Background & Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) management guidelines have been published worldwide; we aimed to summarize, categorize and compare their lifestyle intervention recommendations. Approach & Results: We searched MASLD/nonalcoholic fatty liver disease (NAFLD) management guidelines published between 1 January 2013 and 31 June 2024 via databases including PubMed/MEDLINE, Cochrane, and CINAHL. In total, 35 qualifying guidelines were included in the final analysis. Guideline recommendations were categorized into five domains (i.e., weight reduction goals, physical activity, nutrition, alcohol, and tobacco smoking) and were ranked based on how frequently they appeared. A recommendation was defined as widely adopted if recommended in ≥24 (≥66.6%) of the guidelines. These included increase physical activity; reduce body weight by 7-10% to improve steatohepatitis and/or fibrosis; restrict caloric intake; undertake 150-300 or 75-150 minutes/week of moderate or vigorous-intensity physical activity, respectively; and decrease consumption of commercially produced fructose. The least mentioned topics, in ≤9 of the guidelines, evaluated environmental determinants of health, mental health, referring patients for psychological or cognitive behavioral therapy, using digital health interventions (DHIs), and assessing patients’ social determinants of health. Conclusions: Most guidelines recommend weight reduction through physical activity and improving nutrition, as these have proven positive effects on health outcomes when sustained. However, gaps regarding mental health and the social and environmental determinants of MASLD were found. To optimize behavioral modifications and treatment, we recommend carrying out studies that will provide further evidence on social support, environmental factors, and mental health, and further exploring DHIs.

中文翻译：

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代谢功能障碍相关脂肪性肝病生活方式管理指南的叙述性回顾


背景和目标：代谢功能障碍相关脂肪性肝病（MASLD）管理指南已在全球范围内发布;我们旨在总结、分类和比较他们的生活方式干预建议。方法和结果：我们检索了2013年1月1日至2024年6月31日期间通过包括PubMed/MEDLINE、Cochrane和CINAHL在内的数据库发布的MASLD/非酒精性脂肪性肝病（NAFLD）管理指南。最终分析总共包括 35 条合格指南。指南建议分为五个领域（即减重目标、身体活动、营养、酒精和吸烟），并根据它们出现的频率进行排名。如果指南的 ≥24 （≥66.6%） 推荐，则建议被定义为被广泛采用。这些措施包括增加体育活动;减轻体重 7-10% 以改善脂肪性肝炎和/或纤维化;限制热量摄入;每周分别进行 150-300 或 75-150 分钟的中等强度或高强度体育活动;并减少商业生产的果糖的消费。在指南的 ≤9 中，提及最少的主题评估了健康的环境决定因素、心理健康、转诊患者进行心理或认知行为治疗、使用数字健康干预 （DHI） 以及评估患者的健康社会决定因素。结论：大多数指南建议通过体育锻炼和改善营养来减轻体重，因为事实证明，这些在持续时对健康结果有积极影响。然而，发现了心理健康以及 MASLD 的社会和环境决定因素方面的差距。 为了优化行为改变和治疗，我们建议进行研究，以提供有关社会支持、环境因素和心理健康的进一步证据，并进一步探索 DHI。