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

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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.

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