Abstract
Background
The global burden of nonalcoholic fatty liver disease (NAFLD) is rapidly increasing.
Aims
This study aimed to evaluate the effect of exercise on intrahepatic lipid (IHL), serum
alanine aminotransferase (ALT), body mass index (BMI), and insulin resistance in NAFLD
patients.
Methods
We searched MEDLINE, Embase, Cochrane CENTRAL, KMbase, and the Korean Studies Information
Service System through April 2022. The included studies were randomised control trials
(RCTs) of exercise, in which IHL was measured using magnetic resonance imaging in
adult NAFLD patients.
Results
Eleven RCTs with 577 participants were included in this meta-analysis. Exercise was
significantly associated with a reduction in IHL (mean difference (MD), -2.03; 95%
CI, -3.26 to -0.79; P = 0.001) and a decrease in ALT (MD, -4.17; 95% CI, -6.60 to -1.73; P = 0.0008). Regarding the duration of exercise, maintaining exercise for more than
3 months significantly improved IHL (MD, -3.62; 95% CI, -5.76 to -1.48; P = 0.0009), while exercise for less than 3 months did not (MD, -1.23; 95% CI, -2.74
to 0.29; P = 0.11). BMI and insulin resistance did not improve significantly with exercise.
Conclusions
We found that exercise improved IHL and ALT levels in NAFLD patients. The effect of
exercise is particularly increased when one engages in exercises that last longer
than 3 months.
Keywords
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References
- Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes.Hepatology. 2016; https://doi.org/10.1002/hep.28431
- Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States.Gastroenterology. 2015; https://doi.org/10.1053/j.gastro.2014.11.039
- Global epidemiology of NAFLD-related HCC: trends, predictions, risk factors and prevention.Nat Rev Gastroenterol Hepatol. 2021; https://doi.org/10.1038/s41575-020-00381-6
- Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030.J Hepatol. 2018; https://doi.org/10.1016/j.jhep.2018.05.036
- Nonalcoholic fatty liver disease: evolving paradigms.World J Gastroenterol. 2017; https://doi.org/10.3748/wjg.v23.i36.6571
- Inadequate physical activity and sedentary behavior are independent predictors of nonalcoholic fatty liver disease.Hepatology. 2020; https://doi.org/10.1002/hep.31158
- EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease.J Hepatol. 2016; https://doi.org/10.1016/j.jhep.2015.11.004
- The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases.Hepatology. 2018; https://doi.org/10.1002/hep.29367
- The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease.Hepatol Int. 2020; https://doi.org/10.1007/s12072-020-10094-2
- Evidence-based clinical advice for nutrition and dietary weight loss strategies for the management of NAFLD and NASH.Clin Mol Hepatol. 2020; https://doi.org/10.3350/cmh.2020.0067
- Physical activity intervention for non-diabetic patients with non-alcoholic fatty liver disease: a meta-analysis of randomized controlled trials.BMC Gastroenterol. 2020; https://doi.org/10.1186/s12876-020-01204-3
- Effects of lifestyle interventions on clinical characteristics of patients with non-alcoholic fatty liver disease: a meta-analysis.Metabolism. 2017; https://doi.org/10.1016/j.metabol.2016.12.006
- Exercise-based interventions for nonalcoholic fatty liver disease: a meta-analysis and meta-regression.Clin Gastroenterol Hepatol. 2016; https://doi.org/10.1016/j.cgh.2016.04.036
- Exercise and non-alcoholic fatty liver disease: a systematic review and meta-analysis.J Hepatol. 2012; https://doi.org/10.1016/j.jhep.2012.02.023
- Effect of weight loss on magnetic resonance imaging estimation of liver fat and volume in patients with nonalcoholic steatohepatitis.Clin Gastroenterol Hepatol. 2015; https://doi.org/10.1016/j.cgh.2014.08.039
- Updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease: histological perspective.Clin Mol Hepatol. 2021; https://doi.org/10.3350/cmh.2020.0181
- EASL-ALEH Clinical Practice Guidelines: non-invasive tests for evaluation of liver disease severity and prognosis.J Hepatol. 2015; https://doi.org/10.1016/j.jhep.2015.04.006
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; https://doi.org/10.1371/journal.pmed.1000097
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ. 2011; https://doi.org/10.1136/bmj.d5928
- Effect of aerobic exercise and diet on liver fat in pre-diabetic patients with non-alcoholic-fatty-liver-disease: a randomized controlled trial.Sci Rep. 2017; https://doi.org/10.1038/s41598-017-16159-x
- Effects of high-intensity interval and moderate-intensity continuous aerobic exercise on diabetic obese patients with nonalcoholic fatty liver disease: a comparative randomized controlled trial.Medicine (Baltimore). 2020; https://doi.org/10.1097/MD.0000000000019471
- Effects of exercise on NAFLD using non-targeted metabolomics in adipose tissue, plasma, urine, and stool.Sci Rep. 2022; https://doi.org/10.1038/s41598-022-10481-9
- Dissociation between exercise-induced reduction in liver fat and changes in hepatic and peripheral glucose homoeostasis in obese patients with non-alcoholic fatty liver disease.Clin Sci (Lond). 2016; https://doi.org/10.1042/CS20150447
- Resistance exercise reduces liver fat and its mediators in non-alcoholic fatty liver disease independent of weight loss.Gut. 2011; https://doi.org/10.1136/gut.2011.242073
- Modified high-intensity interval training reduces liver fat and improves cardiac function in non-alcoholic fatty liver disease: a randomized controlled trial.Clin Sci (Lond). 2015; https://doi.org/10.1042/CS20150308
- Exercise reduces liver lipids and visceral adiposity in patients with nonalcoholic steatohepatitis in a randomized controlled trial.Clin Gastroenterol Hepatol. 2017; https://doi.org/10.1016/j.cgh.2016.07.031
- Effect of resistance training on liver fat and visceral adiposity in adults with obesity: a randomized controlled trial.Hepatol Res. 2017; https://doi.org/10.1111/hepr.12781
- Exercise training reverses endothelial dysfunction in nonalcoholic fatty liver disease.Am J Physiol Heart Circ Physiol. 2014; https://doi.org/10.1152/ajpheart.00306.2014
- Randomized trial of exercise effect on intrahepatic triglyceride content and lipid kinetics in nonalcoholic fatty liver disease.Hepatology. 2012; https://doi.org/10.1002/hep.25548
- Effects of moderate and vigorous exercise on nonalcoholic fatty liver disease: a randomized clinical trial.JAMA Intern Med. 2016; https://doi.org/10.1001/jamainternmed.2016.3202
- American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.Med Sci Sports Exerc. 2011; https://doi.org/10.1249/MSS.0b013e318213fefb
- An experimental study of physical fitness of Air Force personnel.U S Armed Forces Med J. 1959;
- ACSM's resource manual for guidelines for exercise testing and prescription.5th ed. Lippincott Williams & Wilkins, Baltimore, MD2006
- Exercise training improves cutaneous microvascular function in nonalcoholic fatty liver disease.Am J Physiol Endocrinol Metab. 2013; https://doi.org/10.1152/ajpendo.00055.2013
- Evidence-based aerobic exercise training in metabolic-associated fatty liver disease: systematic review with meta-analysis.J Clin Med. 2021; https://doi.org/10.3390/jcm10081659
- Non-invasive methods for imaging hepatic steatosis and their clinical importance in NAFLD.Nat Rev Endocrinol. 2022; https://doi.org/10.1038/s41574-021-00584-0
- Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.Hepatology. 2019; https://doi.org/10.1002/hep.30251
- Aerobic exercise but not resistance exercise reduces intrahepatic lipid content and visceral fat and improves insulin sensitivity in obese adolescent girls: a randomized controlled trial.Am J Physiol Endocrinol Metab. 2013; https://doi.org/10.1152/ajpendo.00285.2013
- Effects of aerobic versus resistance exercise without caloric restriction on abdominal fat, intrahepatic lipid, and insulin sensitivity in obese adolescent boys: a randomized, controlled trial.Diabetes. 2012; https://doi.org/10.2337/db12-0214
- Both resistance training and aerobic training reduce hepatic fat content in type 2 diabetic subjects with nonalcoholic fatty liver disease (the RAED2 Randomized Trial).Hepatology. 2013; https://doi.org/10.1002/hep.26393
- Effect of aerobic and resistance exercise training on liver enzymes and hepatic fat in iranian men with nonalcoholic fatty liver disease.Hepat Mon. 2015; https://doi.org/10.5812/hepatmon.31434
- Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: a systematic review.J Hepatol. 2017; https://doi.org/10.1016/j.jhep.2016.08.023
- Association of non-alcoholic fatty liver disease with metabolic syndrome independently of central obesity and insulin resistance.Sci Rep. 2016; https://doi.org/10.1038/srep27034
- Aerobic exercise training reduces hepatic and visceral lipids in obese individuals without weight loss.Hepatology. 2009; https://doi.org/10.1002/hep.23129
- Weight-loss-independent benefits of exercise on liver steatosis and stiffness in Japanese men with NAFLD.JHEP Rep. 2021; https://doi.org/10.1016/j.jhepr.2021.100253
- Current therapies and new developments in NASH.Gut. 2022; https://doi.org/10.1136/gutjnl-2021-326874
Article info
Publication history
Published online: January 16, 2023
Accepted:
December 19,
2022
Received:
September 26,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
