Hickman, IJ and Byrne, NM and Croci, I and Chachay, VS and Clouston, AD and Hills, AP and Buglanesi, E and Whitehead, JP and Gastaldelli, A and O'Moore-Sullivan, TM and Prins, JB and Macdonald, GA, A Pilot Randomised Study of the Metabolic and Histological Effects of Exercise in Non-alcoholic Steatohepatitis, Journal of Diabetes & Metabolism, 4, (8) pp. 1-10. ISSN 2155-6156 (2013) [Refereed Article]
Aims: Type 2 diabetes is a risk factor for the development and progression of non-alcoholic fatty liver disease (NAFLD). Lifestyle intervention is the principal treatment for NAFLD however the effects of exercise alone on the histological and metabolic severity of NAFLD are unclear. This study assessed the effects of 6 months exercise training and diet-induced weight loss on insulin resistance and liver histologyin overweight patients with NAFLD.
Methods: 21 patients were randomised to circuit exercise (EX) training (60 min×3/week) or dietary induced weight loss (DIWL) (-500 kcal/d). Insulin sensitivity (euglycaemic-hyperinsulinemic clamp with tracer), adiposity (CT scan) and histology (liver biopsy) were assessed at 0 and 6 months.Results: Weight decreased by 9.7 ± 4.6% (-6.7 ± 6.3 kg p=0.02) with DIWL but was unchanged after EX. Both groups equivalently reduced visceral fat (DIWL -22 ± 24% p=0.06 and EX -18 ± 18% p<0.05) while only EX increased lean mass (+3% p<0.01). DIWL markedly reduced steatosis (73 ± 36% to 23 ± 32%, p<0.05) and NAFLD activity score NAS (median (range) 5 (1-7) to 1 (0-5), p<0.05). After EX, there was no change in steatosis or NAS. A decrease in steatosis was associated with weight loss (rs =0.82, p<0.0001). An improvement in fibrosis was associated with a decrease in steatosis (rs =0.64, p=0.02). Small improvements in fasting hepatic insulin resistance were similar in both groups while changes in muscle insulin resistance were not significant.
Conclusions: Circuit exercise is safe and efficacious for improving cardiometabolic risk factors in patients with NAFLD, however this dose of circuit training, without concomitant weight loss, was insufficient for histological improvements in NAFLD. The pilot study outcomes should stimulate further development of different exercise protocols (type, frequency and intensity) to address disease-specific conditions in those with severe insulin resistance.
|Item Type:||Refereed Article|
|Keywords:||Exercise; Physical exercise; Weight loss; Metabolic syndrome; Insulin resistance|
|Research Division:||Medical and Health Sciences|
|Research Group:||Human Movement and Sports Science|
|Research Field:||Exercise Physiology|
|Objective Group:||Public Health (excl. Specific Population Health)|
|Objective Field:||Public Health (excl. Specific Population Health) not elsewhere classified|
|Author:||Hills, AP (Professor Andrew Hills)|
|Deposited By:||Health Sciences|
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