Effect of Visceral Manipulation Therapy on Liver Steatosis Indices in Patients with Metabolic Dysfunction Associated Steatotic Liver Disease

Background: Metabolic dysfunction associated steatotic liver disease (MASLD) is a slow evolutionary condition from inflammation to cirrhosis. Manual therapy applied to the liver could optimize its visceral function and relieve inflammation. Given that MASLD prevalence increases with aging and reduced mechanical and metabolic stimulation, understanding non-pharmacological interventions becomes increasingly relevant in older populations. The main objective was to assess the usefulness of visceral manipulation therapy (VMT) on liver steatosis and insulin resistance measured by hepatic steatosis index (HSI) and the homeostasis model assessment (HOMA). Materials and Methos: An open label, randomized clinical trial of patients with MASLD. Patients with steatosis determined by HSI (> 36 indicate steatosis) were randomly assigned in a 1:1 ratio to receive either manual therapy or nothing. Participants were recruited between April and September 2024. VMT was performed by the same osteopathic therapist following a precise protocol for four weeks. The primary endpoint was changes from basal score to after proceeding in the HSI and HOMA. The secondary endpoints were changes in other non-invasive scores to evaluate steatosis, steatohepatitis and fibrosis. All patients received standard care according to their condition. Results: Forty participants, 20 each group, were finally included. Patients undergoing manual therapy experienced a significant mean reduction in the HOMA (7.22 vs. 5.5 p=0.018) and HSI (47.40 vs. 45.55 p=0.036) value after intervention. These findings did not appear in the control group: HOMA (4.17 vs. 4.7 p=NS), and HSI (42.6 vs. 41.9 p=NS). The secondary endpoints there were not changes of the scores to assess steatohepatitis or fibrosis neither experimental nor control group. Conclusions: VMT could be an adjuvant treatment in early stages of hepatic steatosis due to metabolic conditions improving insulin resistance and inflammation.