International Journal of Science Annals, Vol. 8, No. 1, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa SOCIAL AND BEHAVIORAL SCIENCES. Health Care Sciences ORIGINAL RESEARCH Comparative Study of Yogic Practices and Dietary Modifications on Biochemical Variables among Middle-Aged Women on Metabolic Dysfunction – Associated Steatotic Liver Disease Authors’ Contribution: A – Study design; Selva Sundari S.1 ABCDEF , Jayanthy C. V.1 ACE , B – Data collection; Natarajan S.1 ACE C – Statistical analysis; 1 D – Data interpretation; School of Ancient Indian Studies & Fine Arts, Vels Institute of Science, E – Manuscript preparation; Technology & Advanced Studies, India F – Literature search; G – Funds collection Received: 29.04.2025; Accepted: 25.05.2025; Published: 30.06.2025 Abstract Background and Non-Alcoholic Fatty Liver Disease (NAFLD), now more broadly termed Metabolic Aim of Study: Dysfunction – Associated Steatotic Liver Disease (MAFLD), poses a significant health risk for women, particularly in India where its prevalence ranges from 9.0% to 53.0%, with middle-aged women comprising 29.1% of those affected. Key risk factors include obesity, insulin resistance, metabolic syndrome, and hypertriglyceridemia reported in 95.0% of MAFLD cases. The aim of the study: to assess the effects of yoga practices, dietary modifications, and their combination on liver enzyme (ALT/SGPT), triglycerides, and fasting blood glucose levels among middle aged women with mild to moderate MAFLD. Material and Methods: Twenty-one women aged between 40 and 50 were randomly divided into three groups: yoga only (n=7), diet only (n=7), and a combination of both yoga and diet (n=7). The study was conducted for 8-week period with 6 days intervention each week. Pre- and post-test values were analysed using ANCOVA with Scheffe’s post hoc tests. Results: The study revealed that the combined Yoga and Diet intervention led to a statistically significant improvement in liver function (alanine aminotransferase, F(2,17)=15.15, p<0.05) and glycemic control (fasting glucose, F(2,17)=6.64, p<0.05) among MAFLD participants, with the Yoga+Diet group showing the greatest mean reductions (-1.43 U/L and -37.06 mg/dL respectively). While triglyceride levels also declined most in the combined group (-25.10 mg/dL), the difference was not statistically significant (F=0.41, p>0.05). Quantitative outcomes were supported by qualitative observations, including improved adherence, lifestyle engagement, and subjective well-being among participants in the combined intervention group. These findings highlight the synergistic benefits of integrating Yoga and Diet for metabolic and liver health in individuals with MAFLD. Conclusions: The study found that middle-aged women with mild to moderate MAFLD who underwent a combined yoga and dietary intervention demonstrated significant improvement in fasting blood glucose levels, indicating better glycemic control. Although reductions in alanine aminotransferase and triglyceride levels were observed across all intervention groups, these changes were not statistically significant between groups. These results suggest the combined intervention may be effective in improving metabolic health, with potential for greater impact over longer durations or in larger cohorts. Keywords: MAFLD/NAFLD, yoga, diet, ALT, triglycerides, fasting glucose, liver enzymes. Copyright: © 2025 Selva Sundari S. R., Jayanthy C. V., Natarajan S. Published by Archives of International Journal of Science Annals DOI: https://doi.org/10.26697/ijsa.2025.1.4 Conflict of interests: The authors declare that there is no conflict of interests Peer review: Double-blind review Source of support: This research did not receive any outside funding or support Information about Selva Sundari Sakthiswararao (Corresponding Author) – https://orcid.org/0009-0001- the authors: 9967-3525; rudramvidyalayam@gmail.com; Research Scholar, Department of Yoga, School of Ancient Indian Studies & Fine Arts, Vels Institute of Science, Technology & Advanced Studies, Chennai, Tamilnadu, India. Jayanthy Cuddalore Venkatesan – https://orcid.org/0009-0002-1259-1533; Doctor of Philosophy in Yoga, Professor, Department of Yoga, School of Ancient Indian Studies & Fine Arts, Vels Institute of Science, Technology & Advanced Studies, Chennai, India. Natarajan Subramanian – https://orcid.org/0009-0007-3043-233X; Doctor of Philosophy in Yoga, Head, Department of Yoga, School of Ancient Indian Studies & Fine Arts, Vels Institute of Science, Technology & Advanced Studies, Chennai, Tamilnadu, India. 46 International Journal of Science Annals, Vol. 8, No. 1, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Introduction The liver is vital and second largest organ for our health, figures highlight the significant global impact of performing essential functions like metabolism, NAFLD, underscoring the critical need for improved detoxification, digestion, and bolstering the immune awareness, diagnosis, and treatment strategies to prevent system. The liver plays a crucial role in maintaining the disease from advancing to more severe liver homeostasis, which refers to the body’s ability to keep a conditions such as NASH (Non-Alcoholic stable internal environment despite changes in the Steatohepatitis) and Cirrhosis. external surroundings. Liver’s key role includes Yoga is highly valued in today’s world and offers a Regulation of Blood Glucose Levels, Detoxification and hopeful outlook for the future. Esteemed health Waste Removal, Control of Lipid and Protein organizations such as the WHO and NIH acknowledge Metabolism, Regulation of Blood Volume and it as a powerful natural healing method. This ancient Composition, Support for the Immune System. discipline is utilized in therapeutic settings, aiding in Liver problems can arise from various sources, recovery, alleviating stress, and managing chronic including excessive alcohol intake, viral infections such illnesses. A recent investigation conducted has revealed as hepatitis, obesity, diabetes, high cholesterol, exposure that specific yoga asanas as well as relaxation to toxins, certain medications, genetic issues like techniques, significantly enhance liver enzyme levels. hemochromatosis, and sharing needles for drug use. Yogic practices may provide a more effective means of Maintaining liver health is essential for overall well- improving liver function than conventional medical being and preventing serious conditions such as treatments (Ashok Kumar et al., 2021). In Yoga, food Metabolic Dysfunction-Associated Fatty Liver Disease serves a purpose that goes beyond mere nutrition; it is (MAFLD), cirrhosis, and liver failure. seen as a source of energy (Prana) that influences our MAFLD/NAFLD is a comprehensive term that body, mind, and spirit. encompasses all stages and grades of the disease, Adopting a balanced yogic diet can result in improved indicating a population where at least 5% of hepatocytes physical well-being, greater mental clarity, and a more exhibit macrovesicular steatosis without a clear profound spiritual development. alternative cause (such as medications, starvation, or “Ahara suddhau sattva-suddhih, sattva-suddhau monogenic disorders) in individuals who consume dhruva smrtih, smrti-lambhe sarva-granthinam minimal or no alcohol (defined as less than 20 g/d for vipra-moksah” (Chandogya Upanishad, n.d./2019). women and less than 30 g/d for men (Rinella et al., Eating pure food promotes mental clarity, which in turn 2023). encourages constant reflection. This persistent The occurrence of non-alcoholic fatty liver disease is a mindfulness allows individuals to break free from all greatest risk factor for the metabolic diseases such as constraints and attain freedom. A balanced diet and Hypertriglyceridemia, characterized by elevated fat regular exercise are fundamental components of levels in the blood (found 40.74% of individuals with managing NAFLD (Sengupta, 2012). NAFLD), Hypertension, or high blood pressure (found Yoga, particularly asthanga, is often symbolically in 39.34% of NAFLD (Younossi et al., 2016). Metabolic represented as a tree and consists of eight components, Syndrome is present in 42.54% of NAFLD patients and or “limbs”. Patanjali systematized the ancient practice of 41% of individuals with NASH have advanced to yoga into asthanga, which is recognized as one of the six fibrosis, and approximately one-third to two-thirds of branches of Indian philosophy called Yoga Darshan. individuals with type 2 diabetes also have NAFLD These limbs include yama (universal ethics), niyama (Dusheja, A., et al., 2015). It is estimated that 50.00% of (individual ethics), asana (physical postures), those with dyslipidaemia, which includes abnormal pranayama (breath control), pratyahara (sense cholesterol and high fat levels, are affected by NAFLD. withdrawal), dharana (concentration), dhyana Liver disease leads to approximately two million (meditation), and samadhi (bliss). Each limb is fatalities each year, representing 4.00% of total deaths. interconnected, similar to how the limbs of the body are The primary contributors to cirrhosis globally include linked; if one leg is pulled, the entire body responds. viral hepatitis, alcohol consumption, and non-alcoholic Likewise, engaging with one of the eight limbs of yoga fatty liver disease. The most common causes of death in influences the others, as they are not sequential stages to patients with NAFLD overall are cardiovascular disease be completed (Kapatel, 2019). (CVD) and non-hepatic malignancy, followed by liver The collective findings from previous studies provide disease (Singh et al., 2017). sturdy support for the therapeutic advantages of yoga in Non-alcoholic fatty liver disease (NAFLD) has become multiple aspects of mental health and well-being. the primary reason for liver transplants in women The favourable results noted in areas such as self-care, (Sampath Kumar et al., 2019). When managing women mindfulness, emotional fatigue, depersonalization, with NAFLD, it is essential to take into account their perceived stress, sleep quality, and overall resilience specific risk factors, such as hormonal influences and highlight the adaptability of yoga as a comprehensive reproductive considerations (Rinella et al., 2023). intervention. Approximately 1 billion people globally are estimated to There may be a connection between NAFLD and mental be living with NAFLD, and this number is expected to health issues, such as depression, which could be grow as obesity, diabetes, and other metabolic syndrome influenced by dietary habits, lifestyle choices, and factors continue to rise (Younossi et al., 2016). The environmental factors. 47 International Journal of Science Annals, Vol. 8, No. 1, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Personality appears to serve as a link between NAFLD exacerbating lipid dysregulation. Understanding the and psychiatric disorders, influencing lifestyle choices, intricate mechanisms through which cortisol modulates weight fluctuations, meticulousness, and immune triglyceride levels is crucial for addressing conditions system performance (Soto-Angona et al., 2020). associated with metabolic dysfunction. Anxiety and depression are considered risk factors for Research Hypothesis NAFLD (Woodyard, 2011). Integrative lifestyle interventions involving yoga Yoga Therapy on Mind and Emotion: Mechanisms of practices combined with dietary modifications will Action result in greater improvements in liver enzyme levels Yoga therapy, a practice combining physical postures (ALT/SGPT), triglycerides, and fasting blood glucose (asanas), breathing techniques (pranayama), meditation, among middle-aged women with mild to moderate and mindfulness, has been widely recognized for its MAFLD compared to either intervention alone. therapeutic benefits on mental and emotional well- This study explores a significant gap in the management being. The underlying mechanisms through which yoga of Metabolic Dysfunction Associated Steatotic Liver exerts its effects on the mind and emotions involve both Disease (MAFLD) in middle-aged women, a physiological and psychological pathways (Tanna & demographic increasingly vulnerable due to hormonal, Khatri, 2024). Physiologically, yoga enhances metabolic, and lifestyle influences. autonomic nervous system regulation, primarily through The research is important for several reasons. Firstly, it its impact on the parasympathetic nervous system, assesses the individual and combined impacts of yoga leading to a reduction in heart rate, blood pressure, and practices and dietary changes both of which are non- overall stress levels (Calderone et al., 2024). pharmacological, cost-effective, and practical This state of relaxation is thought to counterbalance the interventions on critical biochemical markers related to heightened sympathetic nervous system activity that MAFLD: alanine aminotransferase (ALT), characterizes stress and emotional distress. On a triglycerides, and fasting blood glucose (FBG). The psychological level, yoga fosters a state of mindfulness, notable improvement in FBG within the combined Yoga promoting greater awareness and acceptance of thoughts and Diet group indicates a synergistic effect that may and emotions. This mindfulness practice has been surpass the efficacy of either intervention alone. shown to reduce rumination, increase emotional Secondly, the study offers new perspectives within the resilience, and improve emotional regulation by Indian context, where the levels of insulin resistance, engaging brain regions such as the prefrontal cortex and hypertriglyceridemia, and NAFLD are particularly high, amygdala, which are involved in decision-making, even among non-obese individuals. emotional processing, and stress response regulation Finally, the results of this research carry significant (Gerritsen & Band, 2018). Moreover, breathing public health implications, especially for rural and semi- techniques in yoga activate the vagus nerve, which plays urban areas where obesity is on the rise and healthcare a key role in regulating mood and stress (Feingold, access is limited. 2023). Together, these mechanisms create a holistic These findings could guide future large-scale approach to emotional and mental health, promoting a intervention programs, health education initiatives, and balanced emotional state, reducing anxiety and policy measures aimed at preventing the advancement depression, and enhancing overall well-being. of MAFLD through community-based, lifestyle-focused Triglycerides and Cortisol: Mechanistic Link strategies. Cortisol, a glucocorticoid hormone secreted by the The aim of the study. To assess the effects of yoga adrenal glands during stress, is crucial for metabolic practices, dietary modifications, and their combination functions, particularly in managing lipid metabolism. on liver enzyme (ALT/SGPT), triglycerides, and fasting Increased cortisol levels are closely associated with blood glucose levels among middle aged women with elevated triglyceride concentrations in the bloodstream, mild to moderate MAFLD previously known as often observed in conditions of chronic stress, metabolic NAFLD. syndrome, or Cushing's syndrome. Cortisol promotes triglyceride accumulation primarily through its effects Materials and Methods on adipose tissue. It stimulates lipogenesis by enhancing Participants the expression of genes involved in fat synthesis, while A total of 21 middle-aged women diagnosed with mild simultaneously inhibiting lipolysis, the process by to moderate Metabolic Dysfunction–Associated which stored fat is broken down for energy. Steatotic Liver Disease (MAFLD) were enrolled in the Additionally, cortisol influences liver function by study. increasing the production of very low-density The mean age of participants was 46.5±3.5 years. The lipoproteins (VLDL) (Romero-Gómez et al., 2017), a cohort predominantly comprised married women major carrier of triglycerides. Through these (95.2%), with one divorced participant (4.8%). In terms mechanisms, elevated cortisol levels contribute to the of occupation, the majority were housewives (57.1%), dysregulation of lipid homeostasis, promoting an followed by teachers (23.8%), dance professionals increase in circulating triglycerides. This relationship (9.5%), and others including a physiotherapist, IT between cortisol and triglycerides is further professional, and accountant. The mean height and pre- compounded by the hormone's ability to induce insulin study weight were 156.8±5.8 cm and 75.26±14.06 kg, resistance, leading to impaired glucose metabolism and respectively (Table 1). 48 International Journal of Science Annals, Vol. 8, No. 1, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Table 1 Demographic Characteristics of Study Participants Participants were randomly assigned to one of three Shudhhi, Shitkari), 10 minutes of “OM” meditation. All intervention groups: Yoga Only (n=7), Diet Only (n=7), practices are selected based on the scientific studies and and Combination of Yoga+Diet (n=7). Inclusion criteria conducted under the guidance of professional yoga included simple to no history of chronic liver disease, therapist, and medical personnel supervised the whole having mild to moderate NAFLD/MAFLD, stable process. medical condition, and volunteer participation to Diet Group: Participants received individualized dietary intervention protocols. Men, menopausal women and on plans based on caloric deficit (500 kcal/day below sever or chronic medications affecting weight or liver maintenance) and dietary quality aligned with MAFLD enzymes were excluded. dietary guidelines (low saturated fat, restrained Design and Procedure carbohydrate, increased fibre and increased herbal This research was conducted over an 8-week period decoction tea). Diet adherence was monitored through using a pre-test/post-test experimental design with daily diet logs and weekly check-ins. multiple groups. Yoga+Diet Group: Participants followed both the yoga The blood tests of before and after intervention were practices and dietary protocols described above. compared: Blood index: triglyceride (TG) and Fasting Test Method Blood Glucose (FBG), digestive system index: Glutamic Alanine Aminotransferase (ALT/SGPT) calculated in pyruvic transaminase/ alanine aminotransferase (ALT). Method: IFCC (UV without P5P), Triglycerides Informed consent has been obtained from participants calculated in Method: Enzymatic (GPO-POD) both and ethical clearance was obtained from the institutional using Beckman Coulter DxC 700 AU machine. review board. Statistical Data Analysis Intervention Protocols Analysis of covariance (ANCOVA) was employed to Yoga Group: Participants received 8 weeks, 6 day a compare post-test BMI scores between the groups while week, 60 minutes each day. The practice is mainly in the controlling for pre-test scores. Significant differences form of small and medium intensity yoga exercise, were further explored using Scheffe’s post-hoc test. A mainly including asanas, pranayama, meditation, and significance level of p<0.05 was used for all analyses. yogic counselling. The patients received 60 minutes yoga training including 10 minutes of warm-up, 20 Results minutes of yoga training (Surya namaskar - 3 rounds, Analysis of covariance (ANCOVA) indicated a Ardha Chakrasana, Ardha kati Chakrasana, significant difference in adjusted post-test ALT/SGPT Trikonasana, Parshvakonasana, Pada Hastasana, levels among the three groups, F(2.17)=15.15, p<0.05. Vajrasana, Shansangasana, Janu Shirasasana, However, Scheffé’s post hoc test revealed that none of Vakrasana, Sarala Bhujangasana, Artha Shalabasana, the pairwise comparisons reached statistical significance Pawana Mukthasana, Supta Baddha Konasana, Sarala (CD=0.46). Although the combined Yoga+Diet group Matsyasana Setu Bandhasana), 10 minutes of deep showed the largest mean reduction (-1.43 U/L), it was relaxation, 10 minutes of pranayama techniques not significantly different from the Yoga or Diet groups (Kanishta Pranayama, Bhramari Pranayam, Ujjayi, Nadi (Tables 2, 2A). 49 International Journal of Science Annals, Vol. 8, No. 1, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Table 2 ANCOVA on ALT / SGPT Levels (U/L) Table 2A Scheffe’s Posthoc Test on ALT / SGPT Levels Figure 1 shows the comparative analysis of all three on ALT/SGPT for pre test, post test, and adjusted post groups (Yoga group, Diet group and Yoga+Diet group) test. Figure 1 Comparative Analysis of All Three Groups on ALT/SGPT ANCOVA showed no significant group differences in (-25.10 mg/dL), but this difference did not reach post-test triglyceride levels after controlling for baseline statistical significance. values, F(2.17)=0.41, p>0.05. Scheffé’s post hoc test confirmed that none of the All groups showed a reduction in triglyceride levels, pairwise differences exceeded the critical difference with the Yoga+Diet group having the largest decrease (CD=23.75) (Tables 3, 3A). 50 International Journal of Science Annals, Vol. 8, No. 1, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Table 3 ANCOVA on Triglycerides Levels (mg/dL) Table 3A Scheffe’s Posthoc Test on Triglycerides Levels Figure 2 shows the comparative analysis of all three on Triglyceride Levels for pre test, post test, and groups (Yoga group, Diet group and Yoga+Diet group) adjusted post test. Figure 2 Comparative Analysis of All Three Groups on Triglyceride Levels There was a statistically significant difference in fasting difference=21.70, CD=13.20), indicating that the blood glucose levels across the three groups, combined intervention led to a greater reduction in F(2.17)=6.64, p<0.05. Post hoc analysis revealed that glucose levels than diet alone. the difference between the Diet group and the No other pairwise differences were statistically Yoga+Diet group was statistically significant (mean significant (Tables 4, 4A). 51 International Journal of Science Annals, Vol. 8, No. 1, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Table 4 ANCOVA on Fasting Blood Glucose Levels (mg/dL) Table 4A Scheffe’s Posthoc Test on Fasting Blood Glucose Levels Figure 3 shows the comparative analysis of all three on fasting blood glucose levels for pre test, post test, and groups (Yoga group, Diet group and Yoga+Diet group) adjusted post test. Figure 3 Comparative Analysis of All Three Groups on Fasting Blood Glucose Levels A comparative assessment was performed to investigate The group that participated in both Yoga and Diet the impact of three intervention strategies Yoga, Diet, exhibited the most significant decrease in ALT/SGPT and a combined Yoga with Diet approach on serum levels (M=28.74, change =-1.43 U/L), in contrast to the ALT/SGPT levels, triglycerides, and fasting glucose Yoga-only group (M=29.48, change =-0.66) and the (Table 5). Diet-only group (M=29.82, change =-0.37). The The analysis included adjusted post-test means, mean differences among the groups were statistically gains, and inferential statistics (F-values, p-values, and significant, F=15.15, p<0.05, with a critical difference critical differences determined by the Scheffé test). (CD) of 0.46. Subsequent comparisons revealed that the 52 International Journal of Science Annals, Vol. 8, No. 1, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa combined intervention led to a notably greater reduction (M=177.80, decrease =-12.11). Nevertheless, these than either Yoga or Diet alone. variations did not reach statistical significance, F=0.41, The Yoga+Diet group exhibited the most significant p>0.05, CD=23.75. The considerable variability mean reduction in triglyceride levels (M=168.02, indicates that the differences observed may not be decrease =-25.10 mg/dL), followed by the Yoga group confidently attributed to the interventions. (M=172.59, decrease =-18.26) and the Diet group Table 5 ANCOVA Comparative Analysis of All Three Groups The group that combined Yoga and Diet demonstrated in this sample. This supports existing literature indicating the greatest reduction in glycemic levels (M=109.49, that even modest reductions in ALT through lifestyle decrease =-37.06 mg/dL), followed by the Yoga group interventions may reflect early histological (M=121.43, decrease =-17.99) and the Diet group improvements in liver fat content and inflammation (M=131.20, decrease =-2.91). The observed differences (Romero-Gómez et al., 2017). It is also notable that were statistically significant, F=6.64, p<0.05, CD=13.20, lifestyle modifications particularly those that are suggesting that the integrated approach was more sustainable, such as yoga can lead to reductions in hepatic effective in enhancing glycemic control compared to enzymes over time by improving insulin sensitivity and either intervention on its own. reducing visceral adiposity. However, the lack of These findings suggest that a combined Yoga and Diet significant pairwise differences could be attributed to the regimen produces significantly greater improvements in small sample size and relatively short duration of liver function (ALT/SGPT) and fasting glucose intervention. compared to isolated interventions. While the trend in Triglycerides and Lipid Metabolism triglyceride reduction also favored the combined Hypertriglyceridemia is a hallmark feature of metabolic approach, the results were not statistically significant. syndrome and is frequently elevated in patients with Overall, the data support the implementation of NAFLD. Although all groups showed a mean reduction integrative lifestyle modifications for improved in triglyceride levels, particularly in the Yoga+Diet metabolic health outcomes. group, these changes were not statistically significant. These results mirror findings from previous studies Discussion suggesting that longer-term or more intensive This study aimed to evaluate the comparative interventions may be required to elicit meaningful effectiveness of yoga, dietary modification, and their changes in serum triglycerides (Bellentani et al., 2010). combination on key metabolic parameters ALT/SGPT, Additionally, yoga’s role in modulating the triglycerides, and fasting blood glucose in individuals at hypothalamic-pituitary-adrenal axis and reducing stress risk for or potentially presenting with early-stage Non- hormones like cortisol may indirectly affect lipid Alcoholic Fatty Liver Disease (NAFLD). The findings metabolism over time. Thus, while short-term reductions provide partial support for the role of integrative lifestyle in triglycerides were observed, they did not meet the interventions in modulating metabolic risk markers threshold for statistical significance, indicating a need for associated with NAFLD. extended follow-up or more aggressive dietary ALT/SGPT and Hepatic Health interventions tailored for NAFLD management such as ALT (Alanine Aminotransferase) is a key surrogate low-carb diets. biomarker for hepatic inflammation and hepatocellular Fasting Blood Glucose and Insulin Sensitivity injury in NAFLD. While ANCOVA revealed a The most significant finding in this study was the significant overall effect of the interventions on reduction in fasting blood glucose in the Yoga with Diet ALT/SGPT levels, post hoc comparisons showed no group, which was statistically greater than the Diet-only significant differences between groups. Interestingly, the group. This has strong implications for NAFLD, given combined Yoga+Diet group demonstrated the largest that insulin resistance is a central mechanism in its mean reduction in ALT, suggesting a trend toward liver pathogenesis. Improved glycemic control through function improvement, albeit not statistically significant combined interventions likely reflects improved insulin 53 International Journal of Science Annals, Vol. 8, No. 1, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa signaling and reduced hepatic gluconeogenesis critical in Acknowledgments halting NAFLD progression. We would like to offer our heartfelt appreciation to These results align with previous evidence showing that everyone who has helped us complete this research yoga can improve glycemic control, possibly through project. The authors acknowledged the vice-chancellor mechanisms involving reduced sympathetic activation, and Dean of VISTAS Chennai. Finally, we acknowledge enhanced glucose uptake in skeletal muscles, and anti- the participants of the study; without the participants’ inflammatory effects (Innes & Selfe, 2016). When tremendous contributions of time and effort, this study combined with dietary adjustments, these effects appear could not have been conducted. to be additive or even synergistic, making the integrated approach particularly valuable in the management of Ethical Approval NAFLD and its metabolic comorbidities. Obtained Ethical clearance from the Research Review Clinical Implications Committee (RRC) and the Institutional Ethics Committee Given that NAFLD is largely a lifestyle-driven condition of Vels Institute of Science, Technology & Advanced with no currently approved pharmacological treatments, Studies, Chennai. (Reg. No. UP24G9300003/2024/13- these findings support the role of non-pharmacologic, 11-2024). Participants consent was obtained from all the integrative interventions. The combined effect of yoga participants. and diet targeting both metabolic and stress-related pathways may offer a low-cost, accessible, and Funding Source sustainable strategy for early intervention in NAFLD, This research did not receive any outside funding or particularly for patients in resource-limited settings. support. Conclusions References The present study demonstrates that integrative lifestyle Bellentani, S., Scaglioni, F., Marino, M., & Bedogni, G. interventions, particularly the combination of yoga (2010). Epidemiology of non-alcoholic fatty liver practices and dietary modifications, have a beneficial disease. Digestive Diseases (Basel, Switzerland), impact on metabolic health markers in middle-aged 28(1), 155–161. https://doi.org/10.1159/000282080 women with mild to moderate MAFLD. Among the three Calderone, A., Latella, D., Impellizzeri, F., de Pasquale, intervention groups, the Yoga with Diet group showed a P., Famà, F., Quartarone, A., Calabrò, R. 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Physical and Rehabilitation Medicine, 62(2), 98– https://doi.org/10.1002/hep.28431 103. https://doi.org/10.1016/j.rehab.2018.11.001 Cite this article as: Selva Sundari, S., Jayanthy, C. V., & Natarajan, S. (2025). Comparative study of yogic practices and dietary modifications on biochemical variables among middle-aged women on metabolic dysfunction – Associated steatotic liver disease. International Journal of Science Annals, 8(1), 46–55. https://doi.org/10.26697/ijsa.2025.1.4 The electronic version of this article is complete. It can be found online in the IJSA Archive https://ijsa.culturehealth.org/en/arhiv This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/deed.en). 55