Interests: insulin resistance; obesity; insulin signalling; AMPK; skeletal muscle; NASH; PCOS; magnetic resonance spectroscopy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Non-alcoholic fatty liver disease, (NAFLD) has been recently renamed as metabolic-associated fatty liver disease (MAFLD), based on not only the presence of hepatic steatosis on ultrasound but also the additional presence of either overweight or obesity or metabolic risk factors (type 2 diabetes or components of the metabolic syndrome). This disease has a significant association with a variety of long-term complications, including cardiovascular disease (CVD), liver-related events and hepatic and extra-hepatic malignancy.

This series will explore the detrimental impact of poor diet and/or physical inactivity on NAFLD/MAFLD’s pathophysiology and associated extra-hepatic outcomes through interacting with genetic factors. This may be related to such dietary factors as different macronutrient compositions, different relative intakes of plant vs. meat-based products, sugar-sweetened beverages or ultraprocessed foods with examples from overfeeding/inactivity studies. Additionally, the series will explore the impact of dietary modifications (e.g., intermittent fasting, time-restricted feeding, low-carb diets or low-calorie diets). We will also explore the impact of physical activity modulation, including walking-based, aerobic, resistance or high-intensity interval training.

Original articles/research articles, narrative review, systematic reviews and meta-analyses are invited for consideration.

Prof. Dr. Daniel Cuthbertson
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

NAFLD
MAFLD
metabolic
physical inactivity
exercise
diet
ultraprocessed food
sugar-sweetened beverages

Published Papers (3 papers)

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Research

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12 pages, 651 KiB

Open AccessArticle

Serum Fibroblast Growth Factor 21 Is Markedly Decreased following Exercise Training in Patients with Biopsy-Proven Nonalcoholic Steatohepatitis

by Jonathan G. Stine, Jaclyn E. Welles, Shelley Keating, Zeba Hussaini, Christopher Soriano, J. Wes Heinle, Nathaniel Geyer, Vernon M. Chinchilli, Rohit Loomba and Scot R. Kimball

Nutrients 2023, 15(6), 1481; https://doi.org/10.3390/nu15061481 - 20 Mar 2023

Cited by 3 | Viewed by 2441

Abstract

Background and Aims: Exercise remains a key component of nonalcoholic fatty liver disease (NAFLD) treatment. However, mechanisms underpinning the improvements in NAFLD seen with exercise are unclear. Exercise improved liver fat and serum biomarkers of liver fibrosis in the NASHFit trial. We investigated exercise’s mechanism of benefit by conducting a post hoc analysis of these data to determine the relationship between serum fibroblast growth factor (FGF) 21, which is implicated in NAFLD development, and exercise. Methods: In the 20 wk NASHFit trial, patients with nonalcoholic steatohepatitis (NASH) were randomized to receive moderate-intensity aerobic exercise training or standard clinical care. Mediterranean-informed dietary counseling was provided to each group. Change in serum FGF21 was measured after an overnight fast. Results: There was a significant improvement in serum FGF21 with exercise training compared to standard clinical care (p = 0.037) with serum FGF21 reducing by 22% (−243.4 +/−349 ng/mL) with exercise vs. a 34% increase (+88.4 ng/mL +/−350.3 ng/mL) with standard clinical care. There was a large inverse association between change in serum FGF21 and change in cardiorespiratory fitness (VO₂peak) (r = −0.62, 95% CI −0.88 to −0.05, p = 0.031), and on multivariable analysis, change in VO₂peak remained independently associated with change in FGF21 (β = −44.5, 95% CI −83.8 to −5.11, p = 0.031). Conclusions: Serum FGF21 is markedly decreased in response to aerobic exercise training, offering a novel mechanism to explain the observed reduction in liver fat and improvement in serum biomarkers of liver fibrosis in patients with NASH who do exercise. Full article

(This article belongs to the Special Issue From NAFLD to MAFLD: The Role of Diet and Lifestyle in Its Pathophysiology and Treatment)

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Review

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18 pages, 843 KiB

Open AccessReview

Exercise Is Medicine for Nonalcoholic Fatty Liver Disease: Exploration of Putative Mechanisms

by James Westley Heinle, Kara DiJoseph, Angelo Sabag, Sechang Oh, Scot R. Kimball, Shelley Keating and Jonathan G. Stine

Nutrients 2023, 15(11), 2452; https://doi.org/10.3390/nu15112452 - 24 May 2023

Cited by 4 | Viewed by 3604

Abstract

Exercise remains a key component of nonalcoholic fatty liver disease (NAFLD) treatment. The mechanisms that underpin improvements in NAFLD remain the focus of much exploration in our attempt to better understand how exercise benefits patients with NAFLD. In this review, we summarize the available scientific literature in terms of mechanistic studies which explore the role of exercise training in modulating fatty acid metabolism, reducing hepatic inflammation, and improving liver fibrosis. This review highlights that beyond simple energy expenditure, the activation of key receptors and pathways may influence the degree of NAFLD-related improvements with some pathways being sensitive to exercise type, intensity, and volume. Importantly, each therapeutic target of exercise training in this review is also the focus of previous or ongoing drug development studies in patients with nonalcoholic steatohepatitis (NASH), and even when a regulatory-agency-approved drug comes to market, exercise will likely remain an integral component in the clinical management of patients with NAFLD and NASH. Full article

(This article belongs to the Special Issue From NAFLD to MAFLD: The Role of Diet and Lifestyle in Its Pathophysiology and Treatment)

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19 pages, 4194 KiB

Open AccessReview

Ultra-Processed Food Intake Is Associated with Non-Alcoholic Fatty Liver Disease in Adults: A Systematic Review and Meta-Analysis

by Alex E. Henney, Conor S. Gillespie, Uazman Alam, Theresa J. Hydes and Daniel J. Cuthbertson

Nutrients 2023, 15(10), 2266; https://doi.org/10.3390/nu15102266 - 10 May 2023

Cited by 14 | Viewed by 6178

Abstract

Non-alcoholic fatty liver disease (NAFLD) is associated with overweight/obesity, metabolic syndrome and type 2 diabetes (T2D) due to chronic caloric excess and physical inactivity. Previous meta-analyses have confirmed associations between ultra-processed food (UPF) intake and obesity and T2D. We aim to ascertain the contribution of UPF consumption to the risk of developing NAFLD. We performed a systematic review and meta-analysis (PROSPERO (CRD42022368763)). All records registered on Ovid Medline and Web of Science were searched from inception until December 2022. Studies that assessed UPF consumption in adults, determined according to the NOVA food classification system, and that reported NAFLD determined by surrogate (steatosis) scores, imaging or liver biopsy were included. The association between UPF consumption and NAFLD was assessed using random-effects meta-analysis methods. Study quality was assessed, and evidence credibility evaluated, using the Newcastle Ottawa Scale and NutriGrade systems, respectively. A total of 5454 records were screened, and 112 records underwent full text review. From these, 9 studies (3 cross-sectional, 3 case-control and 3 cohort), analysing 60,961 individuals, were included in the current review. Both moderate (vs. low) (pooled relative risk 1.03 (1.00–1.07) (p = 0.04) (I² = 0%)) and high (vs. low) (1.42 (1.16–1.75) (<0.01) (I² = 89%)) intake of UPF significantly increased the risk of NAFLD. Funnel plots demonstrate low risk of publication bias. Consumption of UPF is associated with NAFLD with a dose–response effect. Public health measures to reduce overconsumption of UPF are imperative to reduce the burden of NAFLD, and the related conditions, obesity and T2D. Full article

(This article belongs to the Special Issue From NAFLD to MAFLD: The Role of Diet and Lifestyle in Its Pathophysiology and Treatment)

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