Exercise Reduces Liver Lipids and Visceral Adiposity in Patients With Nonalcoholic Steatohepatitis in a Randomized Controlled Trial

David Houghton, Christian Thoma, Kate Hallsworth, Sophie Cassidy, Timothy Hardy, Alastair D Burt, Dina Tiniakos, Kieren G Hollingsworth, Roy Taylor, Christopher P Day, Stuart McPherson, Quentin M Anstee, Michael I Trenell, David Houghton, Christian Thoma, Kate Hallsworth, Sophie Cassidy, Timothy Hardy, Alastair D Burt, Dina Tiniakos, Kieren G Hollingsworth, Roy Taylor, Christopher P Day, Stuart McPherson, Quentin M Anstee, Michael I Trenell

Abstract

Background & aims: Pharmacologic treatments for nonalcoholic steatohepatitis (NASH) are limited. Lifestyle interventions are believed to be effective in reducing features of NASH, although the effect of regular exercise, independent of dietary change, is unclear. We performed a randomized controlled trial to study the effect of exercise on hepatic triglyceride content (HTGC) and biomarkers of fibrosis in patients with NASH.

Methods: Twenty-four patients (mean age, 52 ± 14 y; body mass index, 33 ± 6 kg/m2) with sedentary lifestyles (<60 min/wk of moderate-vigorous activity) and biopsy-proven NASH were assigned randomly to groups that exercised (n = 12) or continued standard care (controls, n = 12) for 12 weeks while maintaining their weight. The exercise (cycling and resistance training) was supervised at an accredited sports center and supervised by a certified exercise specialist and recorded 3 times per week on nonconsecutive days. We measured HTGC, body composition, circulating markers of inflammation, fibrosis, and glucose tolerance at baseline and at 12 weeks.

Results: Compared with baseline, exercise significantly reduced HTGC (reduction of 16% ± 24% vs an increase of 9% ± 15% for controls; P < .05), visceral fat (reduction of 22 ± 33 cm2 vs an increase of 14 ± 48 cm2 for controls; P < .05), plasma triglycerides (reduction of 0.5 ± 1.0 mmol/L vs an increase of 0.3 ± 0.4 mmol/L for controls; P < .05), and γ-glutamyltransferase (reduction of 10 ± 28 U/L-1 vs a reduction of 17 ± 38 U/L-1 for controls; P < .05). There were no effects of exercise on liver enzyme levels, metabolic parameters, circulatory markers of inflammation (levels of interleukin 6, tumor necrosis factor-α, or C-reactive protein) and fibrosis.

Conclusions: In a randomized controlled trial, 12 weeks of exercise significantly reduced HTGC, visceral fat, and plasma triglyceride levels in patients with NASH, but did not affect circulating markers of inflammation or fibrosis. Exercise without weight loss therefore affects some but not all factors associated with NASH. Clinical care teams should consider exercise as part of a management strategy of NASH, but weight management strategies should be included. Larger and longer-term studies are required to determine the effects of exercise in patients with NASH. ISRCTN registry.com: ISRCTN16070927.

Keywords: Body Composition; Inflammation; NAFLD; Therapy.

Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Figures

Supplementary Figure 1
Supplementary Figure 1
CONSORT Flow Diagram.
Figure 1
Figure 1
Effect of 12 weeks exercise training (Exercise) or standard care (Control) on absolute changes in intrahepatic lipid (A), visceral fat (B), and triglycerides (C) from baseline. Values are means ± SE.M (n = 24) ∗, significantly different from control (P < .05). ∗∗, significantly different from control (P < .01).

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