A Pilot Randomised Study of the Metabolic and Histological Effects of Exercise in Non-alcoholic SteatohepatitisIngrid J Hickman1,4,5*, Nuala M Byrne6, Ilaria Croci4, Veronique S Chachay4, Andrew D Clouston7, Andrew P Hills5,8, Elisabetta Bugianesi9, Jonathan P Whitehead5, AmaliaGastaldelli10, Trisha M O’Moore-Sullivan2,5, Johannes B Prins2,5 and Graeme A Macdonald3,7
- *Corresponding Author:
- Ingrid J Hickman
Department of Nutrition and Dietetics
Ground Floor, Building 15 Princess Alexandra Hospital
Ipswich Road, Woolloongabba, Queensland 4102, Australia
Tel: +61 7 3176 7132
Fax: +61 7 3176 5619
E-mail: [email protected]
Received date: August 22, 2013; Accepted date: October 11, 2013; Published date: October 17, 2013
Citation: Hickman IJ, Byrne NM, Croci I, Chachay VS, Clouston AD, et al. (2013) A Pilot Randomised Study of the Metabolic and Histological Effects of Exercise in Non-alcoholic Steatohepatitis. J Diabetes Metab 4:300. doi:10.4172/2155-6156.1000300
Copyright: © 2013 Hickman IJ, et al. 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 author and source are credited.
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.