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

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Abstract

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.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

This study was supported by JSPS KAKENHI grants (Grant Number 20K08383) from the Japan Society for the Promotion of Science.

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Authors and Affiliations

  1. Department of Advanced Metabolic Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan

    Yoshihiro Kamada

  2. Department of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, 840-8502, Japan

    Hirokazu Takahashi

  3. Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan

    Masahito Shimizu

  4. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, 830-0011, Japan

    Takumi Kawaguchi

  5. Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan

    Yoshio Sumida

  6. Department of Premier Preventive Medicine, Graduate School of Medicine, Osaka City University, Osaka, 545-8585, Japan

    Hideki Fujii

  7. Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan

    Yuya Seko

  8. Premier Departmental Research of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, 569-8686, Japan

    Shinya Fukunishi

  9. Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Katsutoshi Tokushige

  10. Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Atsushi Nakajima

  11. Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, 1-2 Kawazonocho, Suita, Osaka, 564-0013, Japan

    Takeshi Okanoue

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  1. Yoshihiro Kamada
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  2. Hirokazu Takahashi
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  10. Atsushi Nakajima
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  11. Takeshi Okanoue
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Consortia

Japan Study Group of NAFLD (JSG‐NAFLD)

Contributions

Conceptualization: YK, AN. Writing—original draft preparation: YK, HT, MS, TK, YS, YS, SF. Writing—review and editing: YK, TK, YS, HF, KT. Supervision: AN, TO.

Corresponding author

Correspondence to Yoshihiro Kamada.

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Conflict of interest

AN received speaker fees from Astellas, EA Pharma, Takeda Pharmaceutical Company, Mochida Pharmaceutical Co., Ltd, Biofermin Pharma, Taisho Pharmaceutical Co., Ltd, Mylan EPD, Kowa Company, and Tsumura. MS received speaker fees from Otsuka Pharmaceutical Co., Lyd. AN reports grants from Biofermin, Mylan EPD, Gilead Sciences, Astellas, and EA Pharma.

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Kamada, Y., Takahashi, H., Shimizu, M. et al. Clinical practice advice on lifestyle modification in the management of nonalcoholic fatty liver disease in Japan: an expert review. J Gastroenterol 56, 1045–1061 (2021). https://doi.org/10.1007/s00535-021-01833-9

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  • DOI: https://doi.org/10.1007/s00535-021-01833-9

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