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Randomized Controlled Trial
. 2024 Dec 6;16(23):4225.
doi: 10.3390/nu16234225.

Healthy Lifestyle Changes Improve Cortisol Levels and Liver Steatosis in MASLD Patients: Results from a Randomized Clinical Trial

Claudia Beatrice Bagnato  1 , Antonella Bianco  1 , Caterina Bonfiglio  2 , Isabella Franco  1 , Nicola Verrelli  1 , Nicola Carella  3 , Endrit Shahini  4 , Marianna Zappimbulso  4 , Vito Giannuzzi  4 , Pasqua Letizia Pesole  5 , Anna Ancona  5 , Gianluigi Giannelli  6
Affiliations
Randomized Controlled Trial

Healthy Lifestyle Changes Improve Cortisol Levels and Liver Steatosis in MASLD Patients: Results from a Randomized Clinical Trial

Claudia Beatrice Bagnato et al. Nutrients. .

Abstract

Background: Steatotic liver disease associated with metabolic dysfunction (MASLD) affects up to about 30% of the general adult population and is closely related to obesity and the metabolic syndrome. Cortisol, a stress-related hormone contributing to hepatic fat accumulation and insulin resistance, also promotes progression of the disease. The study aims to investigate the impact of lifestyle modifications on cortisol levels and hepatic steatosis in patients with MASLD. Methods: In a 16-week three-arm randomized trial, 42 patients were randomly assigned to three groups who received dietary advice (CG), dietary advice combined with aerobic exercise (AE + DA), or dietary advice with high-intensity interval training (HIIT + DA). Before the start, after 2 months of intervention, and at the end of the project, medical evaluations, routine biochemical assessments, and psychological questionnaires were analyzed. At baseline and at the end of 4 months, hepatic steatosis was evaluated by Fibroscan®. Results: In the study population, severe hepatic steatosis (74%) and obesity (98%) were prevalent at the beginning of the study. A statistically significant (p-value = 0.001) reduction in circulating cortisol levels was observed over time in the two groups doing exercise, especially in HIIT + DA (p-value = 0.006). Hepatic steatosis, assessed by Fibroscan®, disappeared in 10 participants (CAP value < 248, p-value = 0.003). CAP values and waist circumference decreased in all groups, statistically significantly in the AE + DA group (p-value = 0.005; p-value = 0.04, respectively). Conclusions: The study emphasizes the benefits of combining diet and exercise in managing MASLD. HIIT + DA significantly decreased cortisol levels, while AE + DA was the most potent intervention for reducing hepatic steatosis.

Keywords: Mediterranean diet; exercise; hepatic steatosis; steatotic liver disease associated with metabolic dysfunction.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study design timeline. BIA: Bioelectrical Impedance Analysis; IPAQ-SF: International Physical Activity Questionnaire-Short Form; QoL: Quality of Life; EPIC: European Prospective Investigation into Cancer and Nutrition; T0: Initial Evaluation; T1: Intermedial Evaluation; T2: Final Evaluation.
Figure 2
Figure 2
Flowchart of the participants. N: Number of subjects; M: Male; F: Female; CG: Control Group; DA: Dietary Advice; AE: Aerobic Exercise; HIIT: High-Intensity Interval Training.
Figure 3
Figure 3
Bar graph of cortisol levels (mean and standard deviation) distributed according to time and treatment arms. The Kruskal–Wallis test was used to assess time differences among the three treatment groups.
Figure 4
Figure 4
Box plot of SHS (median and interquartile range) distributed according to time and treatment arms.
Figure 5
Figure 5
Generalized estimating equation (GEE): Predictive margins of cortisol levels by working arms and time.
See this image and copyright information in PMC

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