Effectiveness of calorie restricted diet combined with structured resistance training versus ad libitium physical activity on hepatic steatosis in patients with non-alcoholic fatty liver: A RCT.

Non-Alcoholic Fatty Liver Disease is a chroniccondition marked by excessive fat accumulation in the liver, not linked toalcohol consumption. Globally, it affects 25–29% of the population, withprevalence in Asia, including India, ranging from 9% to 53%, influencedby demographics and socioeconomic factors**.**NAFLD can progressto severe liver conditions like NASH, fibrosis, cirrhosis, or liver cancer. Italso increases the risk of cardiovascular diseases, metabolic syndrome,diabetes, and kidney disorders. The healthcare costs associated with NAFLD have risensignificantly and each one-unit increase in FIB-4 scores correlates with a 3.4%rise in overall healthcare expenses. So, early intervention in terms od dietand lifestyle modification is crucial to curb these escalating costs.

Lifestylemodifications, including dietary changes and physical activity, are pivotal inNAFLD management. Calorie-restricted diets, such as low-carbohydrate,Mediterranean, and ketogenic approaches, have shown promise in reducing hepaticfat and improving metabolic health.

Different type of exerciselike aerobic and resistance training offers unique and complementary benefitsto individuals but, resistance training has additional benefits interms of building and maintaining lean muscle mass, reducing risk of injury,feasibility in cardiopulmonary compromised and obese patients. So, it isimportant to make use of this modality in NAFLD management.

Although resistance exercise is promising forNAFLD management but, significant research gaps exist regarding its optimalapplication, standardized protocols, duration and clinical outcomes. So, wehypothesized that a calorie-restricted diet combined with structured resistancetraining (150 minutes/week) will be feasible and effective.