BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, and lifestyle modification is the current standard treatment. The aim of the study was to estimate the effect of two different physical activity (PA) programs, a low glycemic index Mediterranean diet (LGIMD), and their combined effect on the NAFLD score as measured by FibroScan. METHODS: Moderate or severe NAFLD subjects (n = 144) were randomly assigned to six intervention arms during three months. Interventions arms were a control diet, LGIMD, aerobic activity program (PA1), combined activity program (PA2), and LGIMD+PA1 or LGIMD+PA2. The data were compared at baseline, at 45 days, and at 90 days. Analysis of variance was performed under the intention-to-treat principle. RESULTS: There was a statistically significant reduction in the NAFLD score after 45 days of treatment in every working arm except for Arm 1 (control diet). After 90 days, the best results were shown by the intervention arms in which LGIMD was associated with PA: LGIMD+PA1 (-61.56, 95% CI -89.61 to -33.50) and LGIMD+PA2 (-38.15, 95% CI -64.53 to -11.77). CONCLUSION: All treatments were effective to reduce NAFLD scores, but LGIMD+PA1 was the most efficient.

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