Correlation of Structured Lifestyle Modification Versus Standard Care with Progression Markers from Non-Alcoholic Fatty Liver Disease to Decompensated Chronic Liver Disease In Adults Aged 30-60 Years

Original Article

Abstract

Objectives: To assess the relationship between well-documented lifestyle changes and non-invasive measures of liver fibrosis and portal hypertension in adults aged 30-60 years who have imaging-proven NAFLD.

Methodology: This comparative cross-sectional study Department of General Medicine, Sandeman Provincial Hospital / Bolan Medical College / Hospital, Quetta. From July 2025 to December 2025.We used consecutive non-probability sampling to recruit 64 adults with an imaging diagnosis of NAFLD, who were randomly allocated to either a structured lifestyle-modification group (SLM; n=32) or a standard-care group (SC; n=32). The program included six months of structured diet counseling, supervised exercise, and behavioral support. We assessed APRI, FIB-4, AST/ALT ratio, platelet count, and ultrasound findings. We analyzed data using SPSS and used p<0.05 as the cut-off.

Results: The overall mean age was 46.1±8.2 years; group means were 45.4±8.0 and 46.8±8.4 years, respectively (p=0.74). Males comprised 39 (60.9%) participants. Compared with standard care, structured lifestyle modification was associated with lower APRI (0.62±0.24 vs. 0.83±0.31, p=0.003), FIB-4 (1.21±0.48 vs. 1.62±0.59, p=0.005), and AST/ALT ratio (0.78±0.18 vs. 0.91±0.22, p=0.012). Platelet count was higher (189.6±42.7 vs. 171.2±39.8×10⁹/L, p=0.087). Ultrasound evidence of splenomegaly or minimal ascites was less frequent (12.5% vs. 31.3%, p=0.048). After adjustment, structured lifestyle modification remained associated with lower APRI (p=0.018) and FIB-4 (p=0.021).

Conclusion: Structured lifestyle modification was associated with more favorable non-invasive markers of hepatic fibrosis and early portal hypertension than standard care. Prospective studies with longer follow-up are needed to validate these results.