Materials and Methods: This randomized controlled clinical trial was conducted on 42 male and female NAFLD patients aged 20 to 55. The participants were randomly divided into intervention (diet along with aerobic exercise) (n=21) and control (without diet and exercise) (n=21) groups. The level of disease recovery was evaluated by measuring the level of liver enzymes (AST and ALT), liver ultrasound (to determine the degree of fatty liver), and body mass index (BMI) before and after three months of intervention. Paired and independent t-test, Mann-Whitney U test, and Wilcoxon test were performed using SPSS version 22 software. The clinical significance of the study was estimated using an epidemiological tool known as the number needed to treat (NNT).

Results: No significant difference was observed between the two groups in anthropometric and biochemical parameters, as well as fatty liver grade. However, the decrease in BMI index in the intervention group was insignificant compared to the control group. The degree of liver recovery in the intervention and control groups was calculated to be 69.9% and 33.3%, respectively. Also, the decrease in fatty liver grade in the intervention group was significant compared to the control group (P = 0.028). There was a statistically significant reduction in the severity of fatty liver disease in the intervention group at the end of the research (NNT = 3.5), meaning that for every 3.5 patients with NAFLD treated with diet and exercise for 3 months, one patient showed improvement.

Conclusions: This study showed that lifestyle modifications, such as physical activity and dietary habits, significantly affected fatty liver in NAFLD patients.