SummaryBackgroundEmerging treatment methods, including exercise, diet, and drugs, for nonalcoholic fatty liver disease have been proposed. However, the differences in their efficacy have not been determined. We aimed to compare the effects of these treatments excluding surgery via a systematic review and network meta‐analysis of randomized controlled trials.Data SourceThe data sources included PubMed, Embase, Web of Science and Cochrane up to February 1st, 2023. The endpoints consisted of body mass index (BMI), serum markers of metabolism and liver injury markers, liver fat content, and stiffness.ResultsA total of 174 studies with 10,183 patients were included in this meta‐analysis. In terms of improving BMI, Pan‐agonist of peroxisome proliferator‐activated receptors (PPAR) is the best treatment with the highest SUCRA (surface under the cumulative ranking) of 84.8% (mean = −3.40, 95% CI −5.55, −1.24) by the comparative effectiveness ranking. GLP‐1 (glucagon‐like peptide‐1) has the best effect in improving the liver fat content based on the MRI‐PDFF, steatosis score (SUCRA 99.7%, mean = −2.19, 95% CI −2.90, −1.48) and ballooning score (SUCRA 61.2%, mean = −0.82, 95% CI −4.46, 2.83).ConclusionsPan‐agonist of PPAR was the most efficacious regimen in lowering BMIs, whereas GLP‐1R agonists achieved the highest efficacy of steatosis improvement in this network meta‐analysis.

中文翻译：

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非酒精性脂肪肝的饮食、运动和药物干预的优化策略：随机对照试验的网络荟萃分析

摘要背景已经提出了治疗非酒精性脂肪肝的新兴治疗方法，包括运动、饮食和药物。然而，它们的功效差异尚未确定。我们的目的是通过随机对照试验的系统评价和网络荟萃分析来比较这些治疗（不包括手术）的效果。数据源数据源包括截至 2023 年 2 月 1 日的 PubMed、Embase、Web of Science 和 Cochrane。终点包括：体重指数 (BMI)、血清代谢标志物和肝损伤标志物、肝脏脂肪含量和硬度。 结果 本荟萃分析共纳入 174 项研究，涉及 10,183 名患者。就改善 BMI 而言，过氧化物酶体增殖物激活受体 (PPAR) 的全激动剂是最佳治疗方法，SUCRA（累积排名下的表面）最高为 84.8%（平均值 = -3.40，95% CI -5.55，-1.24） ）通过比较有效性排名。根据 MRI-PDFF、脂肪变性评分（SUCRA 99.7%，平均值 = -2.19，95% CI -2.90，-1.48）和气球评分（SUCRA 61.2%，平均值 = -0.82，95% CI -4.46，2.83）。结论 PPAR 的泛激动剂是降低 BMI 的最有效方案，而 GLP-1R 激动剂在该网络中实现了改善脂肪变性的最高功效荟萃分析。