Clinical practice advice on lifestyle modification in the management of nonalcoholic fatty liver disease in Japan: an expert review

• Published in: Journal of gastroenterology Vol. 56; no. 12; pp. 1045 - 1061
• Main Authors: Kamada, Yoshihiro, Takahashi, Hirokazu, Shimizu, Masahito, Kawaguchi, Takumi, Sumida, Yoshio, Fujii, Hideki, Seko, Yuya, Fukunishi, Shinya, Tokushige, Katsutoshi, Nakajima, Atsushi, Okanoue, Takeshi
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01-12-2021; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Alcohol use; Associations, institutions, etc; Care and treatment; Colorectal Surgery; Development and progression; Diet; Exercise therapy; Fatty liver; Gastroenterology; Gene polymorphism; Genetic polymorphisms; Genetic Predisposition to Disease; Hepatology; Humans; Japan; Life Style; Lifestyles; Lipase - genetics; Liver diseases; Medicine; Medicine & Public Health; Membrane Proteins - genetics; Non-alcoholic Fatty Liver Disease - complications; Patients; Polymorphism, Single Nucleotide; Review; Sarcopenia; Single-nucleotide polymorphism; Societies; Surgical Oncology; Type 2 diabetes; Japan; Alcohol consumption; Lean NAFLD; Sarcopenia; Diet and exercise therapy; Diet habit
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-021-01833-9

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver diseases worldwide, including in Japan. The Japanese Society of Gastroenterology (JSGE) and the Japanese Society of Hepatology (JSH) have established the Japanese NAFLD/NASH guidelines in 2014 and revised these guidelines in 2020. As described in these guidelines, weight reduction by diet and/or exercise therapy is important for the treatment of NAFLD patients. The I148M single nucleotide polymorphism (rs738409 C > G) of
PNPLA3
(patatin-like phospholipase domain-containing 3 protein) is widely known to be associated with the occurrence and progression of NAFLD. In the Japanese, the ratio of
PNPLA3
gene polymorphisms found is approximately 20%, which is higher than that found in Westerners. In addition, the ratio of lean NAFLD patients is also higher in Japan than in Western countries. Therefore, the method for lifestyle guidance for the NAFLD patients in Japan would be different from that for the people in Western countries. The problems in the treatment of NAFLD patients include alcohol consumption and sarcopenia. Therefore, guidelines that can help clinicians treat Japanese patients with NAFLD are needed. In this expert review, we summarize evidence-based interventions for lifestyle modification (diet, exercise, alcohol, and sarcopenia) for the treatment of patients with NAFLD, especially from Japan and Asian countries.